3 days ago
FLUTTERING HEARTS BODE ILL
YOUR heart can flutter, figuratively, when you set eyes on someone or something that stirs excitement, desire or longing.
But when it literally flutters for no apparent reason, it could signal trouble ahead.
According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant cardiologist Datuk Dr Razali Omar, abnormal rhythms of the heart (arrhythmias) come in many forms, and one of the most common is called atrial fibrillation (AF).
'It's the oldest arrhythmia known to man.
'It was described in ancient Chinese texts some 5,000 years ago as a 'weak and irregular pulse',' observes Dr Razali.
Affecting millions worldwide, AF is linked to serious complications if left untreated.
'It used to be associated with advancing age, but we now see a new pattern emerging,' he says.
'AF now affects younger individuals as well.
'The incidence is increasing, not only in older population groups, but also younger ones.
'No one knows why the incidence is increasing, or why the ages of those affected are getting younger.
'Part of it may be due to lifestyle disorders such as obesity, diabetes, hypertension. It may be due to alcohol, as it was recently found that alcohol consumption increases risk as well.
'Obstructive sleep apnoea is also linked to AF.
'But more than that, no one knows for certain the exact cause,' adds Dr Razali.
All these have implications for treatment, requiring the need for AF to be treated holistically, which means addressing possible sources of the problem in addition to direct treatment targeted at the heart.
Dr Razali cautions that not only is incidence of AF increasing, but it now affects younger individuals as well. — ONG SOON HIN/The Star
Understanding AF
AF is an irregular and often rapid heart rhythm originating from the upper chambers of the heart known as the atria.
Normally, the heart's electrical system ensures the four chambers of the heart contract in a coordinated way.
But in AF, the electrical signals become chaotic, leading to a fast and irregular heartbeat.
The condition can be occasional (paroxysmal), persistent or long-standing persistent, with symptoms ranging from palpitations, fatigue and shortness of breath to dizziness and chest discomfort.
Some individuals might not experience symptoms at all (up to 50%, according to Dr Razali) and discover they have AF only through a routine medical exam, or when they are struck by the consequences of the condition.
AF can lead to serious complications like stroke, heart failure and cognitive decline if not properly managed.
'In a person with AF, the risk for stroke is increased by five to six times compared to someone who doesn't have it.
'And stroke from AF is worse than from other causes. AF- related strokes often lead to death, and among those who survive, a significant number are left with long-term disabilities,' stresses Dr Razali.
Diagnosis of AF typically begins with a physical examination and an electrocardiogram (ECG) to detect abnormal rhythms.
In some cases, wearable or implantable monitors may be used to track heart activity over longer periods, especially when symptoms are intermittent.
These are called Holter monitors and they are essentially ambulatory ECG devices that monitor the heart.
Such monitors can track between seven and 14 days, unlike the bulkier monitors of the past that usually track for a day only.
'These days, I also see patients who come to me after their smart watches alert them that they have heart rhythm disturbances.
'Of course, we have to confirm that it truly is AF, but there have been confirmed cases from these,' notes Dr Razali.
Traditional treatment options
According to Dr Razali, managing AF involves the primary goals of reducing the risk of stroke, preventing heart failure and restoring normal rhythm to the heart.
'After thorough assessment, treatment will be instituted based on our primary goals.
'Anti-coagulants are given to prevent blood clots that can cause stroke.
'Oral anti-arrhythmic medications are given to try and control heart rate and attempt to restore normal heart rhythm to prevent heart failure, although there haven't been any new discoveries for the past 30 to 40 years on this front,' he notes.
When medications aren't effective or suitable, catheter ablation – a procedure that targets and destroys the areas of heart tissue causing the erratic signals – is recommended.
Dr Razali observes that catheter ablation, traditionally using radiofrequency or cryotherapy, has been a game-changer for many patients, provided it is carried out in the early stages of AF.
'It's much more difficult to treat chronic AF,' he stresses.
According to Dr Razali, catheter ablation for heart arrhyth- mias have been available in Malaysia since 1992.
'AF ablation started in Malay-sia in December 1999, at the National Heart Insitute (IJN), Kuala Lumpur.
'Although it's the oldest known arrhythmia, it's the 'last' to be ablated since it was relatively late before the source of the arrhythmia was found – in the pulmonary veins.
'Radiofrequency and cryotherapy are thermal energy, and ablation with such energy is not without its challenges, including risk of collateral damage to nearby tissues of the heart, oesophagus, nerves, and even blood vessels.
'In expert hands, such risks are minimal, although the consequences could be catastrophic if it were to occur depending on the affected tissues,' warns Dr Razali.
A new frontier: pulse field ablation
In recent years, a new treatment – pulse field ablation (PFA) – has emerged.
PFA represents an exciting advancement in the treatment of AF because, unlike conventional ablation methods that rely on thermal energy (either heat or extreme cold), PFA uses high-voltage, short-duration electrical pulses to create tiny pores in heart cells – a process known as electroporation.
This approach selectively targets heart muscle cells without damaging surrounding structures like the oesophagus, nerves or blood vessels.
'This selectivity is one of the standout advantages of PFA as it significantly reduces the risk of collateral damage,' emphasises Dr Razali.
The procedure itself is typically done under general anaesthesia, with the patient anti-coagulated to prevent blood clots, which could lead to stroke.
A transoesophageal echocar- diogram (TOE) is carried out beforehand to assess the heart's anatomy and rule out any existing clots. Catheters are threaded through blood vessels to the heart, guided by imaging.
A 3D electroanatomical map is created, and once the catheters are in position, the PFA system delivers a series of controlled electrical pulses to isolate the areas triggering AF, usually around the pulmonary veins.
After ablation, the heart is challenged with isoprenaline to check for any remaining or additional AF triggers.
Once over, the patient is monitored – in the intensive care unit if required. But most patients can expect to go home the next day.
As with any medical procedure, risks still exist, though they are significantly lower with PFA.
The procedure represents a significant leap forward in the treatment of AF, offering patients a safer, quicker and potentially more effective solution.
As the technology continues to evolve and long-term data emerges, it could well become the new gold standard in arrhythmia management.
'I believe PFA is the way of the future. It's essentially the same technique as traditional ablations, it's just the energy source is different,' opines Dr Razali.
Access to PFA may also depend on availability, as the technology is still being adopted in many parts of the world, and even in many parts of Malaysia.
For patients currently living with AF, Dr Razali emphasises the importance of early detection, lifestyle modification and regular follow-up.
'Don't ignore the signs: palpitations, fatigue, or even mild breathlessness. Talk to your doctor.
'With the right treatment, including innovative options like PFA, you can regain control of your heart rhythm and your quality of life.'
KKLIU 2048 / Exp Dec 31, 2027
