Rapid Access Atrial Fibrillation Clinic

Afib is the irregular beating of the top chamber of your heart. To understand why the heartbeat can become irregular in this way, first we need to understand how the heart beats in the first place. In a healthy heart, an electrical impulse sends a wave through the heart muscle causing its chambers to contract (squeeze) in a regular, predictable rhythm, keeping the blood moving as it pumps through the heart to the rest of the body’s organs. When there is a disturbance in the electrical signal, an irregular heart rhythm (a.k.a. arrhythmia) occurs. Atrial fibrillation is a type of arrhythmia.

Afib patients are 3 to 5 times more likely to have a stroke. That means brain damage. That is a big deal. Regardless of age, the dangers of a stroke increase significantly with added risk factors like smoking, high blood pressure, and diabetes. What’s more, from the age of 55 the risk doubles every decade. If you are female, it’s even higher. Remember: you don’t have to have symptoms to be at risk. Get to know your risk factors so you can start to control them right away.

If you have atrial fibrillation, it is critical that you, your family and friends all learn to spot the signs of a stroke. Remember F.A.S.T.

• F ace drooping (e.g. an uneven smile)
• A rm or leg weakness
• S peech is slurred
• T ime to call 911

The abnormal heartbeat and inefficient pumping action of the Afib heart can cause blood to pool and even sit still for an unpredictable period of time. When blood pools it clots. A clot can then make its way to the brain, cutting off blood flow and vital oxygen, killing brain cells within minutes. This is what we call an ischemic stroke.

As an Afib patient, your risk increases if you are female, as your age advances, or if you have any of the following pre-conditions:

• Diabetes
• Hypertension (high blood pressure)
• Vascular disease (coronary artery disease, angina, leg blockages (PAD), etc)
• Stroke (prior stroke, TIA or thromboembolism)
• Congestive heart failure

Congestive heart failure (CHF) is the result of weakened heart muscle. With the rapid and unpredictable beating caused by Afib, the heart muscle tires and even thins over time. The heart is simply not strong enough in CHF to pump oxygen-rich blood to the body’s organs. It is called heart “failure” not because your heart is going to stop working but because it is failing to pump efficiently. CHF is progressive so it is vitally important to address it at the earliest signs and, better yet, prevent it at the first detection of Afib.

No two Afib patients’ symptoms are alike. Some will report less noticeable symptoms than others. Don’t let that fool you. If you have been told that you have Afib, you are at a significantly higher risk of stroke whether you feel symptoms or not. ALWAYS follow the advice, medication regimen and lifestyle changes recommended to you by your healthcare provider to reduce your chances of stroke and/or congestive heart failure.

The most common symptoms related to atrial fibrillation include:

• Shortness of breath
• Coughing and wheezing
• Sudden weight gain (e.g. 2-3 pounds overnight or 3-5 pounds in a week)
• Abdominal pain
• Chronic fatigue (feeling weak or tired)
• Dizziness & light-headedness
• Heart palpitations (uneven, fluttering or racing heart beat)
• Chest discomfort, tightness or pain

In addition to consistently taking your medications as prescribed by the cardiologist, you’ll have to make some lifestyle changes to minimize your chances of having a stroke. Most people with Afib lead active, normal lives when, in addition to medication compliance, they adopt these lifestyle changes:

1. Adhere to the D.A.S.H. diet (D.A.S.H. in English; D.A.S.H. in Portuguese). Also known as Diet Approaches to Stop Hypertension (high blood pressure). D.A.S.H. puts necessary restrictions on sodium (salt), sugar, saturated fats, and overall calories. It recommends a diet rich in fruits, vegetables, fish, low-fat dairy and lean meats.
2. Adjust diet to address diabetes concern. It is important to eat at regular intervals (if you are a diabetic, no more than 6 hours between meals). Limiting sugary foods and drinks is a crucial step.
3. Manage vitamin K levels carefully. Vitamin K is found in leafy green vegetables (like kale and spinach) which are an important component of the D.A.S.H. diet. However, vitamin K can interfere with some older blood thinners like warfarin that may be prescribed to Afib patients. It is important to ask your healthcare provider or dietitian to calculate the optimal amount of leafy greens that you should consume, based on the medications you are prescribed.
4. Follow recommended exercise regimen. Appropriate levels of exercise can be an important component to mitigating heart failure and stroke risk in most people with Afib. You must receive the green light from your physician before engaging in high intensity exercise. If you are on blood-thinners for Afib, avoid high-risk activities like scuba diving, skydiving or contact sports. Building up your endurance gradually is most advisable: you might walk for 5 to 15 minutes per day and slowly work your way up to 30+ minutes per day, over time.

During an atrial fibrillation ablation, a special catheter or wire is used to cauterize and block damaged electrical pathways from sending faulty signals to the rest of the heart. This prevents the abnormal signals from entering the left atrium of your heart and causing atrial fibrillation. Here are helpful guides to learn more about ablation:

• Catheter Ablation
  
• Atrial Fibrillation Ablation
  
• Electrophysiology Study (EPS)
  and Ablation

A cardioversion is a procedure done at a hospital in the ER, ICU or monitored ward that involves the delivery of an electrical shock to your heart to restore your heart’s normal rhythm from an abnormal one like atrial fibrillation. An intravenous catheter will be inserted in your arm to deliver fluids and medications so you are asleep during the procedure. Pads are placed on your chest and back and hooked up to an external defibrillator. When you are asleep the physician delivers an electrical shock. Usually, one shock is required. If the first shock does not work, the physician can try two to three more times with higher energy. The cardioversion is over within a few minutes and the recovery time is quick, with most patients going home within a few hours after the procedure if this was a planned, elective procedure. After the procedure you should not operate a car, drink alcohol, operate heavy machinery or make any important decisions for 24 hours.

Please visit the Ottawa Heart Institute for more information on cardioversions and links on do's and don'ts before and after the procedure.