Risks in the Treatment of Atrial Fibrillation for Females - Risks and Management

What Is Atrial Fibrillation?

Often referred to as A-fib or AF, atrial fibrillation is a cardiac disorder characterized by arrhythmia or irregular heartbeats. These irregular heartbeats are generated due to disorganized impulse generation and conduction by the heart tissues. Blood flow from the upper to lower chambers of the heart is poorly regulated, which results in the heart beating quickly and erratically.

What Happens During an Atrial Fibrillation?

Electrical impulses or signals are typically sent out from the sinus node in the upper right chamber of the heart. A cluster of specialized cells in the upper right heart chamber called the sinus node, sometimes referred to as the heart's natural pacemaker, creates the electrical signals that produce heartbeats. Once signals are sent from the sinus node, they quickly propagate through both atria, allowing them to depolarize at about the same time. This leads to a coordinated contraction of the heart tissues. The signal then moves down to the ventricles (lower chambers), which results in their contraction.

In the case of atrial fibrillation, signals are generated in the atria, not organized. Such signals tend to override the signals generated by the sinus node. This results in several more minor uncoordinated contractions instead of a significant coordinated contraction. These mini or more miniature contractions lead to the quivering or twitching of the heart tissues.

Is Atrial Fibrillation a Common Heart Condition?

Atrial fibrillation is a prevalent heart condition, affecting at least 5 million people in the United States. Usually, it is not a life-threatening condition. Still, it is crucial to diagnose and treat atrial fibrillation since, if not treated, it can result in severe complications, such as stroke. Atrial fibrillation is more common in women than in men. However, this difference decreases with age. Valvular heart diseases are more common in women with atrial fibrillation, whereas coronary artery diseases (also known as CAD) are more in men with atrial fibrillation. Irrespective of the underlying condition, atrial fibrillation elevates the risk of mortality and stroke in both sexes. Furthermore, there is an increased risk of embolism in women, particularly those over 65.

What Are the Different Types of Atrial Fibrillation?

Primarily, there are four types of atrial fibrillation. They are:

• Paroxysmal or Occasional Atrial Fibrillation - In this type of atrial fibrillation, the symptoms may come and go but most often subside within a week without treatment.

• Persistent Atrial Fibrillation - In this type of atrial fibrillation, symptoms do not subside within a week. Patients require treatment (for example, cardioversion) to restore normal electrical conduction.

• Long-Standing Atrial Fibrillation - This type of atrial fibrillation is very similar to persistent atrial fibrillation but lasts for at least a year and is sometimes difficult to treat.

• Permanent Atrial Fibrillation - This is a type of atrial fibrillation in which the heart’s normal electrical conduction cannot be restored. Patients are prescribed medications to prevent complications. For example, patients are prescribed medications to regulate blood pressure and avoid clot formation.

What Is the Most Common Complication Associated With Atrial Fibrillation?

The most common complication associated with atrial fibrillation is the formation of a thrombus (blood clot), which can eventually lead to a stroke. When the upper chambers of the heart quiver, instead of contracting, the blood within them becomes stagnant. When blood stays still or is stagnant, it tends to form clots. These blood clots can then travel to the ventricles or lower chambers of the heart and are pumped to the body. They can reach the brain and potentially lead to stroke.

A stroke, otherwise known as a brain attack, is a complication that occurs when the blood flow within the vessels supplying the brain is interrupted. Age is the primary risk factor which is associated with such complications. The higher the age, the higher the chance of patients encountering such complications.

What Are the Risk Factors Associated With Atrial Fibrillation?

The risk factors associated with atrial fibrillation can be grouped under two categories, namely, cardiovascular risk factors and non-cardiovascular risk factors. They include:

Cardiovascular risk factors include the following:

• Hypertension (high blood pressure).

• Coronary artery disease.

• Valvular heart disease.

• Heart attack.

• Congenital heart disease.

• History of heart surgery.

• Lung diseases.

• Atherosclerosis.

Non-cardiovascular risk factors include the following:

• Obesity.

• Diabetes (increased blood sugar).

• Excessive alcohol consumption.

• Certain medications.

• Tobacco abuse.

• Excessive caffeine consumption.

• Over-active thyroid gland.

• Genetic causes (family history) and age.

What Are the Signs and Symptoms Associated With Atrial Fibrillation?

Atrial fibrillation is associated with the following signs and symptoms:

• Heart palpitations.

• Angina (chest pain).

• General fatigue.

• Dyspnea (shortness of breath).

• Lightheadedness.

• Arrhythmia (irregular heartbeats).

• Weakness.

How Is Atrial Fibrillation Diagnosed?

Several tests can be employed to diagnose atrial fibrillation, and they include the following:

• Physical Examination - Physical examination includes monitoring the pulse rate and blood pressure and looking for symptoms of heart failure, such as swelling in the lower limbs, especially in the feet. The thyroid gland is also examined for abnormalities.

• Electrocardiogram (ECG or EKG) - Electrocardiogram is the primary test following a physical examination. The cardiologist assesses the electrical activity or conduction within the heart with the help of this rapid and painless diagnostic test. It also helps identify the source of irregular heartbeats.

• Echocardiogram (Echo) - In an echocardiogram, with the help of ultrasound, the cardiologist visualizes the blood flow and heart function. This is also a quick and painless procedure with zero downtime.

• Holter Monitor - A type of portable electrocardiogram, the Holter monitor helps monitor arrhythmias for at least a week.

• Event Monitor - An event monitor is also a type of portable electrocardiogram and is worn for a month or two.

• Implantable Monitor - This is an invasive technique; an implantable monitor is a device that is inserted under the skin by the cardiologist to track and monitor the electrical conduction of the heart.

• Blood Tests - Blood tests to assess thyroid and kidney function are performed. Tests are also conducted to assess potassium levels.

How Is Atrial Fibrillation Treated?

The treatment of atrial fibrillation primarily focuses on achieving the following goals:

• Prevention of complications.

• Restoring normal heart rhythm or electrical conduction.

• Regulating the heart rate.

Drug Therapy: Various medications are prescribed to treat atrial fibrillation. Such as:

• Anticoagulants - Also known as blood thinners, these medications help prevent the formation of blood clots, thereby preventing the complications associated with atrial fibrillation. A few examples of these medications include Warfarin, Aspirin, etc.

• Antiarrhythmics - This group of medications works by controlling heart rhythms. They include Amiodarone, Dofetilide, Propafenone, etc.

• Medications to Control Blood Pressure - Various groups of medications are prescribed to regulate the blood pressure of the patient. They include calcium channel blockers, beta-blockers, etc.

Surgical Intervention:

• Electrical Cardioversion - This is a temporary solution and involves the use of low-intensity shocks to reset the electrical conduction of the heart.

• Catheter Ablation - This is a procedure that uses catheters, radio waves, and temperatures of varying intensities to destroy the cells that generate irregular heartbeats.

• Pacemaker - A pacemaker is a device that is surgically inserted in the body to regulate the electrical conduction of the heart.

• Left Atrial Appendage Closure - It is a surgical procedure that is associated with minimizing the risk of stroke and the formation of blood clots.

• The Maze Procedure - It is a surgical procedure in which the surgeon creates a maze in the heart tissue by creating well-planned strategic cuts. These cuts eventually lead to scar tissue formation and help in re-routing the electrical impulses in the desired path.

How Is Atrial Fibrillation in Women Different From That in Men?

Although men and women are almost equally affected by atrial fibrillation, women tend to face adverse complications during the course of treatment. The complications include:

• Electric cardioversion is less opted for by women, and those who opt for it, often experience complications.

• Women are more likely to experience pericardial effusion after catheter ablation. Other complications include pulmonary vein stenosis, esophageal injury, and systemic thromboembolism.

• When prescribed Warfarin, the residual risk of experiencing a stroke is much higher in women.

• When compared to men, women tend to be more susceptible to experiencing a heart attack, even after treatment.

• Compared to men, women receive cardiac glycosides more frequently. Cardiac glycosides are associated with an increased risk of mortality and breast cancer.

• Cardiac glycosides are used to decrease the rate of contractions of the cardiac tissues.

Conclusion

Atrial fibrillation is a cardiac condition in which electrical signals are not just generated by the sinus node but also from other areas of the atria or upper chamber of the heart. Fibrillation is a state in which all the muscle fibers contract at different times, and the end result is a quivering or twitching movement. There are several risk factors for atrial fibrillation, and it often accompanies other cardiovascular diseases like high blood pressure, coronary artery disease, and valvular heart disease. Essentially any condition that can create an inflammatory state or physically stretch out the atria, potentially damaging the cells of the atria, can lead to atrial fibrillation.

Women tend to be more symptomatic than men and often require a personalized treatment plan. While the conventional treatment modalities may work for men, most women experience adverse effects. With advancements in science and technology, newer medications have been designed to cater to such groups of people. Irrespective of the treatment modalities available, it is crucial for both men and women to have a healthy lifestyle so that they are less susceptible to atrial fibrillations.