Atrial fibrillation – “If it’s good enough for Tony Blair”

February 2nd, 2006

The National Institute of Clinical Excellence (NICE) is currently in consultation in connection with best advice for treatment of Atrial Fibrillation. Health care professionals in the NHS are expected to follow NICE clinical guidelines.

What Is Atrial Fibrillation?

Atrial Fibrillation is a condition that affects the heart. It occurs when the electrical impulses that usually make the heart beat regularly become disorganised. This causes the Atria (the two upper parts – or chambers – of the heart) to beat unevenly and rapidly. When this happens, the heart cannot efficiently pump blood around the body and this may cause blood clots to form. Other similar conditions include Atrial flutter otherwise known as cardiac arrhythmias.

Without treatment, Atrial Fibrillation can become serious in that it can occasionally cause breathlessness, chest pain and cause people to become faint and lose consciousness. It can in those circumstances be a life threatening condition.

It significantly carries a risk of blood clots. It is important that appropriate medication is provided to prevent the development of blood clots which in themselves can cause strokes.

Symptoms

Atrial Fibrillation occurs suddenly and may result in palpitations or sometimes chest pain. Atrial Fibrillation can last for different periods of time. Generally, if it lasts for more than a year it is termed Permanent Atrial Fibrillation. More than seven days it is termed Persistent Atrial Fibrillation. If it occurs but stops within forty eight hours it is termed Paroxysmal Atrial Fibrillation. There are other conditions such as acute onset or postoperative Atrial Fibrillation.

Each one of these should be treated independently and specifically following discussion with the health care provider.

Certain people are at increased risk of developing Atrial Fibrillation including those suffering from infection, particularly pneumonia, those who drink excessive amounts of alcohol, those who have suffered pulmonary embolism, those who suffer from over active thyroid or those who have existing lung cancer.

Treatment

It is extremely important that the correct treatment is provided to those suffering from the relevant Atrial Fibrillation condition. The treatment is either by way of medicine (pharmacological treatment) or surgery in the form of electrical cardioversion (that Mr Blair had).

The purpose of all treatment is to try and regulate both the rate and rhythm of the heartbeat.

The treatment of Persistent Atrial Fibrillation involves the prevention of blood clots and this may require regular treatment with anti coagulant such as warfarin or heparin (occasionally aspirin although this may not be sufficient).

Other drugs may be additionally required to control the rhythm of the heart (such as amiodarone and flecainide) but these are also know to have some side effects.

Permanent Atrial Fibrillation will have to be similarly treated with a view to preventing blood clots but there will also be significant need to reduce the heart rate by treatment with beta-blockers and calcium-channel blockers.

The NICE guidelines make specific recommendations about which types of medicine are most appropriate in all of the circumstances that may apply.

The important point is that the risk of blood clots should not be under estimated. There is some concern that treatment with aspirin as opposed to true anticoagulant or beta-blockers/calcium-channel blocker treatments are more widespread and inappropriate.

It is also important to note that follow-up is essential in order to ensure that effective treatment is being provided and that the blood clotting factors are under control.

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