Etiology, pathogenesis, and clinical 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.

Short-term vs. Long-term Therapeutic Approach

Short-term pharmacological interventions are limited in their ability to maintain normal sinus rhythm due (a) to the limited long-term effectiveness of medications, (b) the risk of triggering ventricular arrhythmias, and (c) the risk of long-term adverse effects from medication use (Gutierrez and Blanchard, 2011, p. 64). Therefore, the selection of a short- or long-term therapeutic approach will depends on the individual patient's cardiac history (Gutierrez and Blanchard, 2011). In some cases, short-term therapies such as the "pill-in-the-pocket" approach in which patients take a pill at the onset of an episode are possible (Gutierrez and Blanchard, 2011).. Long-term interventions such as anticoagulant therapy are more appropriate for recurrent or chronic atrial fibrillation (Wilansky and Willerson, 2009). It is important to note that elderly patients are at higher risk of experience adverse side effects of the drugs used to treat atrial fibrillation and care should be exercised in these cases (Roncoli, 2010).

Conclusion

The research showed that atrial fibrillation is condition wherein the human heart beats at an excessively rapid rate, causing reduced blood flow to the body. Although atrial fibrillation is usually not a life-threatening condition, the research also showed that emergency care is required in order to prevent long-term comorbidities. Some of the more common causes of atrial fibrillation include high blood pressure, heart attacks, coronary artery disease, abnormal heart valves, congenital heart defects, an overactive thyroid gland or other metabolic imbalance, certain medications as well as caffeine and alcohol. Finally, the determination of short- versus long-term interventions for this condition must be tailored to the individual, but elderly patients should receive special care when medications are prescribed for atrial fibrillation.