15 questions about palpitations

1. What is atrial fibrillation?

It is a heart rhythm disorder in which the atria of the heart contract rapidly and uncontrollably. The heart rate can rise to 150 to 200 beats per minute, twice as much as normal. The heart consists of four cavities: two atria (or atria) and two chambers (or ventricles). At the top of the heart is the sinus node: the heart’s power station. It sends electrical impulses through the heart, causing the atria to contract first and the ventricles a fraction of a second later. This ensures that the blood is pumped around the heart – and the rest of the body.

In atrial fibrillation, there is not one, but dozens of electrical stimuli that move independently of each other through the atria. Instead of contracting at the same time in a neat rhythm, they just vibrate. As a result of that chaos, the heart chambers are also disrupted.

2. What do you notice about that?

Many patients – but not all – suffer from intense heart palpitations and a feeling of rush. Dizziness, fatigue and shortness of breath also occur. That can be frightening, especially since an attack of atrial fibrillation often comes unexpectedly. Patients sometimes suffer the most from this fear. For example, they no longer dare to exercise or go on holiday for fear that something will go wrong with their heart and they will not get help in time.

3. Are the complaints continuous?

It usually starts as an attack: the complaints arise and disappear on their own. Sometimes such an attack lasts a few minutes, sometimes an hour or a day. Over time, the attacks come back more often and/or last longer. Ultimately, atrial fibrillation can become chronic and there is a constant disturbed and accelerated heart rhythm.

4. Who are most affected by it?

Three quarters of the patients are over 65 years of age. 1 in 100 people in their forties suffer from it. In people aged 65 that is 1 in 20 and in people aged 80 even 1 in 10. In total, about 300,000 Dutch people suffer from atrial fibrillation.

5. Is it dangerous?

No and yes. No matter how fast and irregular the heartbeat is, the chambers of the heart continue to do their job. In that sense it is harmless. But because the blood flows less well through the heart during atrial fibrillation, blood clots can form. These can end up in the brain and cause a stroke. Blood clots can also cause problems in other places, for example in the intestines or kidneys. To prevent this, many patients take anticoagulants, so-called coumarins or vitamin K antagonists. They lower the risk of a stroke by 60 to 80 percent.

Difficult is that the levels of the drug in the blood can fluctuate, for example by eating products with high concentrations of vitamin K, such as green vegetables and cheese. Because the amount of medication must be adjusted accordingly, patients must have their blood values ​​checked at the thrombosis service every two to three weeks. Incidentally, the risk of blood clots differs from patient to patient. Not everyone needs anticoagulants.

6. When is it wise to go to the doctor?

If you have had a racing heart more than twice or if a first attack lasts longer than two days. So even if the complaints have gone away on their own. Because of the increased risk of stroke, it is important that atrial fibrillation is detected early – drugs can then be given to prevent it. In addition, the quality of life often improves significantly with the right treatment. Older people often think that the complaints are part of their age and that there is no point in going to the doctor. But they too can often be helped.

7. How does it come about?

The most common causes are underlying heart problems, arteriosclerosis, high blood pressure and an overactive thyroid. Often it is also a matter of wear and tear on the heart. Fanatic athletes have a higher risk of atrial fibrillation because of the strain on their heart. Seriously overweight, smoking and a lot of alcohol also increase the risk.

8. Can you get atrial fibrillation from coffee or alcohol?

It is almost never the only cause, but alcohol and coffee can cause an attack of atrial fibrillation or make symptoms worse. Like a substance in Chinese food, ve-tsin.

9. Is it hereditary?

There are rare hereditary variants of atrial fibrillation. They usually reveal themselves at a young age. Atrial fibrillation over the age of 60 is often the result of old age or other physical problems.

10. How do you find out if you have atrial fibrillation?

With help from a heart film (ECG). That must be made during atrial fibrillation. If the complaints only occur in attacks, a patient is often given a portable recorder to take home for 24 or 48 hours, with which the heart rate is constantly measured. This is called a Holter exam.

11. What can be done about it?

Initially, an attempt is made to prevent atrial fibrillation with a combination of medicines. There are medicines that lower the heart rate, such as beta-blockers and digoxin, and medicines that make the heart rhythm regular (anti-arrhythmics), such as tambocor and amiodarone. Amiodarone in particular can have unpleasant side effects, such as sun allergies and thyroid problems.

Because the structure of the heart tissue changes as a result of atrial fibrillation, medicines often stop working after a certain time. Then an operation is possible via a thin, flexible tube, a catheter, that is inserted through the groin. It’s called ablation. Through the catheter, bits of tissue in the heart wall that cause rhythm problems are switched off by making small scars in them. The symptoms almost always disappear completely.

Ablation is a complicated technique. That is why only fourteen hospitals in the Netherlands are allowed to perform the procedure. If people become very afraid of atrial fibrillation, they can go to a medical psychologist for help.

12. If you have atrial fibrillation, will you keep it for the rest of your life?

Not if the underlying cause is removed. Suppose: the atrial fibrillation is caused by an overactive thyroid gland. When that is corrected, the atrial fibrillation usually disappears as well. It appears that atrial fibrillation itself can be cured through ablation. But because this technique is relatively new, it is not yet clear whether the complaints can return in the long term.

13. What are the latest developments?

Researchers are working hard on new antiarrhythmics with fewer side effects, such as dronedarone and vernakalant. A new kind of anticoagulant is also in the works. These further reduce the risk of a stroke and lead to bleeding less quickly. The most important news is that patients who use these new anticoagulants no longer have to have their blood checked at the thrombosis service.

The coagulation value automatically remains correct and can no longer be confused by food. Dabigatran is expected to be the first variant of the new anticoagulants that will be marketed (next year). Furthermore, ablation is under development. Physicians can work more and more precisely and help more different patients.

14. What is and is not allowed if you suffer from atrial fibrillation?

Working, playing sports, making love: in principle anything is allowed, as long as you feel comfortable with it. Those taking anticoagulants should avoid some activities, such as contact sports, because of an increased risk of bleeding.

15. How can you prevent atrial fibrillation or reduce symptoms yourself?

Do not smoke, do not drink too much, exercise regularly and do not become overweight.

Tell your story?

People with atrial fibrillation all have a story. About fear of strokes, fatigue, medication… Want to see your story reflected in a film portrait and storybook? Sign up quickly at www.boezemfibrilleren.nl. Find more news, stories and tips about atrial fibrillation here.

This is also possible: check blood values ​​yourself

There are meters on the market that allow someone taking anticoagulants to check their blood levels at home. During training at the thrombosis service, the patient is taught how to adjust the dosage of his medication if necessary. Someone who monitors the coagulation value of his blood at home only needs to go to the thrombosis service four times a year instead of every two or three weeks.

With the cooperation of Lukas Dekker, cardiologist at the Catharina Hospital in Eindhoven and specialized in cardiac arrhythmias.