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I am an 81 year old man. There is asymptomatic atrial fibrillation. I have only 20% in AFib, so my two trips to the hospital for the cardio version were canceled, but I wasn’t in AFib in either case. Everything else is healthy. Do I have to worry if I don’t do anything more?
Atrial fibrillation is a disorder of the normal heart rhythm. Instead of a reliable beat from the atrium (the atrium above the heart), chaotic electrical activity produces an irregular heart rate.
There are two major issues here. The first is that the irregular heart rate can cause the heart rate to become very fast, which can cause symptoms and even damage the heart. In addition, due to the lack of regulated electrical activity, the atrium does not contract, causing the ventricles to do all the mechanical work of the heart. In most cases, the heart can handle this, but in people with heart failure or heart valve damage, this can cause a significant deterioration in heart function.
The second problem is that if the atrium does not contract, blood can collect and coagulate, putting you at risk for embolism. In embolism, blood clots flow downstream, especially to the brain, where they can cause a stroke. People over the age of 75 with atrial fibrillation and young people at high risk of coagulation should take anticoagulants to reduce their risk of stroke.
In addition to anticoagulant therapy, cardiologists who decide how to treat atrial fibrillation need to choose whether to control rhythm or rate. “Rhythm control” tries to bring a person back to normal rhythm. “Rate control” allows you to stay in atrial fibrillation, but use medication as needed to keep your heart rate in the normal range. Cardioversion may not be an appropriate option for cardioversion when a person enters and exits atrial fibrillation, and cardiologists consider medications such as flecainide and amiodarone. Another option is to find and treat the area of the heart that is causing the chaotic rhythm. This process is called ablation and can be done surgically or using a catheter in a cardiac laboratory.
Another option is to wear a device that monitors your heart rate and use medication to prevent your heart rate from getting too high to ensure that your heart rate is within a safe range.
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