What’s atrial fibrillation and why should we know about it?

This is a condition on the rise — partly for lifestyle reasons and partly because we’re getting older.

In atrial fibrillation (let’s call it AF) the heart’s electrical system goes awry, so our normal rhythm and pumping action get out of sync.

Atrial refers to the atria — the top two sections of the heart. Fibrillation describes their movement. Instead of pumping strongly, they quiver or twitch, making our heartbeat feel rapid.

When this happens, blood can pool in the atria, increasing the chance of a clot forming, traveling up to the brain and causing a stroke.

While men get AF on average 10 years earlier than women, women are more at risk of stroke.

AF can show up at any age, but it’s more likely after age 65. About one in four women in their 80s and 90s will have it.

The irregular heartbeat can last for short or long periods or be permanent. Short periods could be just a few seconds, but it can also go on for a day, a week or longer. If it’s going to last, we’ll need treatment and I’ll get to that shortly.

But first, there are factors besides age that boost our risk: obesity, high blood pressure, sleep apnea, type 2 diabetes, alcohol, smoking and inactivity.

These can change the structure of the heart — making it weaker, stiffer, bigger or thicker, all of which are problematic. And they can mess up its electrical signals.

A common complication of AF is heart failure. These two are a bit like cousins and one can lead to the other. They also have the same risk factors.

In heart failure the muscles of the heart are either too weak to pump properly or too stiff to allow the heart to expand and fill with blood.

Since the heart is responsible for sending oxygenated blood around the body, in both AF and heart failure we don’t get the oxygen we need and might feel light-headed, weak or breathless. Feeling dizzy or faint might be the first sign that something’s wrong.

In both conditions, lifestyle shifts such as losing weight, normalizing blood pressure and blood sugar, getting treatment for sleep apnea, limiting alcohol, quitting smoking, and keeping physically active make a big difference.

Exercise (aerobic and resistance) can help to reduce visceral fat and inflammation, and control blood pressure and blood sugar, but it also improves the structure and function of the heart.

Alcohol, on the other hand, can increase risk factors such as blood pressure and sleep apnea.

Habitual drinking, even at moderate levels (e.g. two drinks a day), can swell and stiffen the heart and alter its electrical signaling over time. The recommendation for AF patients is less than three standard drinks a week.

Both conditions often require medication. For AF patients that’ll usually be blood thinners to avoid a stroke plus drugs to control heart rate and manage the heart’s rhythm.

Medications for heart failure might be to lower blood pressure, reduce fluid build-up or improve the heart’s pumping function.

If medication isn’t enough to manage AF, a procedure called ablation is done. This involves using a catheter to scar the tissue where the abnormal electrical signals occur. Scar tissue can’t conduct signals.

Sometimes a pacemaker is inserted and the main signalling node destroyed, so the pacemaker now manages the rhythm. Ablation patients are encouraged to exercise because that helps to avoid having to have it done again.

Ultimately, there’s nothing we can do about getting older but like other degenerative conditions, there’s a lot we can do to avoid or improve AF. And heart failure.

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