Atrial Fibrillation

Ask the DOC

Atrial fibrillation (AF) is by far the most common disorder of the rhythm of the heart. The lifetime risk of developing it is about 37 percent for those over 55 years of age. The biggest risk from AF is developing a stroke from a blood clot from the heart. The clot forms in the corners of the upper heart chamber, or the atrium, because in AF this chamber does not contract, or beat. It just vibrates, or fibrillates, allowing blood in the chamber to form a clot. If the atrium goes back into normal rhythm and contracts, this clot can be ejected out into the bloodstream where it often lodges in the brain. This is why most people with AF must be on lifetime anticoagulation, so clots cannot form. Those at the highest risk for stroke are those who have paroxysmal AF (PAF). In PAF, the heart goes in and out of AF. People with PAF often don’t realize they have it because often there are no symptoms. In addition, those with PAF often will not be in AF when they have an EKG, so the condition is not discovered, until it is too late.

Recently a fascinating study was published on diagnosing those with PAF and AF to reduce the risk of stroke. The study was huge, involving over 50,000 volunteers with an average age of 73 who were not diagnosed with AF. They wore a device that continuously monitored their EKG and heart rhythm for two weeks. Not surprisingly, the study found that many of them had AF and didn’t know it. What is fascinating to me is not the results of the study, which found pretty much the results that were expected, but the way the results were obtained. Until recently, continuously recording a person’s EKG required wearing a bulky recorder with wires and electrodes. The recording device was similar to a Sony Walkman (remember those?!) and, because of the electrodes, the wearer could not bathe or shower. Other, newer devices like event monitors have been developed but the device this study used is a giant technological step forward. They used the iRhythm Zio, an FDA approved EKG recording device. It is a waterproof, single-use adhesive pad that sticks to the skin and records the EKG for up to two weeks. There are no wires or electrodes. Once the recording period is over, the pad is removed and the heart rhythm is examined by the cardiologist. What a neat, clean way to diagnose heart rhythm disorders.

If you are over 55 and have had a stroke, heart failure, hypertension, diabetes, sleep apnea, heart disease, emphysema, obesity, or chronic kidney disease (all risk factors for AF), and you have not been diagnosed with AF, get to your doctor or cardiologist to have your risk of AF evaluated and, if found, treated. Stroke may often be the first sign of untreated AF.

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