At Home Christian Jessen 2014 - 73

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heart, the atria, become chaotic and the heart
beats rapidly and irregularly. The atria stop
pumping blood, which can pool, increasing
the chance of forming a clot. Clots can travel
to the brain and cause a stroke - a 'brain
attack' where the blood and oxygen supply
to an area of the brain is blocked.
Anyone can get AF from teenagers onwards,
but it is more common as you get older and
particularly if you have high blood pressure or
other heart problems. It is estimated to affect
more than one million people in the UK. Alcohol
binges can bring on an attack and drinking too
much can increase the risk of getting AF. Other
common triggers include caffeine, tiredness and
stress, but AF can also happen for no obvious
reason or even when you're asleep.

How do I know if I have AF?

If you have an attack of AF you will usually feel
your heart racing very rapidly (palpitations),
feel breathless and/or dizzy. In extreme cases,
you can even pass out. But symptoms can
be much milder in some people and, most
frighteningly of all, it doesn't cause any
symptoms in up to a quarter of people and can
therefore go unnoticed before it leads to a
stroke. The simplest way to check for AF is to
feel your pulse at your wrist. If it is not beating
regularly, like a clock, or is beating very fast,
you should get it checked by your doctor.

How is AF treated and what
is an ablation procedure?

Fortunately, AF can be cured if it is not left
too long before being detected. Initially, your
doctor should see if you need blood thinning
medications to help prevent a stroke and drugs
to control AF attacks or to slow down heart
rate. If this initial treatment doesn't stop the AF
or causes unpleasant side-effects, your doctor

An AF ablation catheter

'Fortunately, aF
can be cured iF
it is not leFt
too long beFore
being detected'
should refer you to a specialist, like Dr Segal,
immediately. Heart rhythm specialists, or
electrophysiologists, perform a procedure
called ablation to cure atrial fibrillation. It is
a 'keyhole' procedure using fine wires inserted
through the vein at the top of the right leg. The
wires feed into the heart and are used to cauterise
tissue inside the heart to stop AF from happening.
It can be performed with or without a general
anaesthetic and usually takes two to three hours.
AF can be cured after just one ablation, but
about half of people require a second procedure,
especially if you have had AF for a long time or
you have other heart problems. The commonest
complications are bruising or injury to the vein
at the top of the leg or less commonly making a
small hole in the heart requiring a temporary
drain. Serious complications such as needing
surgery, stroke or death are rare (occurring in
less than one in 100 procedures). You only need
one night in hospital and can resume normal
exercise about five to seven days afterwards.
Ablation can be repeated if needed.

Other treatments for AF

If medications don't work, or you can't tolerate
them, and if your specialist doesn't think you're
suitable for AF ablation, they may decide to
implant a pacemaker and then perform a
procedure called AV node ablation. This is
also called 'pace and ablate'.

The Watchman device

Pacemakers stop the heart from beating too
slowly. Once implanted, the specialist then
ablates the connection between the top and
bottom chambers of the heart - the AV node.
This leaves the top chambers still fibrillating but
the bottom chambers beat regularly as they are
now controlled by the pacemaker. This ablation
is very simple and safe, with virtually no risks,
but it leaves the top chambers in AF and
therefore the heart is less efficient than when in
normal rhythm. This approach is irreversible and
is most often reserved for more elderly people.

What if I can't take blood
thinning drugs?

Some people can't tolerate blood thinning
drugs to help prevent strokes because of
side-effects or because they cause bleeding.
Common places where bleeding can happen
are from your nose, your bowel or, most
dangerously, your brain.
If you are at increased risk of stroke due to
AF but you bleed when you start blood thinning
drugs (or your doctors think these drugs are too
risky), these drugs are best avoided. Until fairly
recently there was no other option to reduce the
risk of AF-related stroke, but a few years ago
doctors such as Dr Segal started to implant
devices into the chamber of the heart where
most blood clots form. These umbrella-like
devices are inserted using a 'keyhole' technique
into what is called the left atrial appendage.
The Watchman device, one type of these
devices, has now been shown to be better than
drugs at reducing future risk of stroke. The
procedure is done under general anaesthetic.

FOR MORE INFORMATION
Visit www.oliversegal.com and
www.londonheartrhythmcentre.com
Practice manager Alexis Coward
Appointments 020 7034 8278.
Email alexis.coward@hcahealthcare.co.uk
Blog www.oliversegal.com/category/blog/
Twitter @DrOliverSegal
http://www.oliversegal.com http://www.londonheartrhythmcentre.com http://www.oliversegal.com/category/blog/
At Home Christian Jessen 2014

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