Atrial Fibrillation

Atrial fibrillation (AF), is a heart condition where the upper chambers of the heart, known as the atria, beat irregularly and too fast.

AF can lead to symptoms like palpitations, dizziness, and shortness of breath. In AF, the heart's electrical signals become disorganized, causing the heart to quiver instead of pumping blood effectively.

Between 0.5 – 1 million Australians are estimated to be living with atrial fibrillation (AF).

Although not usually a life-threatening disease, AF can cause a lot of symptoms if not treated effectively.

People with AF can have similar reduction in quality of life than those with other chronic medical conditions

There are four main things that need to be considered in the treatment of AF:

  1. Finding and treating underlying causes
  2. Preventing stroke
  3. Controlling the heart rate
  4. Restoring normal rhythm.

Treatment Approach

Managing atrial fibrillation (AF) requires a comprehensive strategy aimed at controlling symptoms, reducing associated risks like stroke, and improving overall heart health. The treatment approach for AF involves addressing various aspects of the condition:

  • AF is most often driven by lifestyle factors in the same was as other heart disease or diabetes.
  • Strong evidence now exists that modifying lifestyle factors can reduce burden and symptoms of AF and make procedures like ablation more likely to succeed.
  • Recommended targets include:
    • Weight reduction to BMI ≤27 or 10% weight loss
    • Alcohol intake <30g (3 standard drinks)/week
    • Blood Pressure <130/80 mmHg
    • Lowering cholesterol (LDL cholesterol <2.5mmol/L)
    • Exercise target of 30mins 3-4x/week
    • Management of other chronic conditions e.g Diabetes, sleep apnoea or smoking
  • Due to the irregular heartbeat in AF, it is thought that blood pools in the heart and forms a clot, which may then travel to the brain to cause a stroke. As strokes can be deadly or very disabling, people with AF are often prescribed blood thinners.
  • Your Cardiologist will assess your individual stroke risk as well as any bleeding risks and make a recommendation on blood thinners (anticoagulants).
  • Keeping the heart rate controlled remains an effective initial and long-term strategy in many AF patients. A target of <110 beats per minute (bpm) is reasonable.
  • Medications used to slow the heart rate include beta-blockers, calcium channel blockers and digoxin. All these medications are safe when used correctly and monitored. The choice of medication is tailored to the individual depending on a few factors your Cardiologist will review.
  • Rhythm control means putting the heart back to normal rhythm (sinus rhythm) and maintaining this. It can be the first-line treatment or used when symptoms continue even with rate control.
  • The first step in rhythm control may be referral for a cardioversion to determine if symptoms improve during sinus rhythm.
  • Rhythm control is preferred in people with heart failure, younger age, symptoms when rate controlled or patient preference.
  • Rhythm control may also include ‘pill in the pocket’ strategies which are preferred by some patients.
  • Ongoing symptoms despite rate control medication
  • AF with evidence of heart failure
  • Challenging anticoagulation scenarios
  • Patients wishing to be considered for catheter ablation

In appropriately selected patients, catheter ablation can eliminate or substantially reduce symptoms from AF. 

As abnormal beats from within the pulmonary veins are the predominant trigger for AF, ablation via pulmonary vein isolation (PVI) has become a common practice. Over 8000 AF ablations are performed Australia-wide each year, including by our Specialists at The Wesley Hospital. 

Good candidates for AF ablation include:

  • Recurrent AF despite anti-arrhythmic drugs
  • Younger age
  • Paroxysmal (intermittent) symptoms
  • Heart failure (fluid retention)
  • Left atrial chamber is not too enlarged on echocardiogram
  • Side-effects to rate or rhythm control medication

Ablation for AF can be performed using different energy sources, radiofrequency (burning) and pulsed field (electrical) and is usually performed under general anaesthetic. The aim is freedom from symptomatic atrial fibrillation which can be achieved in 70% of patients, although at times a re-do procedure is required.