What Is the Most Common Heart Rhythm Disorder? What Causes It? How Is It Treated?
The most common and clinically important heart rhythm disorder is atrial fibrillation (AF). Its frequency increases markedly with age. However, AF is not a disease seen only in older people; many factors such as high blood pressure, obesity, diabetes, heart disease, sleep apnea, and excessive alcohol consumption can also set the stage for it to appear at a younger age. What is atrial fibrillation? Normally, the atria and ventricles of the heart work in a regular rhythm. In atrial fibrillation, however, the atria of the heart begin to work with very fast and irregular electrical impulses. As a result, the heartbeat becomes irregular. Patients sometimes describe this as "my heart is skipping," "my heart speeds up and then slows down," or "my heart is beating irregularly." However, there is an important point: AF does not always cause palpitations. Some people may have no symptoms at all, and the rhythm disorder may be noticed during a routine examination, an ECG, or a test done for another reason.
Why is it important?
The main problem with atrial fibrillation is not only that the heart beats fast or irregularly. When the atria of the heart do not contract regularly, blood can pool, especially in the left atrium, making it easier for a clot to form. If this clot enters the circulation and travels to the brain, it can cause a stroke. For this reason, one of the first things a doctor assesses in a patient diagnosed with AF is the question, "How high is this patient's risk of stroke?" In patients at high risk of stroke, using appropriate anticoagulant (blood thinner) treatment is one of the most important parts of AF treatment.
Why does it occur?
Many factors can play a role in the development of AF. The most important are:
- High blood pressure
- Advancing age
- Coronary artery disease and previous heart attack
- Heart failure
- Heart valve disease
- Diabetes
- Obesity
- Sleep apnea
- Thyroid disease
- Excessive alcohol consumption
- Smoking
- A sedentary lifestyle
- Some lung diseases
- Structural heart diseases
- Sometimes, especially in younger people, AF can also occur without any significant structural heart disease
being present.
Do Stress and Coffee Cause AF?
Stress, lack of sleep, excessive alcohol consumption, and, in some people, heavy caffeine intake can trigger palpitations. However, it is not correct to say that "drinking coffee is a direct cause of AF." In fact, current data show that moderate coffee consumption generally does not significantly increase the risk of AF. Nevertheless, if a person notices that they consistently experience palpitations or an AF episode after a particular drink, they should share this with their doctor.
What are the symptoms?
The symptoms of AF can vary from person to person:
- Palpitations
- Irregular or fast heartbeat
- Shortness of breath
- Getting tired easily
- Weakness
- Dizziness
- Chest discomfort
- Reduced exercise capacity
- Some patients have no symptoms at all. For this reason, especially in older people and those with hypertension,
- diabetes, or other heart diseases, noticing an irregular pulse should be
taken seriously.
How Is AF Detected? How Is It Diagnosed?
The most basic method for diagnosing atrial fibrillation is electrocardiography (ECG). However, if AF occurs in episodes, an ECG lasting a few minutes taken at the hospital may be normal. In such cases:
- Holter ECG
Long-term rhythm recording devices
Rhythm recordings obtained from wearable devices and smartwatches can help with diagnosis. However, a smartwatch alert alone does not mean a definitive diagnosis of AF. In suspicious cases, confirmation with an ECG is required.
What is the goal of treatment?
There is no single goal in AF treatment. In general, there are four goals:
1. Reducing the risk of stroke
Anticoagulant medications may be used in patients at high risk of stroke. However, not every AF patient is given a blood thinner. The treatment decision is made based on the patient's age, coexisting conditions, and individual stroke risk.
2. Preventing the heart from beating too fast
Heart rate can be kept under control with medications such as beta blockers.
3. Trying to keep the heart in a normal rhythm
In suitable patients, rhythm-control medications or electrical cardioversion may be used.
4. Trying to eliminate AF itself
Catheter ablation may be performed in suitable patients. In this procedure, catheters advanced to the heart through a blood vessel in the groin are used to target the electrical foci that trigger AF, particularly the areas around the pulmonary veins, in an effort to reduce recurrence of the rhythm disorder.
Is it possible to prevent AF?
It is not possible to prevent every case of AF. However, there is a lot that can be done to reduce the risk of AF developing or recurring. To protect your heart:
Keep your blood pressure under control. If you are overweight, lose weight in a healthy way. Get regular physical activity. Do not smoke. Avoid excessive alcohol consumption. Control diabetes and high cholesterol. If you have sleep apnea, get treatment. Get enough regular sleep. Keep the risk factors for cardiovascular disease under control. In particular, weight loss, blood pressure control, physical activity, and treatment of sleep apnea are becoming increasingly important in the management of AF.
When should you see a doctor?
If you feel that your heart is beating irregularly or very fast, especially if this happens repeatedly, you need to be evaluated by a doctor. However, if palpitations are accompanied by chest pain, severe shortness of breath, fainting, or feeling faint, emergency medical evaluation is required. In addition, sudden weakness in the face or arm, difficulty speaking, loss of vision, or marked loss of balance may be signs of a stroke and require emergency evaluation.
The most important message: AF is not just palpitations
Atrial fibrillation is an important heart rhythm disorder that is becoming increasingly common today. However, it can be brought under control with early diagnosis and the right treatment. The goal here is not only to correct the heart's rhythm. Preventing stroke, reducing complications such as heart failure, improving the patient's quality of life, and preventing the progression of AF are the main goals of treatment. In short: If you feel that your heart is beating irregularly, do not dismiss it as just "palpitations." Recurrent irregular pulse in particular may be the first sign of atrial fibrillation.
References:
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- management of atrial fibrillation developed in collaboration with the European
- Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314
3414.
- Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149:e1-e156.
- Kirchhof P, Camm AJ, Goette A, et al.Early Rhythm-Control Therapy in Patients with
Atrial Fibrillation. N Engl J Med. 2020;383:1305-1316.
- Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic
Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):12611274.
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