By Caroline Cederquist, M.D.
Atrial fibrillation is a condition where the upper chambers of the heart (called the right and left atria) do not contract in a regular fashion and are separate from the contraction of the lower chambers of the heart (called the right and left ventricles). When this synchronous contraction of the upper and lower chambers of the heart no longer occurs, the result is an irregular contraction which can be picked up when you are feeling your pulse. Doctors describe the pulse in atrial fibrillation as “irregularly irregular”, as there is no defined pattern which may be the hallmark of other arrhythmias (abnormal heart beat patterns). You may feel this irregular rhythm as “skipped heart beats” or a heart beats that are very fast.
Sometimes atrial fibrillation is associated with shortness of breath especially if the heart rate is very fast. Atrial fibrillation can also be associated with the symptom of fatigue. The reason for this, is that the full contraction from the ventricles may not push the full volume of blood to the body in each beat because the irregular contraction of the atria is not allowing the complete filling of the left ventricle before the contraction that pushes blood around the body.
Interestingly, some people may have atrial fibrillation and may not be aware of any symptoms at all. Over the past twenty years, I have met new patients during a weight consultation and discussed his or her entire history. Sometimes there are some symptoms of fatigue that are mentioned but it was certainly not the reason my patient came to see me. When I perform the physical exam, I have detected an irregularly, irregular pulse and further testing, like an EKG, confirmed atrial fibrillation.
Atrial fibrillation is dangerous for several reasons. If the atrial fibrillation is associated with a rapid pulse, which sometimes can be in the range of a heart rate of 200 or more, a person can develop a heart attack or heart failure from all the strain on the heart. In addition, untreated atrial fibrillation is one of the leading causes of ischemic stroke. In an ischemic stroke, a small clot travels up to the brain and blood is cut off to the brain in the areas supplied by the blocked blood vessel. Atrial fibrillation predisposes people to these small blood clots that form in the atria of the heart because they are not emptying normally due to the irregular heart rhythm.
The hallmarks of treating atrial fibrillation are to get the heart back into normal rhythm with medication or what is called cardioversion (a small electrical shock to the heart) and making sure the person is anti-coagulated (meaning that the blood is thinned) so that blood clots do not occur prior to converting a person back into normal rhythm. Sometimes, the heart rate is unable to return to a normal rhythm and a person is maintained on medication to keep the heart rate in the normal range and the blood thinned to prevent a stroke.
New advances over the few years have include cardiac ablation, where the heart is treated with heat or cold or surgery to interrupt an area of nerve fiber that is transmitting the signal for the abnormal heart rate in the heart.
Atrial fibrillation is becoming more common. The reasons for this is that atrial fibrillation increases with age and people are living longer. 2.2 million adults in the U.S. have atrial fibrillation and their average age is 75 years old. 70% of people with atrial fibrillation are between the ages of 65-85. However, 2.3% of adults over 40 have atrial fibrillation.
Other important risks for the development of atrial fibrillation is sleep apnea and overweight and obesity. The frequency of atrial fibrillation increases with the severity of sleep apnea. In one study, adults with severe sleep apnea were four times more likely to develop atrial fibrillation than adults without sleep apnea.
People who are overweight are more likely to have atrial fibrillation as well as a more severe version of it compared to normal weight people. There are several reasons for this. Overweight and obesity increase high blood pressure and sleep apnea which are risk factors for atrial fibrillation. In addition, fat- especially fat around the heart, is inflammatory and increase irregular heart rate development.
Importantly, STABLE weight loss improves atrial fibrillation. In studies, weight loss improved the conditions of high blood pressure and sleep apnea that increase atrial fibrillation. Importantly, weight loss also decreased the thickness of certain areas of the heart that are enlarged in atrial fibrillation. This shows that there is structural remodeling of the thickened heart which occurs with weight loss. Cardiologists stress the importance of stable weight loss, such as achieved with long term lifestyle change as opposed to fad diets or extreme fasts, as fluctuations in weight up and down are associated with an increased likelihood of return to atrial fibrillation.
Weight loss is a valuable treatment for those with atrial fibrillation or those with high risk for it. Weight loss can affect the amount of medications needed to control atrial fibrillation, such as blood thinners, so it is important that weight loss be closely monitored. Medically monitored treatment with close dietary supervision at Cederquist Medical Wellness Center is available for those with complex medical conditions like atrial fibrillation.
Cederquist Mdical Wellness Center