AF: An Abnormal Heart Rhythm
What Is AF?
Atrial fibrillation (AF) is the most common heart arrhythmia in Western countries and occurs mostly in the elderly. AF produces a rapid and irregular heartbeat, during which the atria (the upper two chambers of the heart that receive blood) quiver, or fibrillate, instead of beating normally.
Because the rapid and irregular heartbeat produced by AF cannot pump blood out of the heart efficiently, blood tends to pool in the heart chambers. This increases the risk of blood clot formation inside the heart, which can then travel from the heart into the bloodstream. If the clot becomes lodged in an artery, it can cause a pulmonary embolism (a sudden blockage of a lung artery) or a stroke.
The mean age for AF diagnosis in men was 66.8 years versus 74.6 years for women. Data from a California health plan suggest that compared with whites - blacks, Asians and Hispanics have significantly lower prevalences of AF.
Risk Factors
Diet
A pacemaker catheter that has been passed through the vein in the groin
Obesity
Bedrest
Family history (having at least one parent with AF)
Fractures in the pelvis or legs
Giving birth within the last 6 months
Recent surgery (most commonly hip, knee, or female pelvic surgery)
Advancing age
European ancestry
Body size (greater height and BMI)
Left ventricular hypertrophy
Left atrial enlargement
Diabetes
Hypertension (high blood pressure) or treatment of hypertension
Presence of CVD (cardiovascular disease)
Hyperthyroidism
CKD (chronic kidney disease)
Heavy alcohol consumption
Data has suggested that moderate-intensity exercise (such as regular walking) was associated with a lower risk of AF. However, data from many studies suggested that vigorous-intensity exercise 5 to 7 days a week was associated with a slightly increased risk of AF.
A study of over 4600 patients diagnosed with AF showed that risk of death within the first 4 months after the AF diagnosis was high. AF is also associated with mortality in individuals with other cardiovascular conditions and procedures, including HF (heart failure), MI (heart attack), CABG (Coronary Artery Bypass Graft Surgery ), noncardiac surgery, stroke and sepsis (a life-threatening illness that can occur when the whole body reacts to an infection).
When standard stroke risk factors were accounted for, AF was associated with a 4- to 5-fold increased risk of ischemic stroke.
Individuals with AF have an adjusted 2-fold increased risk of dementia.
AF and HF (heart failure) share many risk factors and 40% of individuals with either AF or HF will develop the other condition.
Symptoms
Atrial fibrillation often causes no symptoms at all. When symptoms do occur, there may be palpitations (awareness of a rapid heartbeat), fainting, dizziness, weakness, shortness of breath and angina pectoris (chest pain caused by a reduced blood supply to the heart muscle). Some individuals with atrial fibrillation have periods of completely normal heartbeats.
Standard Treatments
Initial treatment focuses on finding and treating the underlying cause of atrial fibrillation. The majority of cases are caused by coronary artery disease and treatment may consist of lifestyle changes, medications that treat high blood cholesterol and hypertension and/or procedures such as angioplasty and coronary artery bypass surgery.
Atrial fibrillation due to thyrotoxicosis (an overactive thyroid gland) can be treated with medications or surgery, while fibrillation due to rheumatic heart disease may be treated by replacing damaged heart valves.
The arrhythmia (irregular heart rate) of atrial fibrillation can be treated with medications, such as diltiazem hydrochloride, digoxin or verapamil, which work to slow the heart rate. Another treatment option is electrical cardioversion, a procedure that delivers an electrical “shock” to the heart to restore normal heart rhythm. Although this procedure is effective in most cases, the rate of recurrence is high, and 50 to 75 percent of patients eventually develop atrial fibrillation again.
When medications are ineffective, catheter radiofrequency ablation or minimally invasive surgical ablation can sometimes be performed. In these procedures, an area of tissue in the atrioventricular node is destroyed to prevent the passage of excess electrical impulses from the atria to the ventricles. The result is often complete blockage of all electrical impulses. A pacemaker is then implanted to control the heart rate and rhythm.
In addition to the treatments described above, individuals with atrial fibrillation are often given medications to prevent blood clots that can lead to stroke, pulmonary embolism and other complications. Treatment usually consists of anticoagulant medications (blood thinners), such as aspirin and warfarin.
Conservative Treatments
According to many studies, the underlying cause of most cases of atrial fibrillation is closure of the small arteries to the heart muscle, due to the Western diet and lifestyle.
There are many controversies surrounding the proper treatment of people with atrial fibrillation. Digoxin is an inexpensive, highly effective, relatively safe, time-honored, generic medication. With the introduction of expensive beta-blockers and calcium antagonists over the past four decades, doctors were told digoxin was inferior for the treatment of atrial fibrillation. But, based on the research, digoxin is the drug of choice for this common condition.
When the heart rate is already normal or slow, there is no need for any medication to regulate the heart rate. In most cases, when rate control is needed, digoxin is prescribed first to slow the heartbeat. If this medication alone is inadequate, then a beta-blocker medication can be added. Calcium channel blockers are more dangerous and are not used in this method of treatment.
Conservative treatment does not usually recommend “cardioversion” with drugs or electric shocks to the heart because research shows this aggressive approach gives results that, at best, temporarily restore normal (sinus) rhythm, and there are significant risks and side effects from cardioversion. The vast majority of the published research papers recommend medications to control the heart rate, rather than cardioversion.
Because people with atrial fibrillation also have an increased risk of forming a blood clot in their heart, which can move to their brain and cause a stroke, the powerful blood thinner, Coumadin (warfarin) is prescribed. The most important complication of this treatment is bleeding; therefore, people with atrial fibrillation who are otherwise healthy, should not routinely be given Coumadin; for many, a baby aspirin daily may be a better choice.
In addition to the judicious use of medications, a healthy low-fat plant-based diet is prescribed for someone with this condition in order to improve the overall health and reduce the risk for strokes and heart attacks. In most cases, once the rhythm of atrial fibrillation occurs it is permanent and a change in diet will not convert atrial fibrillation to normal; it will only lower the risk of further heart damage or stroke.
Dr. Caldwell Esselstyn says, "While A Fib is largely independent of nutrition, and is a heart rhythm abnormality, there are some subset of cases which are presumably related to less than optimal heart circulation. While it would be totally inappropriate for me to suggest plant - based nutrition would cure atrial fibrillation, the many ancillary benefits would indicate plant based nutrition would be of value."
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