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Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
Hi, I’m Dr. Warrick Bishop and welcome to my consulting room. Today I’d like to talk a little bit more about atrial fibrillation and one of the things that people often ask is “who gets it?.” Well, men and women get it. Men – probably slightly more if you look at the numbers. Women interestingly when they suffer the condition run a higher risk of complication. So although there are more men in numbers actually suffer with atrial fibrillation, women have a higher rate of complication and therefore are impacted equally. This is particularly the case as people get older because one of the things that we see with atrial fibrillation is an increasing incidence of the condition as people age. We do see a genetic predisposition and there are certain families where a genetic link can have a significant up regulation of the likelihood of someone within their family developing that condition. This is not the most common situation but it certainly is important to be aware of. When we think about the things that are likely to increase the likelihood of atrial fibrillation, then we can think of “aetiologies” or causes that impact the structure and function of the atrium, the top chamber f the heart. Simple things like high blood pressure where the back pressure has a stretching effect on the atrium, over time will change the shape of the atrium and by changing the shape of the atrium, increase the likelihood of developing an abnormal rhythm within. The change of shape is often associated with scarring – microscopic scarring nonetheless but scarring that affects the way that electricity flows through the atrium and again starts to push that risk of developing atrial fibrillation up.
So age, with a little bit of micro scarring, general wear and tear with time, high blood pressure leading to pressures affecting the atrium. The valves being abnormal can also have an effect on the pressures within the heart and so abnormality of the valves and how they work can lead to back pressures that again impact on the atrium and therefore the structure and subsequently the function. Of course things like cardiac failure or abnormality if the muscle of the heart can also be implicated and associated with an increased likelihood of developing atrial fibrillation. We can also think of things that cause atrial fibrillation in the context of external factors or things outside the heart that impact the heart. It turns out things like diabetes over the long term seem to impact the heart possibly with byproducts of diabetic metabolism ending up within the structure and the fibres of the myocardium, therefore impacting how the atria and the muscles work. We see that obesity is linked with an increased likelihood of atrial fibrillation and obesity together with obstructive sleep apnea a condition where people obstruct their respiratory system at night while they’re asleep and really suffer with low levels of oxygen overnight. These situations trigger a very brisk response of the autonomic nervous system so the body is heightened although the person is asleep and can increase blood pressure and it can drive scarring and inflammation within the heart. Again all contributing to the possibility of developing atrial fibrillation.
We see that people with bad kidney function over a period of time have a high propensity to develop atrial fibrillation – nearly 20 percent of people with chronic renal disease  will develop the condition and this is a complication of multiple things: ele...