Nothing is more important than your health and it’s normal to have lots of questions when you receive a diagnosis of a condition such as atrial fibrillation (AFib or AF). It’s not always easy to think of everything you want to ask when you are sitting across from your doctor, so here is a list of questions for you to download and review before your next appointment – select those that you would like to talk to your doctor about and add any of your own. We’ve also listed and answered here some of the most common general questions people ask about AFib and its treatment.
Questions about the treatment of Atrial fibrillation (AFib)
AFib occurs when abnormal electrical signals disrupt your regular heartbeat –your heart loses its rhythm and starts to beat irregularly or too fast. This reduces your heart’s ability to pump blood efficiently around your body. Read more about AFib here.
Symptoms of AFib vary from person to person but most commonly include:1, 2
- Irregular heartbeat (palpitations, pounding or racing)
- Shortness of breath
- Tiredness or a general feeling of being unwell
- Chest discomfort or pain
- Dizziness or fainting
Some people with AFib do not experience any symptoms. In ‘silent’ cases like this, AFib might be picked up in a standard health check or when looking at another health issue.
The risk of AFib increases with age and can be caused by a variety of factors that can cause damage to the heart.1,2 These include:
- High blood pressure
- Existing heart conditions, such as:
− Coronary artery disease (narrowed or blocked arteries)
− Previous heart attack or heart surgery
− Faulty heart valves
− Congenital (inherited) heart defect
− A problem with the natural pacemaker in the heart (the sinoatrial node) - Type 2 diabetes
- Overactive thyroid gland
- Sleep apnoea (when your breathing stops and starts while you are asleep)
- Lifestyle factors, including:
- Obesity (being overweight)
- Excessive alcohol consumption
- Physical inactivity
- Smoking
In a healthy heart, organised pathways of electrical signals produce a steady rhythm, so your heart contracts to pump blood from the top to the bottom of the heart and then around the body. These regular beats are controlled by the sinoatrial (SA) node, which acts as the heart's natural pacemaker. During AFib, abnormal signals completely disrupt the organised pathways and the controlled pace of your heartbeat. These disruptive signals are often initiated outside the heart but get transmitted into the left atrium of the heart via the pulmonary veins.
Because AFib reduces your heart's ability to pump as it should, blood may not be cleared out of the heart efficiently. If blood is not kept moving by the circulation process, there may be a risk of it pooling and stagnating − most often in a part of the heart called the left atrial appendage (LAAC). This blood has the potential to form a blood clot, which could then be pumped out of the heart and travel to the brain, causing a stroke.
A variety of treatment options are available for AFib. Some treatments focus on managing your heartbeat's rhythm (regularity) and rate (pace), while others focus on the managing the risk of stroke. Your doctor will recommend you a tailored treatment that fits your specific condition. Read more about management options for AFib here.
Following a healthy lifestyle can have a positive impact on the health of your heart and reduce your risk of stroke1, 2:
- Eat a healthy diet and maintain a healthy weight
- Exercise regularly
- Stop smoking
- Restrict/eliminate alcohol and caffeine
For more information on what you can do to improve your heart health and overall well-being, download our guide to healthy living here.
Questions about lifestyle modifications
Maintain a healthy weight, eat a healthy diet, exercise regularly, decrease stress where possible, quit smoking, monitor your blood pressure and cholesterol, stay hydrated, limit over the counter medications and follow your treatment plan as prescribed by your doctor.
Questions about medications
Your healthcare provider may consider treating your atrial fibrillation with medicines that help prevent blood clots from forming and medicines that work by slowing your heart rate or by restoring your heart’s normal rhythm. We encourage you to discuss with your Doctor for further information.
These medications help control the heart rate, ensuring it doesn't beat too fast. While they don't correct the irregular rhythm of AFib, they help reduce symptoms and improve heart function.
Antiarrhythmic medications are used to prevent and reduce the amount of AF episode a person experiences and helps the heart rhythm to return to normal rhythm following an AF episode.
Anticoagulants reduce the ability of your blood to form clots.
Questions about cardiac ablation
Cardiac ablation deactivates or "neutralises" locations in the heart responsible for transmitting the abnormal electrical signals that cause AF. It's a minimally invasive procedure performed by inserting long thin tubes called catheters through a small incision in your groin and advancing them through your blood vessels into your heart. Your specialist (cardiologist or electrophysiologist) monitors on screens the precise position of the catheters inside your vessels and your heart. Once in position, energy is delivered through a catheter to neutralise the target cardiac tissue, so it can no longer transmit electrical signals.
Cardiac ablation relies on energy being delivered to the target tissue to neutralise it. This energy can be:
- Thermal (temperature-based):
- Radiofrequency ablation (RFA) uses extreme heat
- Cryoablation uses extreme cold
- Non-Thermal:
- Pulsed Field Ablation (PFA): uses high-energy electrical pulses to neutralise the target tissue.
Before the procedure, you will undergo a thorough evaluation which may include blood tests, electrocardiogram (ECG), echocardiogram, and possibly a cardiac MRI or CT scan to assess your heart's structure and function. Your doctor may adjust your medications before the procedure. You may also need to fast for several hours prior to the procedure.
You will receive local anesthesia and possibly sedation to help you relax during the procedure. General anesthesia is may be required. A catheter is inserted into a blood vessel for access to the heart. Specialised catheters are guided through the blood vessels and into the heart chambers using imaging techniques such as fluoroscopy (X-ray) and sometimes 3D mapping systems to create a detailed map of your heart's electrical activity. Once the abnormal electrical signals causing AF are identified, the catheter tip delivers either high energy electric pulses (pulsed field ablation), heat (radiofrequency energy) or extreme cold (cryoablation) to create small scars or lesions on the heart tissue. This disrupts the abnormal electrical pathways. Throughout the procedure, your heart's electrical activity and other vital signs are closely monitored to ensure the effectiveness of the ablation and to detect any complications.
After the procedure, you will be taken to a recovery area where you will be monitored closely for several hours. After the procedure, you will be taken to a recovery area where you will be monitored closely for several hours. Depending on your individual health circumstances and what type of ablation you have, hospital stay can range from same day discharge to overnight to a few days. Your healthcare team will discuss this further once treatment options have been decided.
You may need to continue taking medications to control your heart rhythm or prevent blood clots after the procedure. Your doctor will provide specific instructions based on your individual situation.
Regular follow-up appointments with your cardiologist or electrophysiologist will be scheduled to monitor your heart rhythm and make any necessary adjustments to your treatment plan. It’s important to discuss any concerns or questions you have with your healthcare team before and after the procedure to ensure you have a clear understanding of what to expect and how to care for yourself during recovery.
Questions about left atrial appendage closure
Some people with atrial fibrillation (AF or AFib) at high risk of stroke who should take oral anticoagulants may be unable to do so due to contraindications including associated risks, side effects or medical reasons that could also result in a high risk for bleedings. A left atrial appendage closure (LAAC) is a minimally-invasive procedure where a device designed to block off the LAAC is inserted to permanently close off the left atrial appendage.
The device is designed to close the left atrial appendage (which is known to be the main source of blood clots in patients with AFib), preventing the migration of the blood clots to the brain. The LAAC Implant fits into your LAA. It’s designed to permanently close it off and keep those blood clots from escaping. The device is about the size of a coin and made from very light and compact materials commonly used in many other medical implants.
To implant the LAAC device, your doctor makes a small cut in your upper leg and inserts a narrow tube, as done in a standard stent procedure. Your doctor then guides it into the left atrial appendage (LAA) of your heart. The procedure is done under general anesthesia or conscious sedation and takes about an hour.
After the LAAC procedure, patients usually stay in the hospital for one or two days for follow-up. Your doctor will assess your individual characteristics and conditions and will decide which is the best post implant drug regimen for you to have your LAA permanently closed off. They may prescribe you dual antiplatelet therapy (DAPT), novel oral anticoagulants (NOACs) or warfarin, along with aspirin. During this time, heart tissue will grow over the implant to form a barrier against blood clots. Your doctor will monitor this process by taking pictures of your heart to see when you can stop taking medications. Many doctors require follow up appointments over the next year to ensure your recovery is going well.
Questions about pacemakers
A pacemaker is an implanted device designed to monitor and treat an abnormal heart rhythm.
Most pacemakers are small machines with two parts:
- A small, metal battery-operated computer sometimes called a Pulse Generator that is typically implanted in the into soft tissue beneath the skin in the chest.
- Wires (leads/electrodes) that are implanted in your heart and connected to the Pulse Generator.
If the chambers of your heart don’t contract often enough to supply enough blood, your body doesn’t get enough oxygen and nutrients to function properly. As a result, you may feel tired or dizzy, have shortness of breath or have fainting spells. A pacemaker stimulates your heart with electrical impulses to restore a normal rhythm.
The pacemaker continuously monitors your heartbeat and delivers electrical energy (as programmed by your physician) to pace your heart if it’s beating too slowly.
Your pacemaker also stores information about your heart. This allows your doctor to better evaluate the therapy and adjust your pacemaker settings, if necessary.
Implanting a pacemaker system requires a minor procedure in the upper chest, under the skin. Most people go home within 24 hours. You may be asked not to eat or drink anything for a period of time before your procedure. Your doctor will advise which medications to stop or start taking before your procedure and for how long. Wear comfortable clothes to your procedure with a possible change to wear home. Your doctor will give you specific instructions on all aspects of the procedure in preparation.
For the implantation, you will be sedated. Your doctor will insert a lead in a vein near your collarbone using a small incision. The lead is passed through the vein to the heart where your pacemaker is inserted beneath the skin. Before closing the incision, your doctor tests the pacemaker to ensure it is working properly.
Using wireless technology, your doctor can check your pacemaker remotely for easy and convenient follow-up visits. Remote monitoring and technology makes health care more seamless, but you will need to see your doctor in-person for certain types of care. Your doctor will discuss all aspects of post care with you upon discharge from the hospital.
Questions about cardioversion
Cardioversion is a medical procedure used to restore a normal heart rhythm in individuals with abnormal heartbeats (arrhythmias), such as atrial fibrillation (AFib or AF).
There are two types of cardioversion:
Electrical cardioversion: this involves delivering a controlled electrical shock to the heart through paddles or patches placed on the chest. The shock helps reset the heart's rhythm to normal and is usually performed under sedation to ensure the patient does not feel pain.
Pharmacological (chemical) cardioversion: medications known as antiarrhythmics are administered orally or intravenously to help restore a normal heart rhythm. This method is typically used when electrical cardioversion is not necessary.
Cardioversion is recommended for individuals with arrhythmias such as:
- Atrial fibrillation (AFib): the most common reason for cardioversion.
- Atrial flutter: a rhythm disorder similar to AFib.
Cardioversion is generally a scheduled procedure, but can also be performed in an emergency if the arrhythmia is causing severe symptoms. It is different from defibrillation, which is used in life-threatening cardiac arrest situations.
Your healthcare professional will discuss all pre-procedural requirements. These may include fasting, stopping blood thinners for a period of time and some tests.
Patients usually wake up within minutes if sedated for electrical cardioversion. Your heart rhythm is monitored for a short time before going home. Some people may feel tired or sore for a day or two. Blood thinners and medications to maintain a normal rhythm (like beta-blockers or antiarrhythmics) may be prescribed.
