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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, my name is Doctor Warrick and I’d like to welcome you to my consulting room. Today, I’d like to talk about how we treat atrial fibrillation. I’ve spoken about atrial fibrillation previously, but as a quick reminder, atrial fibrillation is when there is a loss of the electrical synchronicity of the top chambers of the heart. The top chambers of the heart called atria. So atrial fibrillation means pertaining to the atria which are fibrillating. And fibrillating is simply another word for twitching or wiggling chaotically. And fibrillation is a chaotic, uncoordinated rhythm. So, the atria move in a completely random, chaotic way.
The consequence of that is that they don’t work properly. They don’t contract in the normal way that we see. The atria contract and then the ventricle in normal, what we call, sinus rhythm. In atrial fibrillation, the loss of synchronicity or the trembling and twitching of the atria mean that the chamber doesn’t contract properly. The atria also send lots of electrical signal signals to the bottom chambers of the heart; to the ventricles. The ventricles are therefore bombarded by these chaotic signals and beat rapidly and irregularly; so fast, often, that the heart doesn’t fill properly.
So, when we’re treating atrial fibrillation, one of the first things we want to do is improve the pump function. There are a number of things we can do to improve the pump function. Firstly, and most obviously, we can try and return the patient to normal sinus rhythm. We can try and stop the atrial fibrillation and return to normal rhythm. Of course, we can do that. We can restore the synchronicity of the pump and the function of the pump.
Sometimes we’re unable to restore sinus rhythm, either immediately or down the line. If that’s the case, then the next thing we would want to do is simply slow the atrial fibrillation so that that chaotic contraction at least slows down. And if it does, then the slower contraction allows for slower feeling and better functional capacity of the left ventricle and the right ventricle. So as we slow a heart that is in atrial fibrillation, we also improve the function of the pump. Not back to normal, but certainly enough to improve symptoms for a patient in the vast majority of people.
Lastly, if we’re dealing with pump function we want to make sure that some of the other issues that could be associated in the context of atrial fibrillation are being dealt with. Is the infection that could be there underlying, has that been dealt with? Is there anemia? Has that been dealt with? Is the thyroid function abnormal? Does the patient have cardiac failure?
So, we can restore normal rhythm. We can slow the rate response of atrial fibrillation, and we can also address some of the associated conditions occurring, all to try and improve pump function. The second thing we want to deal with in actual fibrillation is related to stroke. If the atrial chamber is not moving properly, then blood could pool within the atrial chamber it turns out that both the left and the right atrium have a small recess inside of them; a small corner if you like where blood can pool – and does pool. That area; that recess is called the appendage, and we see in the right atrium and in the left atrium.
If blood pools particularly within the appendage in the left atrium and it pulls air for long enough a clot can form. And if a clot forms within the left atrial appendage,