Mellanie True Hills was leading a hectic life as a technology consultant when, at age 51, one of her coronary arteries became blocked and she experienced heart attack-like symptoms. The emergency surgery that followed saved-and changed her life. She quit her job to start the American Foundation for Women's Health, a nonprofit women's health advocacy group, but then developed atrial fibrillation, a heart rhythm disruption. She struggled with the disorder for two years and then underwent surgery, which cured her. She then created StopAfib.org (part of the American Foundation for Women's Health), a clearinghouse for information on atrial fibrillation.
Atrial fibrillation, or A-fib, as it is commonly called, is the most common type of irregular heartbeat. Several million Americans currently have A-fib-and it's likely that many more have it without knowing it. According to the Mayo Clinic, the risk of A-fib increases with age, affecting about 5.1 million Americans and the numbers are rapidly increasing.
A-fib occurs when the electrical signals that trigger each heartbeat are disrupted, causing the atria (the heart's two upper chambers) to beat faster or quiver instead of contracting as in a normal heartbeat. As a result, blood pools in these chambers instead of being pumped onward. While this may sound benign, A-fib can lead to serious health problems, including…
- Stroke. A-fib causes a fivefold increase in stroke risk. Pooled blood in the atria can form blood clots like debris on the edges of a stag nant lake. Stroke occurs when a clot breaks off and blocks an artery leading to the brain.
- Congestive heart failure. Atrial fibrillation can cause the heart to work less efficiently If left untreated, this can lead to congestive heart failure.
Bottom line: If you think that A-fib can't kill you, you're wrong.
Symptoms
A-fib symptoms vary from person to person. Some of the most common include…
- Heart "skips" a few beats, then races.
- Erratic heartbeat.
- Dizziness and feeling light-headed.
- A feeling of having butterflies, a bag of wiggly worms or a fish flopping in the chest.
- Pressure in the chest or throat similar to a heart attack.
- A feeling of constriction around the left bicep.
Symptoms can last for a few minutes or days at a time (a condition known as paroxysmal, or intermittent, atrial fibrillation) but terminate on their own. In others, symptoms may continue for days, months or even years (a condition called persistent A-fib).
A-fib episodes can be scary. I was always worried about passing out and having a stroke, Since I had blood clots during my first episode, 1 carried a cell phone everywhere and was afraid to be alone or far from a hospital.
Helpful: Be alert to what might trigger an episode, for example, smoking, caffeine, alcohol, exercise and especially stress. Some believe even white flour, white sugar and food additives are triggers.
Diagnosis
The usual way to diagnose A-fib is with an electrocardiogram (ECG). For this test, electrodes are placed on the chest to record the heart's electrical activity. However, a regular EKG won't pick up intermittent A-fib unless you're having an episode at the time you're examined. In these cases, your doctor may recommend that you wear a Holter monitor-a portable EKG device that records all heart activity for up to 48 hours-or an event monitor that's worn for a few weeks, which you activate when you feel an A-fib episode occurring.
Medications
For A-fib patients, there are two treatment goals-to reduce blood clot risk and to control the heart rate or rhythm. Types of medication used to accomplish this…
- Blood-thinning (anticoagulant) medication—typically warfarin (Coumadin)—can lower the risk for a stroke-causing blood clot. These medications are considered critical for many with A-fib. Coumadin can be problematic for many people, as it was for me. For genetic reasons, I was never able to keep my blood viscosity in the normal range. Many people have a gene that makes it difficult to stabilize their blood on Coumadin.
- Rhythm control medication. These drugs, which include sodium channel blockers and potassium channel blockers, are used to restore the heart's normal rhythm. While the drugs help to control A-fib, they don't cure the underlying rhythm problem, and they lose effectiveness after a few years. Some are even toxic to various organs.
- Rate control medication. These drugs slow the heart rate by blocking some of the electrical signals in the atria. They also relax blood vessels. I took the beta-blocker metoprolol (Toprol XL) daily. It proved effective at stopping episodes once they started, so I carried pills with me wherever I went.
Talk to your doctor about finding the right combination of medications that work for you.
A procedure known as electrical cardioversion, in which the heart is given a jolt of electricity to "reset" its electrical signals, may also be used when a patient is having an event.
Self-Care
Identifying and avoiding your personal triggers may be effective in minimizing episodes. Supplements, such as magnesium, potassium and omega-3 fatty acids, have been found by some people to be helpful, although there is little scientific proof that they work.
Maintaining adequate hydration is also important. Dehydration can trigger A-fib and raise the risk for blood clots (it makes the blood more viscous).
A-fib is also correlated with sleep apnea. People with A-fib who have untreated sleep apnea are more likely to revert to A-fib after cardioversion. If you suspect that you have sleep apnea, get it diagnosed and treated.
Other Options
Many patients respond well to medication and/or electrical cardioversion. For some patients, however, A-fib comes back again because medications lose their effectiveness or never worked in the first place. For this group and for those who prefer not to take medication for the rest of their lives—two highly effective options may provide a permanent cure…
- Catheter ablation. A catheter is threaded into the heart through a vein in the leg or neck, and the energy in its tip is used to kill a small area of heart tissue. The dead tissue, known as a conduction block, stops the erratic electrical signals from reaching the heart. Although there is some risk of complication, this procedure has become safer at centers where it is performed often.
- Surgical ablation. An energy source is applied to the surface of the heart to create a conduction block. Called maze surgery, this was previously conducted only as open-heart surgery, but there is now also a minimally invasive version. I underwent the latter and it cured my A-fib completely—and gave me back my life.
