Modern treatments improve life with AFib

What gets your heart rate up?

An adrenaline rush when talking to your crush or engaging in strenuous physical activity can get your heart pumping faster. But what if you are at rest and your heart’s beating out of your chest?

A SILENT KILLER

A normal resting heart rate clocks between 60 and 100 beats per minute. A resting heart rate of 150 to 160 beats in a minute could be a sign of atrial fibrillation (AFib), which is the most common type of treated heart arrhythmia. Palpitations, fluttering and other irregular heartbeats are warning signs.

Easily being short of breath when climbing stairs or fatigue, experienced due to a fast heart rate, are identified as other common symptoms by Dr Jeremy Chow at the Asian Heart & Vascular Centre (AHVC).

The cardiologist says sports watches that track heart rates and pulse oximeters, which became prevalent during COVID-19, are useful tools to monitor heart rhythms. Any noticeable irregularities should be discussed with a general practitioner or a specialist.

Dr Chow’s colleague at the AHVC, Dr Chan Wan Xian, says: “The diagnosis is quite simple. It’s quite painless as well — we just need to do an ECG, or electrocardiogram.”

In an ECG, electrodes in the form of patches are stuck to the skin at chosen spots on the upper body to record the electrical activity of the heart. In some instances, an ambulatory ECG Holter monitor is used as a portable ECG recorder to make a diagnosis.

AFib has a reputation as a silent killer as it can also be asymptomatic. Without treatment, Dr Chan says, “it increases the risk of stroke by up to five times and heart-related death by up to two times”.

The echocardiologist adds: “If not treated properly, promptly, and if it persists, it can actually weaken the heart muscles and cause a condition called heart failure, where the heart can’t pump efficiently.”

GETTING TO THE HEART OF AFib

“When we manage a patient with irregular rhythm like atrial fibrillation, we want to treat two things; we want to first get the rhythm back to normal using ablation,” says Dr Chow.

Since October 2022, a safer and more effective ablation technique for managing the rhythm has been available in Singapore. Compared to thermal ablations, which use hot or cold energy to destroy tissue and pose a risk of internal injury, the latest non-thermal method of pulsed field ablation uses an electrical field to cause cardiac tissue death instead.

Dr Chow, who’s also an electrophysiologist, explains that ablation in general “creates isolation points so that electrical signals from the veins do not come into contact with the heart and cause erratic rhythm”.

Reducing the risk of a stroke is equally important and usually achieved through a left atrial appendage closure. Because the heart does not beat on a regular basis in the atrium, blood clots tend to form “within a small pouch in the heart called the appendage, which is like the appendix of the intestine”, says Dr Chow.

Closing off the appendage with a small plug prevents clots from entering the bloodstream and causing strokes.

MANAGING THE RISKS

Dr Chan observes that the chance of getting atrial fibrillation increases with age, typically afflicting those over 65 years old. “Patients with long-term medical conditions, like high blood pressure, obstructive sleep apnoea and pre-existing heart conditions, also have an increased risk.”

While not all the risk factors can be controlled, Dr Chow recommends maintaining an active lifestyle, reducing salt intake and going for health screenings that can detect diseases like atrial fibrillation if you’re above 40 years old, “so that it does not progress to the full-blown condition, which sometimes may be harder to treat or cure”.

Produced in partnership with Asian Heart & Vascular Centre.