Mater Private, Cork: Treating matters of the heart

Atrial fibrillation is a relatively common condition where the upper chambers of the heart have an irregular, often rapid rhythm which can, if left untreated, lead to stroke or heart failure.

Atrial fibrillation is more common in men than women and rates in the population increases with age. Overall, the lifetime risk of atrial fibrillation has been estimated to be one in five of the population.

Are you that one in five? Have you concerns about an irregular heartbeat?

Atrial fibrillation can be classified under three categories, depending on the duration of symptoms.

1. Paroxysmal atrial fibrillation is self-limiting, lasting relatively short periods, usually stopping within 48 hours

2. Persistent atrial fibrillation: if an episode lasts longer than seven days or requires termination by cardioversion, either with drugs or by direct current cardioversion where the heart is given a small electrical therapy while the patient is under sedation.

3. Long-standing persistent atrial fibrillation: if it is present for a year or more.

Usually people progress from paroxysmal to persistent to long-standing. The time frames can vary.

The risk of stroke varies from less than 1% per year to up to 20% a year. It is important to determine the risk of stroke in each individual and tailor therapy accordingly.

If you have atrial fibrillation your risk of stroke can be easily determined using the ‘CHADS-Vasc’ Score.

The risk of stroke is based on a simple calculation, depending on age, gender and other conditions.

It is easy to remember and the higher you score the greater the risk, your GP can help assess your risk.

C: Congestive heart failure

H: Hypertension (high blood pressure).

A: Age.

D: Diabetes.

S: History of stroke or mini stroke.

VAsc: Presence of vascular disease — hardening of the arteries of the leg, neck or heart.

Treatment of atrial fibrillation

There are two very important aspects to treatment: stroke prevention and treatment of heart rhythm.

A drug called Warfarin will thin the blood and decrease the risk of stroke by up to 80%. However, it is important to check how thin the blood is as Warfarin interacts with medications, food and alcohol.

You may need more frequent tests, but over time these tests will be less frequent and there are now a number of new anticoagulants (blood thinners) on the market. They have been licensed after extensive research in a large number of people worldwide.

Get better, get the best

Atrial fibrillation ablation has emerged as an alternative to pharmacological therapy for the treatment of atrial fibrillation over the past two decades.

Pioneered by Prof Michel Haissaguerre and his group, the technique of atrial fibrillation ablation has improved over time and involves energy directed to heart tissue to destroy abnormal electrical pathways that are contributing to the atrial fibrillation.

The electrode is situated at the tip of a catheter — known as an ablator — and directed into the heart by myself, usually through a vein.

I first map an area of the heart to locate the abnormal electrical activity before the area responsible for generating the abnormal rhythm is destroyed. It can take more than one session to destroy completely the area responsible for the irregular rhythm.

* Mahesh Pauriah graduated from the University of Newcastle with distinction and trained in general medicine at Cambridge University Hospital and later specialised in cardiology training in Merseyside and Dundee. In 2010, he began his sub-speciality training in electro- physiology.

He joined the Mater Private Cork full-time in 2015 and leads the electrophysiological programme which includes the management of atrial fibrillation.

See: www.materprivate/cork