FOR YOUR HEALTH

Getting in rhythm

Managing the heart disorder known as atrial fibrillation

by ANDREA DOWNING PECK

An estimated 350,000 Canadians live with atrial fibrillation (A-fib), as the medical community continues to look for ways to help patients manage the heart rhythm disorder.

“Atrial fibrillation is the most common sustained heart rhythm disorder that we see in clinical practice,” says cardiologist Anne Gillis, professor of medicine at the University of Calgary and past president of the Heart Rhythm Society. “Most individuals who experience it note the heart is going faster than expected for the level of activity they’re engaged in. A-fib can also be associated with other symptoms like chest discomfort, feeling light-headed or shortness of breath.”

A-fib matters because the condition can lead to blood clots in the upper chambers of the heart, boosting the risk of stroke fivefold. A-fib is also linked to a higher chance of developing dementia. Left untreated, it can be deadly.

Who A-Fib affects

A-fib is most common in men, and people 65 and older, but a person’s risk of developing this heart rhythm disorder increases when other medical conditions are present, including:

High blood pressure
Sleep apnea
Obesity
Heart failure
Diabetes
Overactive thyroid
Pericarditis
Coronary artery disease

Triggers

“Alcohol definitely is a trigger for atrial fibrillation,” says Minneapolis cardiologist Dr. Robert Hauser, a Costco member. “We have a term called ‘holiday heart,’ where people overindulge during the holidays and show up with atrial fibrillation in the emergency room.”

“There’s been a lot of research and interest in prevention when it comes to coronary disease—blockages of the blood vessels—but it’s only recently that we’ve come to recognize that these lifestyle factors and prevention strategies also may be relevant to heart rhythm disturbances, especially atrial fibrillation,” says Costco member Dr. Gregory Marcus, professor of atrial fibrillation research at the University of California, San Francisco.

At the 2021 American Heart Association’s annual Scientific Sessions, Marcus presented results from a randomized trial on triggers for patients with intermittent A-fib, defined by temporary episodes that start suddenly but quickly resolve without medical assistance, usually within 24 hours. Caffeine—long considered a potential A-fib trigger—was not shown to increase episodes, but alcohol did.

“Drinking more than one drink a day is clearly a risk factor for atrial fibrillation,” says Marcus.

Smoking, reduced sleep, physical inactivity, dehydration and stress are other lifestyle factors that may be triggers for A-fib, but more research is needed to validate those assumptions.

“If you do identify a trigger, then you address it,” Gillis says. “But often there’s not one trigger. It’s the combination of other comorbidities that increases the risk for atrial fibrillation.”

Gillis notes that the prevalence of A-fib is predicted to at least double over the next four decades, but there are ways to alter that outcome. “There’s an epidemic of obesity, sedentary activity and Type 2 diabetes, so we need to get the population more active, less overweight and aggressively treat hypertension and diabetes and identify sleep apnea,” she says. “Those are things that we know can reduce the burden of atrial fibrillation.”

Treatment types

Medications or surgery are sometimes necessary, especially for those with persistent A-fib lasting longer than seven days.

Common treatment options include medications to control heart rate and heart rhythm, and anticoagulants, as well as catheter ablation, a procedure designed to permanently restore the heart’s proper electrical currents. An implant called the Watchman is an alternative to blood thinners for some patients.—ADP

Atrial fibrillation and stroke risk

Assessing stroke risk in patients is an important part of managing the disease.

To predict stroke risk and determine potential therapies, physicians often calculate a patient’s score on the CHA2DS2-VASc, an acronym reflecting each factor in the assessment tool, looking at age (65 or older), gender and medical history (such as congestive heart failure, hypertension, prior strokes, vascular disease or diabetes). “It’s important to educate the general public to be aware of the condition and if they have symptoms to see their doctor, diagnose the problem and above all prevent stroke,” says Dr. Anne Gillis, professor of medicine at the University of Calgary.—ADP

Costco Connection: Medicines, medications and other tools for healthy living can be found in Costco warehouses and at Costco.ca.

Andrea Downing Peck is a freelance writer based in Bainbridge Island, Washington.