Atrial fibrillation---Continue

TAKING CONTROL

• Avoid caffeine and alcohol. Both can trigger an episode of AF in otherwise healthy people. Binge drinking with alcohol is especially risky---which is why AF is sometimes referred to as 'holiday heart'. Do not exceed two drinks a day---if you drink at all.
• Quit smoking. Nicotine is a drug, and it can trigger abnormal heart rhythms.
• Discuss anticoagulants. Especially if you are an older woman with AF, ask your doctor if taking an anticoagulant would be good for you. According to a study in the journal Circulation, women age 75 and older with newly diagnosed AF were half as likely as their male counterparts to receive a prescription for the anticoagulant warfain (Coumadin).
• Take special care with herbal remedies. Many formulations can interact dangerously with warfarin and other drugs you may need. In particular, avoid ginkgo biloba or garlic extract (these can cause haemorrhaging when taken with warfain). Ephedra (Ma huang) can actually trigger arrhythmias in young, healthy people.
• Just say 'no' to street drugs like cocaine, amphetamines and other 'uppers' or stimulants. They can cause the heart to race at a potentially deadly rate.

Medications

To begin with, your doctor may have you take an anticoagulant drug, either warfarin (Coumadin) or aspirin, to prevent blood cots and reduce your stroke risk. Warfarin reduces the risk of stroke by two-thirds and aspirin reduces it by  a fifth. The drug used will depend on your age and the number of other stroke risk factors you have. If warfarin is chosen, you will be carefully monitored and your dose adjusted accordingly because too much of this drug can cause uncontrolled bleeding.

    After a month or so on anticoagulants, your doctor will move on to the next phase--medications to restore your heart's normal rate and rhythm. (This treatment is usually delayed until the blood thinner has taken effect, because the abrupt normalisation of its rhythm can actually release a blood clot if  one has already begun to form). To slow your heart rate, two classes of drugs are generally used: beta-blockers, such as atenolol  (Tenormin), metroprolol (Lopresor), propranolol (Inderal) or sotalol (Sotalol-BC), and calcium channel blockers, such as verapamil (Isoptin) or diltiazem (Cardizem). Beta-blockers also regulate heart rhythm. An older medication, digoxin (Lanoxin), was once commonly used to slow the heart, but new drugs have generally replaced it.

                                      PACEMAKERS: KEEPING A STEADY BEAT

A pacemaker is a small electronic device that is used to help the heart maintain the correct rhythm. It consists of an impulse generator implanted just under the skin in your upper chest, and placing lead wires that

descend through a vein directly into the heart muscle itself (see illustration). The implantation of the pacemaker is usually done under a general anaesthetic followed by a few days' stay in hospital. You can usually return to your normal activities within two weeks.

      The pacemaker unit will need periodic testing and calibration, which now can sometimes be done over the  telephone lines. The pacemaker operates by a battery which must be replaced every eight to ten years. Receiving a pacemaker may allow you to quit taking anti--arrhythmic and other drugs, thus feeling you from the side effects they may cause.

Pacemaker precautions

You should be monitored regularly, wear a medical identification tag and register with the manufacturer of your unit. Because pacemakers can be affected by strong electromagnetic fields (EMFs), magnetic resonance imaging (MRI) should be avoided.

   Common household items that produce EMFs (microwave ovens, mobile phones) can be used safely, although mobile phones should not be put directly over the pulse generator. Security devices poise no known threat, but try to move quickly through them.

Additional safety tips

• Be sure to inform surgeons or dentists that you have a  pacemaker, so they don't use an electro-cauterisation device to control bleeding. It can alter pacemaker settings.
• prior to any medically invasive procedure, ask your doctor about taking antibiotics to prevent infections that may affect the pacemaker.
• Avoid blows to the body near the site of your pacemaker during physical activities. Consult your doctor if you do receive such a blow.
• Check your pulse regularly to see if your pacemaker is operating at the intended rate.
• Report any unusual symptoms to your cardiologist immediately.