Current Interventions for Atrial Fibrillation

¶ … Atrial Fibrillation

Simply stated, atrial fibrillation describes a condition in which the human heart beats at an excessively rapid rate that can result in diminished blood flow to the body. While the condition is not typically life-threatening, atrial fibrillation still requires immediate medical care because left untreated, the condition can result in adverse, long-term complications. To determine the facts, this paper reviews the relevant literature concerning the etiology and pathogenesis of atrial fibrillation, why it occurs, what happens in electrophysiology terms when atrial fibrillation is present, and prominent risk factors for the condition. In addition, a discussion concerning the prevalence of the condition is followed by an analysis of corresponding clinical signs and symptoms. A description of the diagnostic pathways used to diagnose the condition is followed by a discussion concerning short- versus long-term therapeutic interventions for atrial fibrillation. Finally, a summary of the research and important findings concerning these issues are presented in the conclusion.

Etiology and Pathogenesis of Atrial Fibrillation

The term "atrial fibrillation" is used to describe "an irregular and often rapid heart rate that commonly causes poor blood flow to the body" (Atrial fibrillation, 2015). Some of the common causes of atrial fibrillation include the following:

High blood pressure;

Heart attacks;

Coronary artery disease;

Abnormal heart valves;

Congenital heart defects;

An overactive thyroid gland or other metabolic imbalance; and,

Exposure to stimulants, such as medications, caffeine or tobacco, or to alcohol (Atrial defibrillation, 2015).

In addition, a growing body of research indicates that increased ambient pollution and ozone levels can trigger atrial fibrillations in some people (Rich and Mittleman, 2006). Likewise, medication and illicit drug use (i.e., theophylline toxicity and cocaine) as well as electrolyte abnormalities (hypomagnesemia and hypokalemia) can cause atrial fibrillations (AF Etiology, 2015). During an atrial fibrillation episode, the two upper chambers of the heart (the atria) beat in an irregular fashion that is out of synchronization with the heart's lower two chambers (the ventricles) (Atrial fibrillation, 2015). At present, atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice and the condition is a risk factor for stroke and premature mortality (Rich & Mittleman, 2006).

Prevalence and Incidence of Atrial Fibrillation

Although it remains unclear whether atrial fibrillation is the result or cause of heart failure in some patients, the condition has been found to be more prevalent in individual who suffer from preserved systolic dysfunction (Roncoli, 2010). In addition, atrial fibrillation is more prevalent as people grow older and the condition represents one of the five leading causes of heart failure in 95% of cases in industrialized nations (Roncoli, 2010). It is noteworthy that both the prevalence as well as the incidence and mortality rates for this age-related condition have experienced sustained increases over the past several decades as a result of growing numbers of elderly adults in the United States (Dowling, 2015). At present, the median age at diagnosis of atrial fibrillation in the U.S. is 74.6 years for women and 66.8 years for men (Dowling, 2015). In addition, current estimates suggest that the prevalence of atrial fibrillation will continue to increase from 5.2 million cases in 2010 to 12.1 million cases by 2030 (Dowling, 2015).

Clinical Signs and Symptoms

The clinical signs and symptoms of atrial fibrillation include heart palpitations, shortness of breath, weakness (Atrial fibrillation, 2015), chest pain, dizziness or fainting, fatigue and confusion (Signs and symptoms of atrial fibrillation, 2015). There are three main types of atrial fibrillation as described in Table 1 below.

Table 1

Three main types of atrial fibrillation

Type

Description

Paroxysmal Atrial Fibrillation

This type can occur and then spontaneously resolve to a normal condition following a period ranging from a few seconds to several months. This type is characterized by rapid pulse rate changes.This type of atrial fibrillation is associated with more symptoms compared to the other two types described below.

Persistent Atrial Fibrillation

This type does not resolve spontaneously and pharmacological or cardioversion is required to return the heart's rhythm to normal; left untreated, the heart will remain out of rhythm.

Permanent Atrial Fibrillation

This type is uncorrectable and neither pharmacological or conversion therapy interventions are capable of returning the heart to normal rhythm.

Source: Adapted from Types of atrial fibrillation, Hearth Rhythm Society, 2015

Diagnostic Pathways

The diagnostic tests set forth in Table 2 below are used to identify optimal interventions

Table 2

Atrial Fibrillation Diagnostic Pathways

Type

Purpose

Strengths

Chest radiography

Identify possible pulmonary disease

Capable of diagnosing pneumonia, vascular congestion, chronic obstructive pulmonary disease

Complete blood count

Identify comorbid conditions

Capable of diagnosing anemia and infections

Complete metabolic profile

Identify electrolyte abnormalities; assess kidney and liver function and blood glucose levels

These abnormalities may cause or exacerbate atrial fibrillation

Echocardiography

Assess heart size and shape; chamber sizes and pressures; valve structure and function

Identifies pericardial effusion; wall motion abnormalities; systolic and diastolic function

Electrocardiography

Diagnose atrial fibrillation and identify other arrhythmia

Identifies atrial flutter and atrial tachycardia as well as other cardiac conditions (e.g., left ventricular hypertrophy, ischemia, strain, injury)

Source: Adapted from Gutierrez and Blanchard, 2011, p. 63

Short-term vs. Long-term Therapeutic Approach