This document discusses atrial fibrillation, a common heart condition where the heart beats irregularly. It can increase risk of stroke due to blood clot formation. Treatment options include medication to control heart rate or restore normal rhythm, cardioversion, and ablation. Lifestyle factors like alcohol, stimulants, sleep apnea and thyroid issues can contribute to atrial fibrillation risk. Symptoms range from mild palpitations to severe issues like confusion and fainting.

1. Atrial
Fibrilla*on
and
Stroke
Dr.
Sunil
Garg
Cardiologist
ASAP
2014

2. Atrial
Fibrilla*on
• Abnormal
rhythm
of
the
heart
• Very
common
problem
• Over
the
age
of
40
–
one
in
four
chance
of
developing
atrial
fibrilla*on
• More
frequent
in
men
than
in
women

3. Atrial
Fibrilla*on
• Affects
the
atria
or
upper
chambers
of
the
heart
• Electrical
impulses
do
not
properly
circulate
through
the
heart
• Make
your
heart
beat
too
quickly,
too
slowly
or
in
an
uneven
fashion

4. Electricity
of
the
Heart

5. Atrial
Fibrilla*on
• Two
Forms
• IntermiQent
(Paroxysmal)
– Episodes
that
occur
with
varying
frequency
or
last
for
a
variable
period
of
*me
before
spontaneously
stopping
• Chronic
(Persistent)
– Sustained
and
usually
does
not
stop

6. Cause
of
Atrial
Fibrilla*on
• Increases
in
frequency
with
aging
and
typically
occurs
in
people
with
underlying
heart
disease
• Most
common
causes
– Chronic
high
blood
pressure
(hypertensive
heart
disease)
– A
heart
aQack
– Heart
Valve
Disease
(MS
or
MR)
– A
complica*on
of
heart
surgery

7. Atrial
Fibrilla*on
and
Alcohol
• Binge
drinkers
can
usually
develop
atrial
fibrilla*on
that
is
usually
transient
• OWen
occurs
over
weekends
or
holidays
when
alcohol
intake
is
excessive
• “Holiday
Heart
Syndrome”

8. Atrial
Fibrilla*on
and
Hyperthyroidism
• Occurs
in
13
percent
of
people
with
an
overac*ve
thyroid
• Accounts
for
5%
of
all
cases
of
atrial
fibrilla*on
• Make
sure
your
thyroid
levels
are
checked
• Treatable
and
reversible
cause

9. Atrial
Fibrilla*on
due
to
S*mulants
• Drugs
that
s*mulate
the
heart
can
contribute
to
the
development
of
atrial
fibrilla*on
• Caffeine
• Tobacco

10. Atrial
Fibrilla*on
and
Sleep
Apnea
• Condi*on
where
pa*ents
stop
breathing
for
prolonged
periods
while
sleeping
• Overweight
• History
of
Snoring
• Excessive
Sleepiness
during
the
day*me
• Treatment
can
eliminate
atrial
fibrilla*on

11. Atrial
Fibrilla*on
and
Lung
Disease
• Chronic
Lung
Diseases
can
cause
Atrial
Fibrilla*on
• Par*cularly
seen
in
pa*ents
with
emphysema

12. Lone
Atrial
Fibrilla*on
• Some
people
with
atrial
fibrilla*on
have
no
apparent
cause
• Structurally
normal
heart

13. Atrial
Fibrilla*on
Symptoms
• Mild
Symptoms
– Unpleasant
palpita*ons
or
irregularity
of
the
heart
– Mild
chest
discomfort
/
sensa*on
of
*ghtness
– A
sense
of
racing
heart
– Lightheadedness
– Mild
shortness
of
breath
and
fa*gue
that
limit
the
ability
to
exercise

14. Atrial
Fibrilla*on
and
Symptoms
• Severe
Symptoms
– Difficulty
breathing
– Shortness
of
breath
with
exer*on
– Fain*ng
or
near
fain*ng
– Confusion
– Chest
Discomfort
– Fa*gue

15. Atrial
Fibrilla*on
and
Risk
of
Stroke
• Chao*c
rhythm
may
cause
blood
to
pool
in
your
hearts
upper
chambers
• This
leads
to
clot
forma*on

16. Atrial
Fibrilla*on
and
Risk
of
Stroke
• Serious
complica*on
from
Atrial
Fibrilla*on
• Can
lead
to
permanent
brain
damage
• Clot
may
also
travel
to
– Eye
– Kidneys
– Spine
– Important
arteries
in
the
arms
or
legs

17. Risk
Factors
for
Stroke
• CHADS2
– Conges*ve
Heart
Failure
– Hypertension
– Age
(65
to
74
versus
>75)
– Diabetes
– Previous
Stroke
or
TIA

18. Atrial
Fibrilla*on
and
Heart
AQack
• People
who
have
a
heart
aQack
are
at
risk
for
developing
Atrial
Fibrilla*on
• Having
atrial
fibrilla*on
doubles
your
chances
of
having
a
heart
aQack

19. Atrial
Fibrilla*on
and
Heart
Failure
• If
not
controlled,
can
weaken
the
heart
and
lead
to
heart
failure
• Usually
improves
with
treatment
and
control
of
the
heart
rate

20. Atrial
Fibrilla*on
Diagnosis
• Electrocardiogram
• Holter
Monitor
• Event
Recorder
• Echocardiogram

21. Atrial
Fibrilla*on
Treatment
• Short
Term
Treatment
– Rate
Control
– Cardioversion
• Transesophageal
Echocardiogram

22. Atrial
Fibrilla*on
Treatment
• Short
Term
Treatment
– Rate
Control
– Cardioversion
• Transesophageal
Echocardiogram

23. Atrial
Fibrilla*on
Treatment
• Long
Term
Treatment
– Rhythm
Control
• Efforts
to
restore
and
maintain
a
normal
rhythm
are
made
• Can
be
done
via
– Cardioversion
– An*arrhythmic
Drugs
– Abla*on
Procedure

24. Rhythm
Control
• Advantages
– Improved
cardiac
func*on
– Reduced
Symptoms
for
some
people
– Reduced
need
for
medica*ons
• Disadvantages
– High
rate
of
recurrence
of
atrial
fibrilla*on
– Side
effects
of
medica*ons
(AAD)
– Adverse
effects
of
medica*ons

25. Atrial
Fibrilla*on
Treatment
• Long
Term
Treatment
– Rate
Control
• Con*nue
to
have
atrial
fibrilla*on
• Use
medica*on
to
slow
the
heart
rate
down
• Can
be
difficult
to
use
medica*ons
to
slow
the
heart
rate
down

26. Nonpharmacological
Treatment
• Radiofrequency
Abla*on
– Developing
Procedure
– Risk
of
Complica*ons
• Pacemaker
– May
be
needed
for
a
slow
heart
beat
or
to
help
with
medica*ons
• Surgical
Procedures
– Complete
MAZE
Procedure

27. Atrial
Fibrilla*on
and
An*coagula*on
• Increased
risk
of
stroke
as
a
result
of
blood
clots
that
can
form
in
the
heart
• Most
people
are
advised
to
use
a
treatment
to
reduce
the
risk
of
developing
blood
clots
• Most
commonly
used
treatments
include
an*coagulants
or
an*platelet
drugs

28. An*coagulant
Drugs
• Can
reduce
the
risk
of
stroke
by
50
to
70%
– Warfarin
– Dabigatran
(Pradaxa)
– Apixaban
(Eliquis)
– Rivaroxaban
(Xarelto)

29. An*platelet
Drugs
• May
be
used
in
pa*ents
with
lower
risks
• May
be
used
in
pa*ents
who
are
intolerant
to
an*coagulant
drugs
– Increased
bleeding
risk
– Recurrent
falls
• ASA
81
mg
daily
• Clopidogrel
(Plavix)
75
mg
daily

30. What
Can
You
do?
• Monitor
Your
Blood
Pressure
• Control
Your
Diabetes
• Take
your
Medica*ons
/
Blood
Thinners
if
you
have
been
diagnosed
with
Atrial
Fibrilla*on
• See
your
doctor
if
you
develop
the
symptoms
listed

31. Thank
You