Guest Blog – Atrail Fibrillation Association
Diagnosing & Treating AF (part 2 of 3 guest blogs about AF)
The simplest way to detect AF is to feel a pulse. If the rhythm of the beat seems irregular, this may indicate AF. However it is very important to check this with a doctor and to find out whether you do actually have AF. If a clinician suspects you have Atrial Fibrillation, they will arrange for you to have an ECG (electrocardiogram). An ECG is painless and records the electrical activity of your heart. Usually this is carried out in a GP surgery or at a local hospital, however, if your episodes ‘come and go’, you may be given a monitor – this is worn (simply taped to your chest) for 24 hours or more, and continuously records the electrical activities of your heart.
When the monitor is returned the clinician can download the information and assess it. The heart rhythm can be diagnosed with certainty and possible underlying heart problems may often be detected.
Following the ECG, and if you are diagnosed as having Atrial Fibrillation, you may need to have an echocardiogram (a scan) which can assess the structure and overall function of the heart. This test is painless and without any risk to a patient. The results from this test will tell the physician about heart muscle disease (thickening or thinning), the size of the main pumping chambers, and the state of the heart valves, any of which might have aggravated the heart rhythm abnormality.
A variety of blood tests may be needed, depending on the individual’s medical history. In almost all cases, the activity of the thyroid gland will be measured through a blood sample, because over activity may provoke AF.
Free, medically approved and endorsed patient information can be ordered or down loaded from Atrial Fibrillation Association
If a patient has suffered chest pain, a marker of heart muscle damage (troponin) is often measured. If a patient is taking any other medication or has underlying heart disease or has any other medical problems, suitable tests will also be carried out.
Once Atrial Fibrillation has been diagnosed, there are a number of treatments available. The mainstay of treatment of AF is with drug therapies. Other non-drug therapies such as pacemakers and ablation therapies are reserved for certain subsets of AF patients. The drugs used to restore the normal heart rhythm are known as anti-arrhythmic drugs. They work by blocking specific channels in the cardiac cell. Anti-arrhythmic drugs comprise different drug classes and have different modes of action. Moreover, someclasses and even certain drugs within a class are effective for particular rhythm disturbances. Some drugs, aim for Rhythm Control, that is, to restore and maintain normal rhythm but can have troublesome side-effects.
Another type of drug such as beta-blockers aim for Rate Control. This means slowing the irregular heart rate without attempting to restore the normal heart rhythm. Rate control is not inferior to rhythm control and is an attractive alternative in patients with a high risk of AF recurrence. In less active patients, other rate control drugs, such as digoxin can be used. Combinations of digoxin and beta blockers or calcium antagonists may be required to achieve effective rate control. Amiodarone is often used for rate control in AF when its rhythm control efficacy has been exhausted. However, given its significant side effect profile, it is not routinely used for rate control.
Unfortunately, there is no “one size fits all” answer to the management of AF. Multiple drugs may be tried and adjusted until one is found that achieves the desired goal of optimal rate or rhythm control with minimal side effects.
Recently several new drugs have been approved for use with AF. One, Pradaxa, also known as Dabigatran, prevents blood clots which cause stroke, which is a risk for people with AF. There are also surgical interventions for AF such as Catheter Ablation and Cardioversion. Cardioversion is suitable for those recently diagnosed while Ablation is reserved for those with intrusive symptoms that impact significantly on quality of life, are refractory to treatment with medication or where medical therapy is contraindicated because of other conditions or intolerance.