Q&A: Roundup on Atrial Fibrillation
What is atrial fibrillation?
Atrial fibrillation (sometimes called "a-fib" for short) is a type of arrhythmia, or irregularity of the heart beat. It originates in either the left or right atrium, the two upper pumping chambers of the heart. Normally, the atria fill with blood returning to the heart. (The right atrium receives blood from the venous system, and the left from the lungs.) Each atrium then contracts, propelling this blood into the heart's two larger, lower chambers, the ventricles. The ventricles contract and eject this blood—from the right ventricle into the lungs to be reoxygenated, and from the left ventricle into the aorta to be circulated through the rest of your body.
In atrial fibrillation, the heart's normal electrical "pacemaker" is bombarded by competing electrical charges, which originate in the atria. These competing impulses initiate chaotic muscle contractions, so instead of contracting forcefully to move the blood out, the atria quiver or "fibrillate." This can cause a loss of up to 30 percent of the "atrial kick" that contributes to the blood output of the heart, and can send heart rates up to 230 to 250 beats per minute.
Atrial fibrillation is the most common arrhythmia I've seen in my practice. I have treated it in young and old patients. Two to four percent of people over 60 years of age experience atrial fibrillation.
What causes atrial fibrillation?
Atrial fibrillation can be the result of several common causes and can occur:
- If the atria become enlarged or lose their ability to contract
- If the heart's electrical conduction system ages, becomes fibrotic, or misfires
- If metabolic states such as hyperthyroidism overstimulate the conduction system
- After the heart is manipulated in open heart surgery
- Due to long-standing high blood pressure
- Due to valvular disease
Sometimes the exact cause of atrial fibrillation is unknown. It's also important to note that atrial fibrillation can occur in perfectly healthy hearts.
If you are vulnerable to bouts of atrial fibrillation, you should avoid chocolate and other foods containing caffeine, and chemicals such as ephedrine in over-the-counter cold remedies.
I had ablation therapy for my a-fib, and it didn't seem to help. Now what?
In the therapy called catheter ablation, a surgeon uses sound waves, much like radio waves, to eliminate excitatory nerve fibers in heart muscle tissue that carry the impulses.
In a recent study conducted by the French physicians who pioneered the technique, a second ablation improved the results greatly. At one, two, and five years after a first ablation, 40 percent, 37 percent, and 29 percent of patients were still free of a-fib. In those patients who had a second ablation, the results improved to 87 percent, 81 percent, and 63 percent.
I've had many patients who weren't satisfied with the results after their first ablation therapy. The takeaway message from this study is that, even if your first ablation doesn't give you the results you expect, be willing to give it a second try; the results are impressive.
Why do I have to take "blood thinners" with atrial fibrillation?
Blood thinning agents, or anticoagulants, such as aspirin and Coumadin help prevent clots from forming in the fibrillating atria, and protect against stroke. Cardiologists disagree about when to give anticoagulation therapy, but most patients with chronic atrial fibrillation require it.
A major risk from anticoagulants involves possible bleeding or hemorrhage. Anticoagulants slow blood clotting time, but thinning the blood too much can carry risks. In the elderly, overly prolonged clotting times can increase the chance of internal bleeding. If you play contact sports or are traumatized by an injury, "thinned blood" which clots slowly can be risky.
When weighing the risks and benefits of anticoagulation therapy, physicians screen their patients very carefully for a history of GI tract bleeding, high blood pressure, renal disease, hemorrhagic stroke, and the potential for falls.
If you begin anticoagulation therapy, your doctor will closely monitor your blood clotting times, especially when this therapy first begins, to determine if your blood is "too thick" or "too thin." I strongly recommend anticoagulant therapy with Coumadin or aspirin for my patients who are good candidates. However, everyone is different, and you need to discuss your options with your physician.
What about pacemakers and atrial fibrillation? Are there any cases when something like that might be necessary?
Atrial fibrillation can be caused by a condition called "sick sinus syndrome." (In this case, "sinus" refers to the sinus node, a point of electrical action in your heart. There's no connection to the sinuses in your skull.) Medications can control the high heart rate that's associated with sick sinus syndrome, but they can go overboard a little at times and cause excessively slow heart rate. That's the point at which a pacemaker would kick in. Sick sinus syndrome can also cause long pauses between beats; the pacemaker would fire in that event, too.
While a pacemaker might seem to be an awfully invasive solution, there are times when it's necessary. My own mother-in-law has a pacemaker for her a-fib and sick sinus syndrome.
What can you do if you don't tolerate the medications typically prescribed for atrial fibrillation?
I have had many patients who could not tolerate drugs for atrial fibrillation. This was a nightmare for all of us until I began using complementary therapies. For those patients, I have used very low doses of the least toxic drugs along with various herbs.
If patients can't tolerate digoxin, I've had some success using hawthorn berry, 500 mg three times a day.
For patients who go "in and out" of atrial fibrillation, they can see a greatly improved quality of life by taking my Awesome Foursome plus 1–2 grams of fish oil daily. Daily doses for a-fib are:
- CoQ10: 100–200 mg
- L-carnitine: 1–3 grams of a broad-spectrum combination
- Magnesium: 200 mg once or twice , of a broad-spectrum combination
- D-ribose: 5 grams 2–3 times a day
Together, these will provide the raw materials your heart needs to keep itself in regular rhythm.
Other possibilities are grounding or Earthing, and 100 mg of nattokinase daily. Either of these will help thin your blood, but as of yet there's not enough evidence to suggest they are enough in cases of a-fib.
Remember, you must work with your physician to make the transition to these therapies.
Enjoy What You've Just Read?
Get it delivered to your inbox! Signup for E-News and you'll get great content like you've just read along with other great tips and guides for Dr. Sinatra!
Meet Dr. Sinatra
Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy. More About Dr. Sinatra
Dr. Stephen Sinatra's Favorites
Doctor-recommended support for healthy cholesterol ratios, blood pressure & overall heart health
Refuel your cellular engines for efficient heart function
Strength, energy, endurance--get the targeted nutrient support a man needs most
Stay youthful, healthy, vibrant and balanced with nutrient support designed to meet a woman's needs