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Frequently asked questions

What is an arrhythmia?

An abnormal heart rhythm, or arrhythmia is a change in the pace or pattern of the heartbeat. This change in pace, during an arrhythmia, is considered either too fast or too slow.

What are the different types of arrhythmias?

Bradycardia - The heart beats slower than normal.
Tachycardia- The heart beats faster than normal. Supraventricular Tachycardia (SVT)-A series of very rapid heartbeats that begin in the upper chambers (atria) of the heart.
Atrio-Ventricular Nodal Reentry Tachycardia (AVNRT)- A form of SVT, where an accessory pathway allows electrical impulses to travel in a circular pattern and the heart may contract with each rapid cycle.
Atrio-Ventricular Reentrant Tachycardia (AVRT) or Wolff-Parkinson-White Syndrome (WPW) - An accessory pathway (bridge) makes it possible for electrical impulses to travel from the atria to the ventricles without going through the typical pathway.
Atrial Fibrillation (AF) - Upper chambers of the heart (atria) beat rapidly and in an uncontrolled manner (fibrillation).
Atrial Flutter- Upper chambers of the heart (atria) beat rapidly but more organized then in atrial fibrillation.
Ventricular fibrillation -The heart’s lower chambers (ventricles) quiver and can’t contract or pump blood to the body.
Ventricular Tachycardia (VT)- Abnormal electrical pathways exist in the lower chambers of the heart (ventricles) causing rapid contractions.

What is Atrial Fibrillation (also referred as AF or AFib)?

AF is characterized by an irregular and often fast heart rhythm that results in uncoordinated contraction of the top 2 chambers of the heart (ie, atria). 

It occurs when there is a fault in the electrical activity of the heart, causing the heart to beat in an irregular and uncoordinated fashion.1 AF is the most common form of cardiac arrhythmia affecting 1 in 4 people over 40 during their lifetime.2 With over 11 million people across Europe affected by AF and numbers predicted to rise by 70% by 2030,3  it is becoming of one of our most significant health challenges.  

Find out more on the different types of Atrial Fibrillation

What are the causes and risks of Atrial Fibrillation?

AF is the most common form of cardiac arrhythmia and is becoming one of the most important public health challenges, affecting over 11 million people across Europe.4

AF is a highly common age-related arrhythmia affecting as many as 1 in 4 people over 40 during their lifetime.  There are a number of both modifiable and non-modifiable risk factors for the development of AF. Modifiable risk factors include hypertension, obesity, endurance exercise, obstructive sleep apnea (OSA), thyroid disease, and alcohol consumption. Age, sex, family history, race, tall stature, and other types of heart and valvular disease are all non-modifiable risk factors. Early onset AF has a strong heritable component.5

Among the multiple risk factors involved in the development of AF, age is perhaps the most powerful.6

AF induces a slow but progressive process of structural remodelling of the atria. Some structural remodelling can be irreversible which supports the need to treat AF early to avoid more permanent damage.5

 

What are the symptoms of AF?

Symptoms of AF can significantly impact patients’ quality of life and are the main reason patients seek medical advice.
The symptoms of atrial fibrillation vary greatly and most often consist of a noticeably irregular, fast pulse and heart palpitations. Moreover, tiredness, dizziness or shortness of breath may also occur, as the heart pumps slightly less efficiently than with a regular and easy rhythm. However, there are also some people in which atrial fibrillation goes unnoticed.

Which type of AF is most common?

In Europe, 75% of patients have paroxysmal or persistent AF.7

  • Persistent AF is twice as common in patients with symptoms than without, whereas permanent AF is 3 times as common in patients with symptoms than without, primarily due to treatment.8*

How is AF Diagnosed?

Early detection of Atrial Fibrillation is important to ensure prompt and adequate management, which not only aims to control symptoms but to avoid later complications.5
A diagnosis of AF is often made by pulse palpation, in which the pulse is classically described as being ‘irregularly irregular’.

Confirmation of AF requires a rhythm recording displaying the electrical activity of the heart using an electrocardiogram (ECG or EKG), showing the typical pattern of AF: completely irregular RR intervals, an absence of P waves, and coarse or fine fibrillation waves at baseline. An episode lasting at least 30 seconds is diagnostic.9,5

The history and physical examination of the patient are focused on identifying risk factors (e.g. excessive alcohol consumption), comorbidities, and physical findings of AF

What treatments are available for AF patients?

Treatment options for AF Management

  • Medication to control the heart rate or rhythm

  • Blood thinning medication - people with atrial fibrillation are more at risk of having a stroke

  • Cardioversion – where the heart is given an electric shock to restore the normal rhythm

  • Catheter ablation – where the area inside the heart that is causing the abnormal rhythm is destroyed using radiofrequency or cryo energy

How do I assess the stroke risk of my patients?

The risk of stroke is assessed by considering the presence or absence of various stroke risk factors, the most common of which are used to formulate a stroke risk assessment scoring, the most common one is known as the CHADS2 (Congestive heart failure, Hypertension, Age, Diabetes and Stroke)10

The CHA2DS2-VASc score is an extension of the CHADS2 scheme as it adds vascular risk (peripheral arterial disease, previous MI, aortic atheroma) and female gender is also included in this scoring system.

References

1. Iaizzo PA (2015). Handbook of Cardiac Anatomy, Physiology, and DeviceS. Springer Science+Business Media, LLC: Switzerland. 2. Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D et al. (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110 (9): 1042-1046. 3. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6 213-220. 4. Global Burden of Disease Collaborative Network (2016) Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2017. Accessed 2018-04-20. Available from http://ghdx.healthdata.org/gbd-results-tool. 5. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37 (38): 2893-2962. 6. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB et al. (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14 (10): e275-e444. 7. Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI et al. (2015) Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 128 (5): 509-518 e502. 8. Boriani G, Proietti M (2017) Atrial fibrillation prevention: an appraisal of current evidence. Heart (0):1–6. 9. Lip G et al. (2016) Atrial Fibrillation. Nat Rev Dis Primers. 2016 Mar 31;2:16016. 10. Lip G et al. (2010) Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach: The Euro Heart Survey on Atrial Fibrillation, CHEST 2010; 137(2):263–272. *. Permanent AF means AFIB is constant despite medications or other treatment.

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