Atrial Fibrillation Awareness Month

We sat down with cardiologist Dr. Islam Ibrahim, a cardiac electrophysiology fellow at the Libin Cardiovascular Institute, for Atrial Fibrillation Awareness Month to discuss this common arrhythmia. Continue reading to learn more about AFib, how it’s treated and current research in the field underway at the Libin Cardiovascular Institute. 

What is atrial fibrillation (AFib)?

AFib is the most common arrhythmia (irregular heartbeat). Usually, the heart’s upper chambers, called the atria, beat in a steady rhythm to move blood into the lower chambers. With AFib, the atria quiver instead of beating as they should, making the heartbeat irregular and often too fast. When the atria don't squeeze well, blood can pool and form clots. This is the main reason AFib can lead to problems like stroke.

AFib is a long-term condition that needs ongoing management. It can occur without symptoms and is sometimes only diagnosed after a stroke. 

How common is AFib?

AFib affects millions of people worldwide, and the number is growing as people live longer. About one in three or four people will develop AFib during their lifetime. Experts expect these rates to keep rising, mostly because more people are living longer.

Who is affected by AFib? 

Age is the main risk factor for developing AFib. AFib is rare before age 60, but it is much more common as people age. Additionally, AFib is more common in men, but women often experience more noticeable symptoms, and, in some cases, have worse outcomes. 

People are also more likely to develop AFib if they have other cardiovascular conditions, like high blood pressure, heart failure, a previous heart attack or heart valve disease. Other health conditions — including sleep apnea, obesity, diabetes and thyroid problems — can also increase the risk. Having a family history of AFib is another risk factor.

Lifestyle can play a role, too. Heavy alcohol consumption and binge drinking can trigger episodes of AFib, a phenomenon sometimes referred to as “holiday heart.”  AFib can also occur in younger, otherwise healthy people. In some cases, it may be associated with genetics or very high levels of endurance exercise.

What causes AFib?

For AFib to develop, both “kindling” (vulnerable heart tissue) and a “spark” (trigger) is needed. Kindling can include cardiovascular or other pre-existing conditions (see above) or age- or blood-pressure related changes in the atria. The spark is an abnormal electrical signal, most often from originating from the pulmonary veins. 

How is AFib treated?

Treatment usually focuses on three goals: preventing stroke, controlling the heart’s rhythm or rate, and addressing the underlying risk factors. 

For stroke prevention, some people with AFib need blood thinners, depending on their individual risk of stroke. Doctors consider factors such as age, high blood pressure, diabetes, heart failure and previous stroke when making this decision. Treatment can also focus on restoring and maintaining a normal heart rhythm with medication or a procedure called catheter ablation, which is becoming more common and effective. For others, controlling how quickly the heart beats may be enough. Finally, managing factors such as high blood pressure, weight, sleep apnea and alcohol use is an important part of AFib treatment and can reduce episodes.

Can AFib be reduced or prevented? 

Lifestyle choices impact the risk of developing AFib and improve outcomes for those treated for the condition. Here are some tips:

• Maintain a healthy weight. For people who are overweight, research shows that losing weight can significantly reduce the frequency and burden of AFib.
• Treat sleep apnea if present. 
• Control blood pressure.
• Limit alcohol. Even moderate drinking can increase the risk of AFib and reducing intake can lower the risk of AFib returning. 
• Take part in regular, moderate exercise. Extreme or long-term endurance training may increase risk for some. 
• Manage diabetes and other cardiovascular risk factors.

What are some AFib research projects currently underway at the University of Calgary?

The Libin Cardiovascular Institute at UCalgary is taking part in several studies that are helping to shape the future of AFib care:  

• RASTA-AF is a multi-center trial studying whether aggressively controlling risk factors, such as blood pressure, weight and sleep apnea, and targeting specific arrhythmia triggers, can help prevent AFib from returning.
• LIBREXIA-AF is testing a new blood thinner called milvexian to see if it works as well as apixaban in preventing stroke and blood clots in people with AFib.
• COAST-AF is comparing a personalized ablation approach to pulmonary vein isolation alone in people with persistent AFib.
• CPKN605A is a study testing a new oral medication called PKN605 to see whether it reduces AFib burden and confirm it is safe and well tolerated.
• STAR AF 3 compares three different ablation strategies to find which works best for people with persistent AFib.