Atrial Fibrillation

ENGLISH / MALTESE

What is ATrial fibrillation?

  • Atrial fibrillation (AF) is a condition characterised by an abnormal heart rhythm (arrhythmia).

  • Normally, electrical impulses in the heart arise from a natural pacemaker site known as the sino-atrial (SA) node,  enabling the heart to pump in synchrony.

  • In AF, an abnormal area of heart muscle, often located in the left upper chamber (left atrium)is responsible for generating disorganised and irregular electrical activity.

  • The upper chambers consequently begin to twitch or fibrillate. 

  • This results in an irregular heartbeat which may be slow or  fast.

What causes Atrial Fibrillation?

AF often presents in combination with an underlying issue, although a specific cause may not be identified. Examples of  underlying conditions which cause AF include:

Other less common causes include alcoholism, hyperactive thyroid, infection,  surgery, drugs, caffeine, amongst others.

How many people are affected by ATrial Fibrillation?

  • AF affects 0.5% of the global population.

  • The majority of people affected by AF are older than 65 years.

“In Malta, 1 out of every 4 individuals older than 75 years has AF”

What will I feel if I have ATrial fibrillation?

Occasionally, you may feel nothing at all, or you may experience symptoms, most commonly due to an elevated heart rate 

  • Shortness of breath 

  • Palpitations

  • Tiredness 

  • Chest pain

  • Dizziness 

  • Fainting

  • Facial flushing

What can happen to me if I have ATrial fibrillation?

  • Blood flow within the upper chambers of the heart is turbulent since they are fibrillating irregularly. This increases your risk of blood clot formation in the heart. 

  • Occasionally, a blood clot may travel to another part of the body and block blood vessels. This can result in serious complications such as a stroke if the brain vessels are occluded. 

  • You may also develop heart failure if heart muscle malfunctions.

How can I check if I have ATrial fIbrillation?

  • An irregular rhythm when checking the pulse on your wrist is often suggestive of AF.

  • An electrocardiogram (ECG) is used to check the electrical rhythm of the heart. 

  • Electrodes are placed at certain locations over your chest and limbs and leads are attached to electrodes to record electrical activity.

  • An ECG can be recorded over a 10-second strip or else for a longer period (24 to 72 hours). This is called a 24/72-hour Holter ECG. 

  • The ECG is then checked for specific patterns which are suggestive of AF. This includes fibrillation waves and an irregular rhythm.

  • Other tests may be performed including blood tests, chest x-ray and/or an ultrasound of the heart (echocardiogram).

How can I prevent and treat ATrial fibrillation (AF)?

  • A healthy lifestyle is important in preventing or delaying the development of AF.

  • Exercise regularly, maintain a healthy diet and weight, good blood pressure and blood glucose control, do not smoke, reduce your alcohol intake, as well as a reduction in stress, are known to decrease the likelihood of AF.

  • AF is often well tolerated and can be controlled if you follow the doctor’s advice 

  • The treatment of AF is based on rate or rhythm control; both are effective and achieved with oral medication (for example atenolol or amiodarone). 

  • As there is an increased risk of blood clot formation, you will often be prescribed anticoagulation therapy to thin your blood. Examples include warfarin and newer treatment such as rivaroxaban or apixaban. The decision for anticoagulation is dependant on achieving a balance between your  individual risk of blood clot formation versus the risk for bleeding

  • Other treatment options include DC cardioversion, which involves the controlled delivery of an electrical shock to the heart, or electrophysiology procedure which typically involves ablation of an area which is acting as a trigger for the AF.

  • A pacemaker may occasionally be fitted.

Take-Home Messages

Atrial fibrillation results in an irregular heart rhythm which increases your risk of a blood clot and stroke

You may not have symptoms or present with a variety of complaints including palpitations, shortness of breath and dizziness, among others

Treatment includes oral medication for rate or rhythm control of the heart, with or without anticoagulation (blood thinners) 

HELP AND SUPPORT

If you have any questions regarding our article feel free to contact us on info@maltaheartfoundation.org or our Facebook page.

This article was authored by Dr. Bernard Borg and edited by Dr. Neil Grech, in collaboration with the Malta Heart Foundation and Maltese Cardiac Society.

Cardiac ConditionsMHF Admin - Matthew Farrugia