Treating Afib: Hospital Procedures And Protocols

Atrial fibrillation (AFib) is a common type of irregular heartbeat that can lead to serious complications if left untreated. While AFib is not life-threatening on its own, it significantly increases the risk of stroke and heart failure. Treatment for AFib aims to address the underlying cause and reduce the likelihood of these life-threatening events. In a hospital setting, patients with AFib may undergo diagnostic tests such as electrocardiograms (ECG/EKG) and blood tests to determine the best course of treatment. Treatment options include medications to control heart rate and rhythm, blood thinners to prevent blood clots, and minimally invasive procedures such as cardioversion and catheter ablation to restore a normal heart rhythm.

Electrocardiogram (ECG/EKG)

An electrocardiogram (ECG/EKG) is a test used to diagnose atrial fibrillation (AFib) and other types of arrhythmias. It involves creating a graph of the electrical signals travelling through the heart, which can indicate whether the heart is beating in a uniform or irregular pattern. Typically, a standard 12-lead ECG is used in a clinical setting, recording electrical signals from various angles in the heart to produce twelve distinct waveforms.

The ECG test is an important tool for diagnosing AFib, which is characterised by an irregular heart rhythm originating in the upper chambers of the heart. This irregular rhythm is caused by the heart's electrical system malfunctioning, resulting in multiple signals being sent simultaneously instead of a steady pattern. Consequently, the upper chambers struggle to contract and pump blood into the lower chambers, leading to a fast and chaotic heartbeat.

During an ECG test, electrodes are placed on the skin of the chest, arms, and legs. These electrodes detect the tiny electrical changes on the skin that occur with each heartbeat, providing valuable information about the heart's activity. The test is non-invasive and painless, making it a safe and effective method for diagnosing AFib.

The results of an ECG test can reveal whether the heart is beating in a sinus rhythm or an irregular pattern indicative of AFib. A sinus rhythm indicates that the upper and lower chambers of the heart are beating in synchronisation, although this does not necessarily imply overall heart health. On the other hand, an AFib result signifies an irregular heart rhythm, which is the most common form of serious arrhythmia.

Additionally, the ECG app on the Apple Watch has been clinically validated to classify ECG recordings into AFib and sinus rhythm with high specificity and sensitivity. While it cannot replace a medical diagnosis, it can provide valuable information about heart rate and rhythm, enabling users to take proactive measures and consult their doctors if necessary.

Blood tests

Cardiac enzyme levels, such as creatine kinase (CK) and troponin, are also measured to investigate a possible myocardial infarction. B-type natriuretic peptide (BNP) levels are evaluated to assess for congestive heart failure, and D-dimer levels are checked if the patient has risk factors for pulmonary embolism. Blood tests can also help identify other causes of AFib, such as hyperthyroidism, infections, and inflammatory diseases, allowing healthcare providers to create a more tailored treatment plan for the patient's specific condition.

Echocardiogram

Atrial fibrillation (AFib) is an arrhythmia that can cause heart palpitations, fatigue, and dizziness. It is a serious condition that affects millions of people worldwide and often requires hospitalization. In a hospital setting, there are various treatment options for AFib, including medications, procedures, and lifestyle changes. One important diagnostic tool used in hospitals to guide treatment decisions for AFib is an echocardiogram.

An echocardiogram is a test that uses ultrasound technology to create images of the heart. It is a non-invasive procedure that can provide valuable information about the structure and function of the heart, helping doctors diagnose and manage AFib. The test is often ordered to evaluate the heart's structure and function, especially in patients with suspected heart disease or those at risk of developing AFib.

There are different types of echocardiograms, including the standard transthoracic echocardiogram (TTE) and the transoesophageal echocardiogram (TOE). The TTE is a simple and cost-effective test that evaluates the cardiac and vascular structures, including the left ventricle, mitral valve, left atrium, aortic valve, and aorta. It can detect minor abnormalities and is useful for long-term management and risk stratification. The TOE, on the other hand, is a more complex and expensive procedure that may be used to guide cardioversion or ablation procedures. It provides excellent visualization of the atria and appendages and is useful in specific circumstances, such as when patients require expedited cardioversion.

Echocardiography plays a crucial role in the management of AFib. It helps doctors assess the severity of the condition and make informed decisions about treatment options. For example, echocardiogram results can indicate the need for additional treatments such as antithrombotic therapy or OACs (oral anticoagulants). Additionally, echocardiography can be used to guide procedures such as radiofrequency ablation, improving the accuracy and success rate of the treatment.

In summary, an echocardiogram is an essential tool in the hospital setting for diagnosing and managing AFib. It provides detailed information about the heart's structure and function, helping doctors make treatment decisions and improve patient outcomes. The type of echocardiogram performed depends on the patient's specific circumstances and the information required to guide their care.

Cardioversion

There are two types of cardioversion: electrical and chemical. Electrical cardioversion involves delivering a high-energy shock to the heart to reset its rhythm. It is more commonly used than chemical cardioversion due to its higher success rate. Before electrical cardioversion, patients are typically sedated with medicine to ensure comfort during the procedure.

Chemical cardioversion, on the other hand, employs medications to restore a normal heart rhythm. Healthcare providers may attempt this method or techniques like the Valsalva maneuver, which involves holding one's breath and increasing abdominal pressure to lower the heart rate, before resorting to electrical cardioversion.

Catheter ablation

Before the procedure, patients may need to stop taking blood-thinning medications, fast for several hours, and arrange for someone to take them home from the hospital. The procedure itself typically takes two to four hours, but this can vary depending on the person. After the procedure, the patient is moved to a recovery room where a nurse monitors their condition. They may need to stay in the hospital for six to eight hours, or possibly overnight, before being discharged.

The recovery process typically involves some soreness, tiredness, and discomfort in the chest for a few days. It takes several weeks for the work done during the procedure to turn into scar tissue, and it can take up to three months to fully evaluate how much the ablation helped. Patients may need to take blood-thinning medications for several months after the procedure to prevent blood clots.

Frequently asked questions