Atrial Fibrillation

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Atrial Fibrillation

Description: In normal heart rhythm (called sinus rhythm), a pacemaker called the sinus node fires off about once a second initiating a heart beat.   Tha-fibere are other tissues in the atria which can act as pacemakers if the sinus node fails, and also the atrial tissues can conduct electricity.  In atrial fibrillation pacemakers are firing off all over the atria creating chaotic electric circuits.   This means the heart beats irregularly, usually too fast, the atrial do not contract normally but just fibrillate.   This means they do not empty all the blood out of the atria and its appendages, clots can form and these can break off and go anywhere in the circulation causing a blocked artery anywhere in the body - leading to a stroke, heart attack, gangrene in leg etc.

Atrial fibrillation can be intermittent or continuous.   The patient usually feels a change in heart rhythm, may feel faint as the rhythm changes and short of breath.

The cause of fibrillation is usually enlargement and stretching of the atria (the top chambers of the heart).  This can happen with heart valve disease, high blood pressure or heart failure, however often no obvious cause can be found.  Sometimes conditions like hyperthyroidism (excess thyroid hormone),  diabetes, obesity, smoking, some drugs (asthma drugs, NSAIDs, steroids and drinking excess alcohol.  Occasionally excess physical activity can precipitate an attack.

What your doctor can do

Investigations.

  • Confirm what the abnormal rhythm is with an ECG, or a Holter monitor which is an ECG recorder worn for 24 hours to see what the rhythm is.
  • To identify any possible cause for the fibrillation: an echocardiogram, blood tests or stress ECG.

Treatment -

  • Sudden onset of atrial fibrillation - if possible go to hospital straight away, not that it is dangerous, but if caught in the first 12 - 24 hours the heart can be 'shocked' back into the normal rhythm under a general anaesthetic - cardioversion (click here).
    Also, the hospital will use drugs to slow the heart rate, often intravenously - amiodarone, beta blockers, diltiazem or verapamil, magnesium.
    If the fibrillation does not stop within 24 hours the patient is started on anticoagulants (sometimes heparin or clexane then warfarin  or dabigatran.
    The patient is then discharged and usually returns after 6 weeks to consider cardioverting now that there is no risk of any clots being present.
  • Intermittent attacks of atrial fibrillation - see if there is any obvious cause, if so avoid it - hard physical exercise, smoking, excess alcohol.  Even drinking a very cold drink (the oesophagus runs beside the atria and the cold liquid can irritate the atria).    Often patients are given a tablet - flecainide, beta blocker to take to stop the attack.    Often the attacks just peter out, usually while resting or sleeping, and if they do not, then go to hospital as above.
  • Persistent atrial fibrillation - three things need to be considered:
    • Rate control - drugs such as diltiazem, verapamil or beta blockers (metoprolol) are usually used.  Occasionally digoxin, which has been used for centuries, is used but rarely these days.   If amiodarone is used to control rhythm and bring it back to normal, this should NOT be used long term as it has severe long-term side effects.
    • Treating the underlying cause - high blood pressure, heart failure, hyperthyroidism etc.
    • Anticoagulants to prevent clots forming in the atrial and then breaking off into the circulation (emboli).  The decision on whether anticoagulation is needed is made using a number of factors - the CHADS2 score (high blood, pressure, heart failure, diabetes, previous stroke, age over 75).   If none of these are present than maybe anticoagulation is not necessary, if one or more then anticoagulate.   Drugs that can be used include aspirin - this is very weak and only stops 20% of clots and shouldn't be used.  Warfarin and dabigatran are the drugs currently recommended -  the latter being easier to  use as it does  not  require regular blood tests, and there is less risk of bleeding.

Procedures

  • Electrophysiological therapy: electrophysiology catheters are placed in the atria, and can destroy pathways that are causing the fibrillation.   This can be very successful, in the hands of a skilled operator.

What you can do :

 Lifestyle

  • First make sure you understand what atrial fibrillation means and if they are serious or just a nuisance. Reassurance can often make them disappear
  • Then relax and stop worrying, because stress creates adrenaline which makes palpitations much worse.
  • Study to see if anything precipitates them such as vigorous exercise, some foods, coffee, cigarettes, severe stress. If you can find a cause, try to avoid it.
  • Routinely it is best to try stopping alcohol and caffeine ( coffee, tea, sports drinks etc) for a while.   Do not drink very cold drinks, especially if you are hot.

 

Nutritional supplements –

  • A good multivitamin/multimineral will make sure that the heart has all the nutrients and minerals it requires.
  • Omega 3 fish oils,1–2 grams daily, can have a rhythm-controlling effect.
  • Magnesium (and calcium). Magnesium is essential to keep the heart rhythm regular, therefore we use 800–1,000mg daily in all our patients with palpitations.
  • CoEnzyme Q10 can improve the energy supply to the heart and may help some people with palpitations - try 100mg/day for a few weeks and see if it helps.
  • Hawthorne has been used for heart disease for many centuries, and in many countries of Europe is part pf conventional medical therapy.  It has a number of confirmed actions including  stabilise heart rhythm, helps open arteries, improved heart function and has a mild sedative action.  For people with intermittent atrial fibrillation, this may be very helpful. (Note it can interact with digoxin, and because it lowers the blood pressure any drugs which also lower BP may be enhanced).
  • Some people ask if taking fish oils or vitamin E both of which have a mild anticoagulant action, can be used instead of warfarin or dabigitran.  The answer is NO!   A stroke or heart attack due to a clot in atrial fibrillation is usually major because the clots are so large.  These supplements are just to weak to prevent these clots from forming.

The Nutritional supplements I use and recommend to my patients

For my patients with atrial fibrillation I recommend - USANA - Essentials, Biomega, Active Calcium plus, Coquinone -

Other therapies

There are a number of other therapies which you might like to look at.  They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help.    They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner.    My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.

Nutritional supplements

I believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.