Chaotic, rapid heartbeats
AF is an arrhythmia characterized by chaotic cardiac beats that are irregularly irregular. The heartbeat frequency can even be beyond 150 beats per minute.
Well-organized electrical system
The heart is made up of muscle cells distributed in 4 chambers: 2 atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. and 2 ventricles.
During a heartbeat, all the muscle cells in the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. must first contract simultaneously so that both atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. contract together. Next, it is the turn of all the muscle cells in the ventricles to contract simultaneously so that the ventricles contract.
The coordination of the contraction of the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. with that of the ventricles requires a good conductor for the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. and an electrical system that conducts this contraction from the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. to the ventricles.
It is an arrhythmia located in the atria
Atrial fibrillation is located in the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles.. It prevents them from contracting effectively.
The atria behave like musicians playing different songs simultaneously, without their bandmaster. It’s an electrical cacophony.
When one looks at the atria while in atrial fibrillation, it is much like seeing “jello” being shaken. There is a lot of erratic movement, but no effective contraction.
The gatekeeper is under fire
The ventricles do not contract at regular intervals either.
As there is no more “maestro” to manage the electric activity of the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles., the atrioventricular node (the gatekeeper of the electric impulse towards the ventricles) gets bombarded by the chaotic electric impulses from the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles.. The transmission of the electric signal towards the ventricles will also be irregularly irregular.
The pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with does not have tempo anymore.
Risk of clot formation into the heart
The main risk of AF is systemic embolism.
As the atria do not contract in an effective way, a blood clot may form on the walls of the atria because bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood does not circulate; it stagnates. Portions of this clot may detach and reach the general circulation, which can lead to arterial embolisms.
If a clot reaches the brain, it is then a CVA (stroke).
In spite of that, AF is considered a benign arrhythmia.
ONE CAN LIVE VERY WELL WITH AF. THERE CAN BE NO SYMPTOMS OR PERCEPTION OF PALPITATIONS“Palpitation” is a symptom related to an abnormality in heartbeats. There are several types of arrhythmias. This term is like a surname that encompasses several first names.
Some patients can be completely asymptomatic, as no palpitations are perceived. For others, palpitations“Palpitation” is a symptom related to an abnormality in heartbeats. There are several types of arrhythmias. This term is like a surname that encompasses several first names. can be fast, uncomfortable and a source of anxiety.
In certain situations, the frequency may be normal or even slow, because of medication or of a disease of the electrical system of the heart.
6% of the general population is affected and often without identifiable causes
The causes of AF are multiple, but often there is no identifiable cause. The incidence of AF, i.e. the frequency of this condition in the general population is 6%.
Some risk factors
On the other hand, it is well known that older patients, patients with high blood pressure or diabetes develop AF more often.
Certain diseases or problems can contribute to the occurrence of AF, such as vascular diseases, problems of the cardiac muscle or the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, inflammation of the pericardium after cardiac or chest surgery, pulmonary problems (COPD, pulmonary embolism) and even certain thyroid problems (hyperthyroidism).
Two main treatment approaches
The treatment of atrial fibrillation (AF) is based on two main strategies:
- Heart rhythm control, whose goal is to terminate the arrhythmia and restore a normal rhythm, known as sinus rhythm.
- Heart rate control, which aims to slow the heart rate without necessarily eliminating the arrhythmia.
– An important evolution in management
For many years, catheter ablation was mainly proposed when medications were no longer sufficient to control atrial fibrillation or caused significant side effects. As a result, this procedure was often considered late in the course of the disease.
Over time, clinical experience and advances in technique have changed this approach. It is now recognized that, in certain individuals—particularly younger patients who are otherwise healthy—earlier intervention may provide long-term benefits. The goal is no longer only to relieve symptoms, but also to limit the impact of atrial fibrillation on the heart over time.
In this context, catheter ablation may be considered earlier, sometimes even before the appearance of marked symptoms. This approach aims to reduce the persistence of the arrhythmia, lower the risk of future complications, and improve the overall course of the disease.
It is nonetheless essential to emphasize that this decision is never automatic. The choice of treatment is always based on an individualized assessment that takes into account age, the duration of atrial fibrillation, the overall condition of the heart, associated medical conditions, and the person’s preferences.
The decision is made in collaboration with the medical team in order to propose the most appropriate option for each situation.
1 – Ablation: treating the arrhythmia at its source
When catheter ablation is selected, the goal is to treat directly the mechanism responsible for atrial fibrillation.
This procedure may be proposed at the initial evaluation or after failure or intolerance of previous treatments, particularly when symptoms are significant or persistent.
During the procedure, the areas within the atria responsible for the arrhythmia are precisely identified. They are then neutralized using:
- radiofrequency energy (heat),
- cryotherapy (cold),
- or pulsed field ablation.
By targeting the very source of the rhythm disorder, this approach often allows for long-lasting elimination of the arrhythmia.
→ To read: Ablation of an arrhythmia
2 - When ablation is not chosen as the first option
Even though catheter ablation may be proposed earlier in some individuals, it is not always the initial choice.
Other ways of treating atrial fibrillation may be entirely appropriate, depending on the clinical situation and how the arrhythmia manifests itself.
A – Controlling heart rate
In people who are minimally symptomatic or asymptomatic, it is often simpler to manage atrial fibrillation by slowing the heart rate with medications. This approach is still frequently considered as first-line therapy, particularly in older patients.
In some cases, however, these medications may slow the heart excessively. When this occurs, the discussion may include the possibility of implanting a permanent cardiac pacemaker. This device acts as an electrical safety net, preventing the heart rate from falling below an inadequate level.
Its function can be compared to that of a thermostat in a room. If the temperature drops below the programmed level, the heating system turns on.
Conversely, when the temperature is adequate or too high, the system remains on standby. In the same way, the pacemaker intervenes only when the heart rate becomes too slow and remains discreet the rest of the time.
B – Controlling heart rhythm with medication
In some individuals, even if ablation is not selected as the first option, palpitations“Palpitation” is a symptom related to an abnormality in heartbeats. There are several types of arrhythmias. This term is like a surname that encompasses several first names. may significantly impair quality of life. In this context, another strategy consists of attempting to restore and maintain a more regular heart rhythm with medication.
Two medication-based approaches may then be considered.
The first involves taking a daily medication aimed at preventing episodes of atrial fibrillation. This option is generally proposed when episodes are frequent or prolonged.
The second approach, sometimes referred to as “pills in the pocket,” consists of taking a medication only at the onset of symptoms.
This strategy is mainly used in people whose episodes are infrequent, well tolerated, and occur sporadically. It allows daily medication to be avoided while still providing an option to terminate the arrhythmia when it occurs.
In all cases, treatment effectiveness and tolerance vary from one person to another. The choice of strategy is based on an individualized evaluation and regular medical follow-up.
Electrical cardioversion
In some situations, a normal heart rhythm is not restored despite the initiation of antiarrhythmic therapy. When this occurs, another strategy may be considered. It consists of delivering a controlled electrical shock to the chest in order to “reset” the heart’s electrical system. This brief electrical pause then allows the heart to resume a normal rhythm under the guidance of its natural “conductor.”
This procedure is known as electrical cardioversion.
Contrary to the image often portrayed in television shows, cardioversion is neither spectacular nor violent. The body does not jolt as seen on screen, and the procedure takes place in a controlled medical environment.
Electrical cardioversion requires a short period of anesthesia. Once the person is fully asleep, the shock is delivered. Sedation wears off quickly, and awakening is usually smooth.
Like any medical procedure, cardioversion carries certain risks. These are carefully assessed and explained beforehand, and this option is chosen when the expected benefits outweigh the potential risks.
Chronic or paroxysmal atrial fibrillation
Atrial fibrillation can be present in a chronic way (permanent) or periodical (paroxysmal atrial fibrillation).
To prevent clot formation and embolism
The physician will decide if the use of an anticoagulant medication is indicated, based on certain factors such as age, the presence of diabetes or high blood pressure, a history of stroke or heart failure.
ANTICOAGULANTS ARE NOT MEANT TO THIN THE BLOODBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood, BUT TO PREVENT BLOOD CLOTS FROM FORMING.
Once this type of medication is initiated, it will most likely be required indefinitely.
The physician must weigh the risks of embolization versus the risks of bleeding, whenever he/she decides to prescribe an oral anticoagulant medication.
You should never stop this therapy on your own.
Related articles
Latest articles
