Heart Health Today

Atrial fibrillation is on the rise



Illustration by Emma Moreman

The average lifespan of US residents has followed a generally upward trend for decades, but heart disease remains a formidable health threat as we age. Heart disease is the leading cause of death in this country, accounting for about one in every four deaths.

Individuals with atrial fibrillation, a form of heart disease in which the heartbeat is irregular or abnormal, make up a significant portion of the number of people stricken with heart disease; an estimated 2.7-6.1 million Americans are living with atrial fibrillation, according to the Centers for Disease Control and Prevention, and their numbers appear to be on the rise. Some experts claim that the incidence and prevalence of atrial fibrillation have reached epidemic levels in the US and worldwide. Increased detection might partly account for the upswing, along with a graying population, since atrial fibrillation becomes more common as we grow older, says Ernest Podrasky, MD, a board-certified cardiologist at Core Physicians in Exeter.

While accumulating years alone can take a toll on the heart, a range of factors can cause or contribute to atrial fibrillation, from a heart defect to severe pneumonia. People with certain chronic diseases, such as diabetes, face a higher risk of developing atrial fibrillation, and, along with advanced age, high blood pressure and poor lifestyle choices related to diet, exercise, smoking and alcohol consumption — particularly binge drinking — also increase vulnerability to the disorder, says Carl M. Fier, MD, FACC, chief of cardiovascular services at Elliot Hospital in Manchester. Some people will experience only brief and intermittent episodes of atrial fibrillation, with the heart converting back to a normal beat on its own, while in other cases atrial fibrillation persists throughout a person’s life.

Indeed, time — and timing — play an important role in the workings of the heart. When a heart functions normally, a small batch of cells in the upper part of the heart act as a sort of bandleader or natural pacemaker, Podrasky explains, establishing the heartbeat and directing the various areas of the heart to beat in a timely fashion. But during atrial fibrillation, the two upper chambers of the heart initiate their own heartbeat. They quiver and work ineffectively, and become out of sync with the lower chambers.

Many who experience atrial fibrillation notice a fluttering or flip-flopping sensation in their chest, or the feeling of a skipped or rapid heartbeat, while others who have atrial fibrillation do not notice any troublesome sensations in their chest, but feel fatigued or short of breath. Some people who have the disorder don’t feel any symptoms at all.

Regardless of whether a person who has atrial fibrillation notices any symptoms, atrial fibrillation can have serious consequences. Because the heart is not pumping properly during atrial fibrillation, blood can pool in the heart and cause blood clots to form. If a blood clot travels through the bloodstream and reaches the brain, then it can result in a stroke. Left untreated, atrial fibrillation can also lead to weakening of the heart and heart failure, Fier says.

The fact that some people have atrial fibrillation but don’t feel anything out of the ordinary presents a “clinical conundrum,” Fier notes, because “the longer you’re in atrial fibrillation, the higher your risk of having a stroke.” It’s not uncommon for someone to arrive at a doctor’s office or emergency room feeling short of breath, fatigued or dizzy, he says, and discover after having an EKG taken or a pulse check that they are in atrial fibrillation. “And they’ll have no idea when it started,” Fier says. “It could have been days, weeks or months ago.” It typically takes about 48 hours for clots to form, he says. “Every day, every hour after that that you’re still on that [atrial fibrillation] rhythm, you’re incrementally increasing your risk of having a stroke.”

Management of atrial fibrillation can be very different from one person to the next, Podrasky says, and is typically influenced by the effect that the disease has on the heart, the person’s risk for stroke and his or her symptoms. Contrary to popular belief, pacemakers are not often used to treat atrial fibrillation, but medication is commonly prescribed to reduce the likelihood of clotting or to control the heart rate.

Other treatment options include restoring a normal rhythm via an electrical charge, with medicine or through radiofrequency ablation — a nonsurgical but invasive procedure that has developed over the past decade and, Podrasky says, “is getting better and better.” Seventy percent of the time, radiofrequency ablation can completely eliminate the problematic rhythm, he says. Although the procedure is not 100 percent effective, it can be an attractive option for people who are highly symptomatic, have not been able to tolerate heart-slowing medications, or who have not been able to maintain a normal rhythm despite being on different anti-arrhythmic medications.

And for those patients who do need to take anticoagulant medication, or “blood thinners,” to reduce the risk of blood clots, good news: Today there are new and improved alternatives to the longtime go-to anticoagulant medication, Coumadin (the brand name for warfarin). Coumadin can be an effective medicine, but it carries dangerous potential side effects and can interact with food and other medications. It also typically requires inconvenient close monitoring that entails blood draws. The new anticoagulants, though not without drawbacks — including cost — are much more patient-friendly, Fier says. They do not necessitate monitoring with blood testing, and they do not tend to interact with common medications. “They are at least as effective,” he says, “and for the most part, much safer than Coumadin when you’re anticoagulating the patient.”

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