September is Atrial Fibrillation Month

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

September is National Atrial Fibrillation Month. We have asked Dr. Kirsten O. Healy who is a member of our Medical Advisory Board, to discuss atrial fibrillation, a condition in which the heart beats in an abnormal way. Dr. Healy is a cardiologist at New York with Cardiology Associates since 2010 and an attending cardiologist at New York-Presbyterian Hospital, Weill Cornell Medical Center. More than 750,000 hospitalizations occur each year because of atrial fibrillation. This condition contributes to an estimated 130,000 deaths each year. The death rate from this heart rate abnormality as the primary or a contributing cause of death has been rising for more than two decades.

Dr. Pat


1. What is atrial fibrillation?
Atrial fibrillation is a type of arrhythmia that originates in the upper chambers of the heart (atria) and causes an irregular heartbeat. Normally, electrical signals that cause the heart to contract and pump blood originate in the sinus node in the right atrium. However, with atrial fibrillation, the electrical impulses are disorganized and scattered throughout both atria, interrupting normal conduction of the heart. In certain situations, this irregular heart rhythm makes it difficult for the heart to contract normally. This can lead to decreased blood flow and oxygen throughout the body.


2. What are the symptoms of atrial fibrillation?
The most common symptom of atrial fibrillation is palpitations or the sensation of a racing, uncontrolled heartbeat. Fatigue and weakness are also common presenting symptoms and are more common in the elderly. Dyspnea on exertion can occur when heart rates are uncontrolled with walking and therefore blood flow is not meeting the increased oxygen demands. Atrial fibrillation seldom presents with syncope, or loss of consciousness, and if a syncopal episode occurs, other arrhythmias should be considered. “Silent atrial fibrillation” is an asymptomatic form of atrial fibrillation where patients report no symptoms. This is diagnosed in a routine examination or when patients present with a complication related to atrial fibrillation, like a stroke.


3. How long does atrial fibrillation last?
Atrial fibrillation may be transient or constant. It is important to understand the frequency of the atrial fibrillation to appropriately tailor the treatment. The three main types of atrial fibrillation are:

  1. Paroxysmal atrial fibrillation is when the atrial fibrillation is intermittent and can last less than one week. It may happen for a few minutes at a time or can occur for several days. Often this type of atrial fibrillation is brief and medications are not needed.
  2. Persistent atrial fibrillation usually lasts longer than a week. Medications and other treatment, like a cardioversion (see below), are usually used to treat this type of atrial fibrillation to restore normal rhythm.
  3. Permanent atrial fibrillation lasts longer than a year and does not go away. It cannot be corrected by medications. Control of the rate of atrial fibrillation is important as well as appropriate treatment for the prevention of stroke.


4. Why does atrial fibrillation occur?
Age is the most common risk factor for developing atrial fibrillation and the risk increases with every decade. Atrial fibrillation mainly occurs when there are anatomic abnormalities or damage to the heart’s structure. Hypertension, underlying coronary artery disease and abnormalities of the cardiac valves are common causes. Often atrial fibrillation is linked to exposure to alcohol, caffeine and tobacco. Metabolic imbalance, like thyroid disease, is a common and a very treatable etiology. Also, it is extremely common to develop atrial fibrillation after open heart surgery or lung surgery. In many of these postoperative patients, the atrial fibrillation will resolve as they recover from their surgery. Some medications are also common triggers. For example, steroids that are commonly used to treat asthma or other inflammatory conditions have recently been shown to correlate with the development of atrial fibrillation. Stimulant therapy is commonly used today to treat attention deficit disorder known as ADD. Brand-name stimulant medications include Adderall, Ritalin, Vyvanse, Concerta, Dexedrine, and others.These drugs increase blood pressure and heart rate and as a result can lead to the development of arrhythmias and specifically atrial fibrillation. Patients that appear to be most at risk for developing atrial fibrillation while on these medications include those with a prior episode of atrial fibrillation, structural heart disease or advanced age. Assessment of clinical benefits and risks should be made on an individualized basis when therapy is warranted. It is important that these medications are used at the lowest effective dose and shortest duration in women over 40.

There are some people who develop atrial fibrillation without any obvious cause and they have a structurally normal heart, a condition called lone atrial fibrillation. Typically, these people with lone atrial fibrillation are younger people and the complications are rare.

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