When to call in the electrophysiologist

When to call in the electrophysiologist

KUALA LUMPUR - Imagine that your heart is like a house: You call a plumber when the pipes are clogged up.

That's how you'll understand atrial fibrillation (AF), says Datuk Dr Razali Omar, consultant cardiologist and electrophysiologist at National Heart Institute. If your arteries (which he likens to water pipes) are clogged, you'll see a cardiologist to "unclog" them.

If you have a faulty electrical system, you call an electrician. Similarly, you'll probably see an electrophysiologist if there's something wrong with the electrical system in your heart.

The human heart has an electrical system? Well, yes.

The heart has four chambers - left and right atria (the upper chambers) and the left and right ventricles (the lower chambers). Its pumping action is regulated by the flow of electricity. In a person with a normal heart rate and rhythm, the heart beats between 50 and 100 times per minute.

With AF, the heart beats irregularly or rapidly (up to 180 beats per minute). When the heart cannot pump blood efficiently, there is a chance that blood will pool in it.

By itself, AF is not likely to cause sudden death. However, the complications arising from AF make the condition problematic. For example, if insufficient blood is supplied to the body, a person may feel tired, suffer chest pains or have fluid accumulating in the legs and lungs. If untreated, this is likely to cause heart failure.

By far, the most serious complication of AF is the increased risk of a patient developing a stroke.

This happens when the pool of blood in the heart clots and travels into the bloodstream, potentially blocking blood vessels in the brain. Starved of oxygen, a stroke is likely to occur.

At present, AF patients are given anticoagulation therapy which includes the use of medication with "vitamin K antagonists" (VKAs) to prevent a stroke.

A healthy lifestyle helps maintain a healthy heart.

Although highly effective, there are limitations as VKAs can interact with a host of things such as common medication, alcohol and food that are high in vitamin K.

Such limitations were the impetus behind the landmark RE-LY (Randomised evaluation of long term anticoagulant therapy) study, of which Dr Razali was the Malaysian coordinator.

Completed in 2009, this study involved over 18,000 patients from 44 countries and demonstrated the efficacy of the latest anticoagulation therapy compared to more conventional ones.

Malaysia, with its ageing population, is likely to see a higher incidence of AF patients as AF is prevalent among the elderly.

Dr Razali advises that the best way to prevent the onset of AF is to reduce alcohol intake and to lead a healthy lifestyle so as not to develop heart disease, diabetes and hypertension.

Common signs and symptoms of AF

  1. Palpitations 
  2. Feeling weak
  3. Fatigued
  4. Breathless
  5. Chest pains
  6. Confusion
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