Peterborough Regional Vascular Health Network

ATRIAL FIBRILLATION: Patient Information Package Version 1.0

What is atrial fibrillation? Atrial fibrillation is a heart rhythm disorder which can affect individuals of any age. It is more common in older age groups and quite common in people after age 70. The rhythm is characterized by irregularity of heartbeat. It may be fast, slow, or both, but is always irregular. A related condition is atrial flutter which can be more regular. There are many potential causes of this disorder but often, nothing specific is found.

Normal Sinus Rhythm

Atrial Fibrillation

Why is atrial fibrillation a concern? The main risk of atrial fibrillation is reduced blood flow (cardiac output) and the risk of stroke. For these reasons your doctor will want to treat this disorder to minimize complications that might arise.

What symptoms does it cause? Some patients feel nothing at all. Others are profoundly short of breath, fatigued, or have chest pain. For some the first sign of atrial fibrillation is stroke. Symptoms may vary day to day.

What is the main focus of treatment? In order to reduce complications there are two main lines of attack. The first is to anticoagulate (take blood thinners) to reduce the chance of stroke. Risk of stroke is four times higher if you don’t take your coumadin. The second goal is to control the heart rate and, bring the rhythm back to normal if possible.

What medications will I need? Almost everyone needs to be on the blood thinner Coumadin (warfarin) although in some younger patients, Aspirin or other alternatives may suffice. Most patients will also be on a medication to slow the heart down. Digoxin, beta blockers, and the calcium blockers diltiazem and verapamil may be used for this purpose. After you have been anticoagulated for about five weeks there may be an attempt to bring the rhythm back to normal. This usually involves adding at least one more drug and may require electrical cardioversion (shock across the chest). Sometimes various drugs are tried and more than one session of shock may be necessary.

Why bother? Even if you feel well, your risk of stroke will be reduced if we can get the rhythm back to normal. Many people who think they feel well now are surprised at how much better they feel when the rhythm has been restored to normal. In many patients restoring the rhythm to normal allows them to lead a relatively active life whereas they are quite limited when in atrial fibrillation.

Will the electric shock hurt? No. You will receive an anaesthetic and will be asleep during the procedure. The selection of the anaesthetic will depend on a number of factors, but most often short acting drugs are used which are very well tolerated and permit you to go home within an hour of the procedure.

Is the electric shock dangerous? No procedure is entirely free of risk. However, electrical cardioversion is extremely safe and well tolerated. The risk of the procedure has been deemed to be less than the risk of the rhythm disturbance itself.

AND NOW A WORD FROM THE PHARMACY…

You may be on a number of medications for the treatment of atrial fibrillation. One of the most important will be Coumadin which thins the blood and reduces your chance of stroke. Because a number of other medications can affect Coumadin and thereby make it more or less effective, it is essential that your doctor and pharmacist know about all of the things you take even if they are not by prescription. Your pharmacist is committed to helping you understand your medications and their proper use. Therefore, please follow these guidelines:

· Whenever you are on Coumadin (warfarin), and filling a new prescription for any drug, be sure to tell the pharmacist that you also take Coumadin (this is especially important if you are filling your prescription somewhere other than your usual pharmacy). Consider wearing a “MedicAlert” bracelet or carrying a wallet card.

· Be sure to also tell the pharmacist about other medications you may have recently received, especially antibiotics, arthritis drugs, diabetic pills, and all other heart drugs.

· Be sure to notify the pharmacist if you are taking any over-the-counter remedies or herbal medicines as well, especially ASA (aspirin) containing drugs, skin creams and ointments, acetaminophen (Tylenol) and vitamins. Notify the pharmacist if there are significant changes in your consumption of alcohol or major dietary changes.

· Your doctor will advise you to go the lab at regular intervals to check on the level of thinning of your blood. The test is called an INR. Be sure to go on the day you are booked for the test, and get further instructions from your doctor on how much to take thereafter.

We hope that this information will help you understand atrial fibrillation better and give you insight in to its treatment. If you have further questions you should ask your doctor, pharmacist, or visit the Peterborough Regional Vascular Health Network Website which you can access at: www.kawarthacardiology.com.