The human heart holds a special place in anatomy, physiology, literature and culture. To give someone “a place in one’s heart” is regarded as the ultimate gesture of supreme trust and eternal love. Our constantly beating companion holds a place of honour in the greatest literary works, wherein countless odes have been written about it – from the time when some smart ancestor decided to relate the feelings of love and passion to the heart.

We have always been in touch with our heart probably more than most other organs in our body. Maybe because every moment of our lives we hear and feel this magnificent organ beating. We rest assured in the thought that as long as our heart is beating perfectly, we are safe and secure. Sometimes, the heart just doesn’t beat the way it should. In some it may beat with a slight murmur, in others it might beat irregularly. A common condition – Atrial fibrillation (AF or AFib) – is the most common type of arrhythmia (irregular heartbeat), affecting 1-1.5% of the population [1]. As the name suggests, this condition is caused due to a malfunction in the atria (upper chambers of your heart).

Age is an important factor in this condition. Patients of AF in the western world are between 55 to 64 years, while in India, the condition is diagnosed in patients at least 10 to 12 years younger than their Western counterparts [2].

What Causes AF?

Normally, the two portions of your heart, atria (upper) and ventricles (lower), work in coordination to pump blood. When the electrical system that controls this has a slight glitch, the atria experience chaotic electrical signals and they “quiver.” This is when you feel you feel a “flutter” in the heart. Doctors call this “fluttering” atrial fibrillation. Due to this, your heart is not able to function optimally. So, the blood does not circulate properly and can accumulate in your heart and develop clots.

Your age, family history, other heart ailments, heart surgery, concomitant diseases like diabetes, blood pressure, chronic kidney disease, cancer, obesity or viral infections, certain types of medicines like steroids and finally your lifestyle, all determine whether or not you will get an AF [3].

Symptoms: What should I keep a lookout for?

AF causes your heart to beat faster than usual, that you may describe as ‘pounding,’ ‘racing’ or ‘skipping of a heartbeat.’ This usually lasts for a few minutes. Apart from these, you may feel physical symptoms such as chest pain, abdominal pain, light-headedness, dizziness, fatigue, weakness, shortness of breath or even confusion.

AF is of different types. The duration of the symptoms is dependent on the type that has occurred. It may last for 7 days or less (paroxysmal fibrillation), 7 days or more (persistent fibrillation), more than 12 months (long-standing persistent) or exist as permanent fibrillation.

How can I prevent it? What precautions can I take?

Small changes in lifestyle can definitely lower the risk of AF and even prevent it. Adopting a routine to keep your heart healthy is the key. Eating a well- balanced diet that is low in salt, cholesterol and trans- fat and rich in whole grains, accompanied by adequate fruits and vegetables, exercising well, maintaining a healthy weight, keeping away from alcohol, avoiding smoking and minimizing stress are good ways to keep your heart healthy.

How is it diagnosed?

Diagnosis of AF requires you to report your symptoms to your doctor as soon as they occur. He or she may, in turn, direct you to an Electrophysiologist, a cardiologist who specializes in arrhythmias. To obtain correct diagnosis, the doctor will take your family and medical history, perform a physical examination to check for abnormalities in the heart, carry out tests to check your heart activity, perform blood tests and take a chest X-ray.  

What are my treatment options?

Treatment of AF is directed towards the following:

1. Rate control: Doctors prescribe certain medicines, alone or in combination, to slow down the heart rate.
2. Rhythm control: This can be achieved through medication or procedures called cardioversion (sending low-energy signals into your heart) or ablation (creating scar tissue in the heart). They are performed under anaesthesia.
3. Blood thinners or anticoagulants: These medicines are prescribed to people with AF who are at an increased risk for stroke. They prevent the formation of clots and help avoid stroke. Patients taking anticoagulants have to be careful of injuries as clotting of blood is difficult.
4. Others: The doctor will also treat concurrent diseases such as diabetes, blood pressure and suggest lifestyle changes to reduce the risks.

Is it written in my genes?

Many answers to the unsolved questions lie in our genetic make-up. As it turns out, an early onset, (before the age of 60) of lone AF (i.e. occurrence of AF without a history of heart disease) is a heritable condition, with higher risks associated in individuals with a family history, first- degree relatives and if it runs in the family, affecting many members [4].

A lot of genetic variants have been associated with an increased risk of AF. The 4q25 region remains the most replicated locus, across multiple studies [5]. An individual’s risk may increase up to 7-fold. Modification in the atria muscles and changes in the electrical potential conduction of heart muscles have been postulated as potential mechanisms causing the elevated risk in variant carriers.

A deeper understanding of the impact of genetic variants on biological pathways is underway. This will not only improve our understanding of the inheritable characters of the disease, but also allow rhythm or rate-control targeted therapy.

An overall assessment of family history, clinical indications, presence/absence of genetic risk factors, etc is ideal for determining whether or not one is at greater risk than the average individual. Genetic tests are effective tools, which can be placed in preventive wellness strategies (Genomepatri) or for confirming clinical diagnosis.

September is AF Awareness Month!

September was declared as AF awareness month by the US Senate on September 9, 2011. StopAfib.org, a ‘nonprofit patient advocacy organization and website’ was started by Mellanie True Hills to spread information and awareness about the condition among patients as well as doctors. She, along with other organizations, led by the American Heart Association officiated September as the AF awareness month. Being a patient of AF herself and then celebrating 6 AF-free years motivated her to tell her story and work towards spreading awareness. Her organization has helped countless patients and doctors understand the condition and treatments better. She still continues to work through her blog and organization [6].

We can never be sure of what the future holds for us. But, we can certainly make appropriate adjustments towards leading a healthy, active, happy and stress-free life. Genetic predisposition or not, a positive attitude and a healthy routine can keep you safe for a long time! Remember – a Happy Heart means a Happy You!

References:

1. Modi SK and Modi R. Atrial Fibrillation in India: Is it a Tide Rising or a Tsunami? Austin Journal of Cardiovascular Disease and Atherosclerosis 2017; 4(1): 1030-1032.
2. Raja DC and Kapoor A. Epidemiology of Atrial Fibrillation – An Indian Perspective. Supplement to Journal of The Association of Physicians of India 2016.
3. Saumitra Ray, Amitava Mazumdar. Management of Atrial Fibrillation in Indian Scenario.
4. Øyen N et al. Familial Aggregation of Lone Atrial Fibrillation in Young Persons. Journal of the American College of Cardiology 2012; 60(10): 917-921.
5. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal 2016. (doi:10.1093/eurheartj/ehw210)