September is Atrial Fibrillation Month

What is atrial fibrillation?

You might be thinking to yourself, what is atrial fibrillation (AF) and why should I care about it? To start off, AF is the most common type of irregular heartbeat.¹ Why is this important? Atrial fibrillation can lead to more severe complications, such as stroke or heart failure! Data show that patients with untreated AF are at a greater risk for having a stroke. How AF can cause a stroke is due to how the heart operates in these patients. The heart beats irregularly, causing blood to settle in the heart and form clots. These clots can be transported to the brain and cause a stroke.

Who does atrial fibrillation affect?

Atrial fibrillation affects up to 6.1 million Americans, with an overall frequency of occurrence around 1%.² In people aged 40 years or older, the general life-time risk for AF is 1 in 4. It is also seen more commonly in men than women.¹ Children are rarely affected by AF, unless they are born with structural heart disease.³ Some people are at a higher risk for developing AF than others. Factors known to increase your chances of developing atrial fibrillation are listed:

·       Increasing age

·       Hypertension

·       Diabetes

·       Heart attack

·       Heart failure

·       Obesity

·       Smoking

·       Excessive alcohol use

·       Hyperthyroidism

·       Family history of atrial fibrillation

How does one know if they have AF?

Patients can have AF without even knowing it. Many patients do not experience any symptoms. If a patient does have symptoms, they might feel things like a rapid pulse, shortness of breath, lightheadedness/dizziness, or vision problems. These symptoms are not specific for AF, and are seen in other health problems; getting diagnosed properly is key for detection of AF.

How is AF diagnosed?

A physician should be the one to diagnose atrial fibrillation. The main diagnostic test used to identify if a patient has AF is called an electrocardiogram (ECG). An ECG measures the rate and frequency of heartbeats. When a patient is in AF, an ECG is used to document the presence of it. Once diagnosed, blood tests should be completed to rule out other problems associated with AF.

What are the different types of AF?

There are three main types of AF, and each type is defined based on the frequency, duration, and rate of abnormal heart rhythms. Table 1 gives a broad summary on how each AF differs.

Table 1. Types of Atrial Fibrillation⁴

Type	Definition
Paroxysmal AF	·       Lasts less than 7 days without treatment
Persistent AF	·       Lasts longer than 7 days and does not end by itself
Permanent AF	·       Lasts longer than 7 days, even after medical attempts to fix it

How does one manage/treat atrial fibrillation?

One possible way to manage atrial fibrillation is through “electrical cardioversion.” This is a procedure where the heart undergoes electrical shocks, causing the heart to go from its irregular beats back to normal, regular rhythm. Not all patients can undergo this procedure, and the cardiologist will decide which patients should use it. Candidates of cardioversion are recommended to take a blood thinner called an anticoagulant for at least 3 weeks prior to electrical cardioversion, and for at least 4 weeks afterwards to prevent development of a stroke.

There are two main groups of drugs to help control the heartbeats in AF patients: rate controlling medications or rhythm controlling medications. A cardiologist should be the one deciding what type of medication a patient should be on. Some common rhythm control medications are amiodarone, flecainide, sotalol, and dronedarone. Some common rate control medications used would be beta-blockers (such as metoprolol), calcium channel blockers (such as diltiazem or verapamil), and digoxin.

As stated earlier, risk of stroke is a concern for patients with AF. Some patients are at higher risk, and a physician or pharmacist can determine a patient’s risk. If there is an increased risk for developing a stroke, most patients would be on a blood thinner, such as aspirin and/or an anticoagulant. Choice of anticoagulant depends on what your physician feels best fits your needs. The anticoagulants available are warfarin, dabigatran, apixaban, and rivaroxaban.

Overall, people can live a long, normal life with AF; however, proper diagnosing, treatment, and management are the keys to preventing complications. For more information on AF, refer to the links below, or speak to your physician or pharmacist!

·       Atrial Fibrillation Association

o   http://www.atrialfibrillation-us.org/

·       American Heart Association on Atrial Fibrillation

o   http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-AF-or-AFib_UCM_302027_Article.jsp

·       StopAFib

o   http://www.stopafib.org/resources.cfm

   

1. Atrial fibrillation. In DynaMed [database online]. EBSCO Information Services. http://web.a.ebscohost.com/dynamed/detail?vid=3&sid=fc02e003-71da-44d1-9c78-f3b1b619e210%40sessionmgr4002&hid=4201&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=115288. Updated July 28, 2014. Accessed August 14, 2014.

2. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. Chapter 8. The Arrhythmias. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 9e. New York, NY: McGraw-Hill; 2014.http://accesspharmacy.mhmedical.com/content.aspx?bookid=689&Sectionid=48811457. Accessed August 12, 2014.

3. Marchlinski F. Chapter 233. The Tachyarrhythmias. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012. http://accesspharmacy.mhmedical.com/content.aspx?bookid=331&Sectionid=40727006. Accessed August 14, 2014.

4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;

5. Strum M. Chapter 10. Anticoagulation Services. In: Ellis AW, Sherman JJ.eds. Community and Clinical Pharmacy Services: A Step-by-Step Approach.New York, NY: McGraw-Hill; 2013.http://accesspharmacy.mhmedical.com/content.aspx?bookid=684&Sectionid=45145845. Accessed August 14, 2014.

Written by: Daniel Ky UIC Rockford PharmD Candidate 2015.