The chances of getting atrial fibrillation, a heart-related illness that affects people above 50 years, are high in obese and physically inactive people, and those experiencing obstructive sleep apnoea. Uncontrolled blood pressure, heavy alcohol use, especially binging, and mental stress can also trigger the disease, says Dr Ajit Thachil, consultant cardiac electrophysiologist, Lisie Hospital, Kochi, in an interview with Anna Jose. Edited excerpts:
What is atrial fibrillation and its incidence rate in India?
Atrial fibrillation (AFib) is a condition causing rapid uncoordinated irregular heartbeat from the upper chambers of the heart. The possibility of getting affected by the disease increases as the heart gets older. However, there is no accurate data available on the prevalence of atrial fibrillation in India. Worldwide, it is calculated that around 10% of people aged above 65 suffer from the condition.
How is the condition diagnosed? Do regular heart check-ups help?
In most cases, patients with AFib do not present with any symptoms. They may not be aware they have atrial fibrillation. The condition is symptomatic in a minority, and they may experience a fast heartbeat, breathing difficulties, and giddiness. In some cases, this condition of fast heartbeats leads to stroke, and we test and retrospectively diagnose atrial fibrillation. Though regular monitoring of heartbeat in people over the age of 50 years can increase the possibility of diagnosing atrial fibrillation, it is often difficult to diagnose the condition in asymptomatic people as it often occurs only for a few minutes or an hour. Studies on how to diagnose the disease more reliably in the general population are still going on.
How can we prevent the occurrence of the disease?
The condition, as it is related to ageing, is not preventable most of the time. However certain modifiable factors can be addressed to reduce the incidence of Afib. The chances of occurrence of the disease are high in obese and physically inactive people. It is also high among people who experience obstructive sleep apnoea, a sleep-related breathing disorder that occurs when the upper airway is repeatedly blocked during sleep. Most such people snore during sleep, and have daytime drowsiness; this can sometimes be reduced by maintaining an ideal body weight.
Also, uncontrolled blood pressure for a long time and alcohol use, especially on binges, can increase the chance of this disease. Another trigger for Afib is mental stress. Substance abuse can also trigger Afib. Thus, weight loss, regular moderate physical activity, avoiding alcohol overuse, and control of hypertension and mental stress, can reduce the incidence of Afib. Cases of atrial fibrillation caused by heredity are rare.
What are the treatment options available for the disease?
First of all, it is better not to treat most people with asymptomatic atrial fibrillation, if the heart is normal. We need to identify who needs treatment. The patients who require treatment are a minority. We need to prevent the occurrence of strokes due to AFib. People with longer duration of Afib who also have other risk factors like diabetes, high blood pressure, heart muscle dysfunction and old age, the condition can lead to stroke. Medications can help prevent the occurrence of strokes. The advancements in medical science in the last 10 years have made stroke-preventing medicines safe for patients. Treatments are available for Afib per se also. There are two kinds of treatment - medication and ablation. Taking medicines only when they experience an irregular heartbeat can help people with less frequent occurrences of the disease. Patients who suffer from the condition frequently will have to take medicines regularly, and they usually work for around 50-60% of people.
What is ablation for treating atrial fibrillation?
Cardiac ablation, a minimally invasive keyhole procedure done through the blood vessels in the groin, is found to be more successful and safer in treating atrial fibrillation than medicines. While the success rate of medications is 50%, the success rate of ablation is 70-80%; success rates are higher in relatively younger patients with normal hearts and early stages of AFib. Also, in cases of chronic or persistent atrial fibrillation, medicines may not be effective, and ablation has to be done. It is advised to undergo the treatment at the earliest, as delaying the ablation unduly makes it less effective.