DR MILES DALBY

Atrial fibrillation (AF) is caused by rapid disorganised electrical activity of the atria of the heart. The hallmark of AF is an irregular pulse. AF is a very important rhythm abnormality because it is common and can cause two principal problems. Firstly AF makes the pumping function of the heart less efficient, especially if the heart rate is too fast or slow which can cause breathlessness or reduced exercise tolerance and sometimes damage to the heart muscle. Secondly, because the atria of the heart don’t pump properly in AF, blood can become stagnant, particularly in a small outpouching called the left atrial appendage (LAA) which can result in blood clots which can travel to the brain causing stroke. AF can be permanent or can come and go ‘paroxysmal AF’ (PAF).

Treatment of AF falls into two areas.

First whether to ‘accept’ the AF and manage the related issues or to try to restore or maintain normal sinus rhythm using drugs or a controlled electric impulse ‘cardioversion’. Maintaining sinus rhythm can be difficult, however it has significant benefits for the heart and depending on the individual patient may be achievable with drug therapy or AF catheter ablation.

The second consideration is thromboprophylaxis (with warfarin, an alternative anticoagulant drug or a LAA occlusion device) and this will depend on the individual patient stroke risk. There are a number of scoring systems to aid this decision.

When investigating AF in the clinic your cardiologist will need to take history and perform a physical examination. In addition they will want to perform some tests which will often include blood tests, a chest x-ray, ECG and echocardiogram. A holter monitor will usually be performed especially if PAF is suspected. Further tests to exclude significant coronary artery disease such as a CT scan, myocardial perfusion scan, stress echo or coronary angiogram may be recommended.

Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.