Why atrial fibrillation happens? What are risk factors for Atrial fibrillation? What can trigger atrial fibrillation? What is paroxysmal atrial fibrillation?
What causes atrial fibrillation? What are risk factors for Atrial fibrillation? Dr. Anton Titov, MD. What is trigger in AFib? What is substrate in atrial fibrillation? Hypertension is a risk factor. Thyroid dysfunction is a risk factor for atrial fibrillation. Heart geometry changes ("substrate") and electrical signal changes ("trigger") lead to cardiac arrhythmia. Diabetes and metabolic syndrome are big risk factors for Afib. Heart failure increases risk of atrial fibrillation. Older age increases probability of developing atrial fibrillation. How to treat atrial fibrillation today? Video interview with top expert in cardiology. Second opinion ensures that diagnosis of atrial fibrillation is correct and complete. Second opinion also helps to choose the best treatment strategy for atrial fibrillation. Seek second opinion on atrial fibrillation and be confident that your treatment is the best. What causes atrial fibrillation. AFib Risk factors. Atrial fibrillation prevention and treatment. Medical Second Opinion. Atrial fibrillation (AFib) is one of the most common arrhythmias. Atrial fibrillation also happens in patients who had heart surgery operations and thoracic surgery operations. Treatment of atrial fibrillation often requires oral anticoagulants (warfarin / Coumadin). Dr. Anton Titov, MD. Oral anticoagulants have significant side effects, such as hemorrhagic strokes and large bruises if a patient falls. It is bleeding in the head. Atrial fibrillation treatment is not innocuous. Dr. Anton Titov, MD. Who is at most risk for atrial fibrillation? How to prevent atrial fibrillation? What are the best strategies to treat atrial fibrillation if it already occurred? Medical Second Opinion. Dr. Dale Adler, MD. You are just correct. Atrial fibrillation is a growing problem. Atrial fibrillation frequency is age-related. We know that 4% of patients older than 60 years of age have atrial fibrillation. 15% of patients older than 80 years of age have atrial fibrillation. Increase in atrial fibrillation with age makes sense because atrial fibrillation occurs when there are "triggers" on top of the "substrate". What do we mean by atrial fibrillation triggers? Triggers in atrial fibrillation are additional electrical impulses that bombard left upper chamber of the heart (left atrium of the heart). The "substrate" in atrial fibrillation means that the left upper chamber of the heart (left atrium) is not able to shake off those electrical impulses, "triggers". Dr. Dale Adler, MD. Instead the substrate allows those triggers to become sustained in some way. Triggers for atrial fibrillation can come from several causes. We know that a patient undergoes heart surgery. There is irritation in the lining around the heart. That irritation can cause extra heartbeats. Sometimes the top chamber of the heart, left atrium, is stretched even before heart surgery. The electrical capabilities of left atrium might not be perfect. In such situation left atrium may perpetuate atrial fibrillation after heart surgery. Thoracic surgery similarly creates a risk for atrial fibrillation. Sometimes we remove a patient's lung. That will cause a top chamber of the heart on the right side to stretch. This could cause some extra heart beats. They become the triggers for atrial fibrillation. Sometimes the pumping chamber on the top left side of the heart, left atrium, is not in perfectly good health. Then you may find exactly the same situation. The "triggers" after lung removal fall onto damaged "substrate" of left atrium. Dr. Dale Adler, MD. This causes atrial fibrillation. In patients who did not have surgery high blood pressure (hypertension) can lead to atrial fibrillation. In hypertension the main pumping chamber of the heart on the left side (left ventricle) has to work harder. The heart is a muscle. When the muscle works harder, it gets thicker. Sometimes a patient lifts weights. Then the muscles that work get thicker. Once the heart muscle is a little thicker, it means that top chamber of the heart has to work harder to squeeze the blood into that chamber. When top chamber of the heart works harder, it stretches a little bit. When the top chamber of the heart is stretched, its electrical system is also stretched. Now you have created "the substrate" for atrial fibrillation. When extra heartbeats fall onto stretched top chamber of the heart, atrial fibrillation develops. "The trigger" falls onto "substrate" and is perpetuated in the form of atrial fibrillation. So high blood pressure (hypertension) and age are two predisposing risk factors for atrial fibrillation. Anything that perturbs the heart is a risk factor for atrial fibrillation. Heart valve problems predispose to atrial fibrillation. Because problems with heart valves can stretch the heart chambers. These problems are mitral regurgitation and aortic stenosis. Dr. Dale Adler, MD. Problems with the lining around the heart (pericardium) are a risk factor for atrial fibrillation. Pericardial inflammation can irritate the heart. Problems with the lungs also can cause atrial fibrillation. Electrolyte imbalance or thyroid gland problems are also predisposing factors for atrial fibrillation. But all such "triggers" have to land onto "substrate" of damaged top chamber of the heart. This is how atrial fibrillation appears and persists. You are correct that anticoagulation in atrial fibrillation is our biggest fear. The problem is that the top chamber of the heart is undulating, it is fibrillating. In such conditions the blood clot may form. This blood clot could break off and travel along blood vessels. Sometimes blood clot travels from the heart into the brain, it can cause a stroke. Sometimes blood clot travels elsewhere. It could cause in acute infarction or problem in the intestines (intestinal infarction). Dr. Dale Adler, MD. Blood clot can cause problems in the legs too. The risk of blood clot forming inside the heart of patients with atrial fibrillation depends on how stretched is that heart. A patient's general risk for forming blood clots is also important. We can predict these risks.We can determine factors that increase risks of clot formation in atrial fibrillation. Age is a very important risk factor to predict blood clot formation in atrial fibrillation. Age of patient between 65 and 75 is a risk factor for clot formation. Age above 75 years is even higher predictor of blood clot formation in atrial fibrillation. Hypertension (high blood pressure) is a risk factor for clot formation inside the heart of patients with atrial fibrillation. Because hypertension stretches the chambers of the heart. Dr. Anton Titov, MD. Heart failure is a very large risk factor for clot formation in patients with atrial fibrillation. Because heart failure implies that there are problems of moving the blood through the heart. Dr. Dale Adler, MD. Diabetes is a predisposing risk factor for clot formation in patients with atrial fibrillation. We know that patients with diabetes have a higher incidence of clotting. History of stroke is a very big risk factor. Because history of stroke tells us that something is wrong with patient's blood vessels. Diabetes creates problems with blood clotting and how all vascular risk factors come together. Women have a higher risk of increased clotting than men do. Especially women older than 65. Dr. Anton Titov, MD. Any vascular disease also presents additional risk for clot formation in atrial fibrillation. We can combine all risk factors for clot formation in a patient with atrial fibrillation. We can express this risk factors as a mathematical score. So we determine the score for a patient with atrial fibrillation. This score reflects a patient's risk of having a blood clot. Based on that score we can decide atrial fibrillation treatment. We can tell if the patient should receive oral anticoagulant medication. In the past doctors thought that aspirin may help in atrial fibrillation. But we reviewed all studies with aspirin. There was only one study where aspirin was remarkably effective. So we say that aspirin will treat the doctor. Aspirin is not going to treat the patient. So a patient with atrial fibrillation has the risks of forming a blood clot inside the heart. Dr. Dale Adler, MD. Sometimes you determine that this risk is high, you must prevent them from having a stroke. Therefore you need to use a blood thinner. It is medication to prevent clot formation. The standard blood thinner is warfarin (Coumadin). This medication existed for a long time and it is extremely effective. The risk of stroke in a patient who is on anticoagulant decreases 10 times. This is compared with the risk of stroke in a patient who is not on anticoagulant medication. But you are just correct. Dr. Anton Titov, MD. The process of starting a patient with atrial fibrillation on anticoagulant medication is tough. Because in the first few days of taking oral anticoagulant the patient is at increased risk of bleeding. For patients with atrial fibrillation there is always a risk of bleeding. Bleeding can happen in the gastrointestinal tract. Bleeding can happen under the skin or inside the mouth. Of course, the most dreaded bleeding in a patient on oral anticoagulants is bleeding in the head. What causes Atrial Fibrillation? Who is at most risk for AFib? How to decrease risk of stroke? What are treatment principles of atrial fibrillation?