Atrial Fibrillation: Symptoms, Diagnosis, and Treatment Options

Arrhythmia (180-194 bpm)

On December 21, 1992, at 10:00 AM, I experienced a heart rate of around 190 beats per minute, accompanied by cold sweats and dizziness, which lasted until I sought medical attention at 3:30 PM.
My blood pressure was 127/97, and my heart rate was 194.
I received an injection that brought my heart rate back to normal, maintaining around 88-96 beats per minute, and I was sent home for observation.
However, at 7:00 PM, I woke up with severe headaches and an accelerated heart rate, prompting another visit to the hospital.
I received another injection, which again normalized my heart rate to 88-96 beats per minute, and I was advised to return home for observation.
I was prescribed Isoptin 40 mg (12 tablets, white), to take one tablet four times a day (after meals and before bedtime) for three days.
I was instructed to undergo catheter ablation during my next outpatient visit.
This condition has been ongoing for about two years, with the most severe episode occurring on December 21, when I visited the emergency room twice in one day.
I also experienced an episode on the morning of December 22, but it was alleviated after taking the medication.

Patient details: 27 years old, height: 174 cm, weight: 62 kg.
(Please contact me if you need any additional information.)

JO, 20~29 year old female. Ask Date: 2003/12/22

Dr. Zhong Yuxun reply Cardiology

Dear Jo,
According to your letter, it appears to be paroxysmal tachycardia, most commonly paroxysmal supraventricular tachycardia (PSVT).
The cause is typically an additional conduction pathway within the heart, leading to a reentrant circuit.
This condition can be effectively treated with catheter ablation, which is a procedure available at major hospitals.
It is advisable to consult a cardiologist as soon as possible.
Sincerely,
Dr.
Yu-Chuan Chung,
Director of Cardiology, Taoyuan Hospital, Department of Health, Executive Yuan

Reply Date: 2003/12/22

More Info

Atrial fibrillation (AF) is a common type of arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various symptoms and complications, including an increased risk of stroke and heart failure. Understanding the symptoms, diagnosis, and treatment options for AF is crucial for effective management.

Symptoms of Atrial Fibrillation
Patients with AF may experience a range of symptoms, which can vary in intensity and duration. Common symptoms include:
1. Palpitations: A sensation of a racing, fluttering, or pounding heart.

2. Dizziness or Lightheadedness: This can occur due to inadequate blood flow to the brain.

3. Shortness of Breath: Patients may feel breathless, especially during physical activity.

4. Fatigue: A general feeling of tiredness or lack of energy.

5. Chest Pain or Discomfort: Some patients may experience chest pain, which can be mistaken for angina or a heart attack.

In your case, the episodes of rapid heart rate (up to 194 beats per minute), accompanied by cold sweats and dizziness, are indicative of AF. The fact that these symptoms have persisted for about two years suggests a chronic condition that may require further evaluation and management.

Diagnosis of Atrial Fibrillation
The diagnosis of AF typically involves several steps:
1. Medical History and Physical Examination: A thorough history of symptoms and any underlying conditions is essential.

2. Electrocardiogram (ECG): This is the primary diagnostic tool for AF. It records the electrical activity of the heart and can show the characteristic irregular rhythm.

3. Holter Monitor: In cases where AF is intermittent, a Holter monitor may be used to record heart activity over 24-48 hours.

4. Echocardiogram: This ultrasound of the heart can assess heart structure and function, helping to identify any underlying heart disease.

5. Blood Tests: These may be performed to check for thyroid function, electrolyte levels, and other factors that could contribute to AF.

Treatment Options for Atrial Fibrillation
Treatment for AF aims to control the heart rate, restore normal rhythm, and prevent complications such as stroke. Options include:
1. Medications:
- Rate Control: Medications such as beta-blockers (e.g., Isoptin) or calcium channel blockers help control the heart rate.

- Rhythm Control: Antiarrhythmic drugs may be prescribed to restore normal rhythm.

- Anticoagulants: To reduce the risk of stroke, blood thinners (e.g., warfarin, direct oral anticoagulants) are often recommended, especially if there are additional risk factors.

2. Cardioversion: This procedure can be performed electrically or chemically to restore normal heart rhythm.

3. Catheter Ablation: For patients with persistent AF or those who do not respond to medications, catheter ablation may be considered. This minimally invasive procedure targets the areas of the heart responsible for the abnormal electrical signals.

4. Lifestyle Modifications: Patients are encouraged to adopt heart-healthy habits, including regular exercise, a balanced diet, and avoiding stimulants such as caffeine and alcohol.

Conclusion
Given your symptoms and the need for further evaluation, it is essential to follow up with your healthcare provider for a comprehensive assessment. The recommendation for an electrophysiology study (電燒) indicates that your doctor is considering more advanced treatment options to manage your AF effectively. Regular monitoring and adherence to prescribed medications will be crucial in managing your condition and preventing complications. If you experience any new or worsening symptoms, do not hesitate to seek medical attention promptly.

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