Atrial Fibrillation (AFib) is a heart condition that causes an irregular and often rapid heartbeat. AFib affects millions of people worldwide and can lead to serious health complications, including stroke.
While there is no cure for AFib, treatments are available to help manage the condition and reduce the risk of complications. This article specifically addresses if a defibrillator can or should be used on an individual suffering from AFib.
A defibrillator is a device that delivers an electric shock to the heart. This shock can stop the irregular heartbeat and restore a normal rhythm. Defibrillators are commonly used in emergency situations, such as when someone goes into cardiac arrest. Most defibrillators today for public use are automated external defibrillators (AEDs) and are considered public access defibrillators (PAD).
AFib is a kind of supraventricular arrhythmia which is an irregular heartbeat that starts in the upper chambers of the heart and may induce a fast, slow, or erratic heartbeat.
In contrast, Ventricular Arrhythmia (VFib) originates in the lower chambers of the heart and often if untreated can result in sudden cardiac arrest (SCA).
The leading two causes of AFib are high blood pressure and defective valvular diseases. The heart has four different valves: aortic valve, mitral valve, pulmonic valve, and tricuspid valve. Atrial fibrillation can occur in any valve that is not functioning properly. If the heart is not pumping blood effectively then the body and organs are not getting enough oxygen. The blood that the heart supplies is usually oxygen-rich, and when the organs are not getting enough oxygen, they tend to show the symptoms of dyspnea and palpitation. Many times this can lead to SCA and if not treated, sudden cardiac death (SCD).
A defibrillator, and especially the internal cardioverter defibrillator or ICD, is a device that helps to regulate cardiac rhythm abnormalities. The working process is much like the Pacemaker, but it is much more efficacious. The defibrillator has programmable features which can change its rate of electrical shock as the heart rhythm of the patient shifts. If the heart rhythm has advanced rapidly, it provides an electrical shock to repolarize the heart, and thus, the heart is back to its usual rhythm. Defibrillators are primarily used for ventricular tachycardias and ventricular fibrillation. A-fib can lead to ventricular tachycardia and fibrillation, and as such, the diseases can be treated with an implantable cardioverter-defibrillator.
There is more than one category of atrial fibrillation. This depends on the time and occurrence of the fibrillation. Occasionally the symptoms stay longer than usual, and in those cases, the effect of the disease is permanent and present on the victim. The fibrillation stays for moments and goes away with time in other cases. As such, the fibrillation doesn’t do sufficient damage, and the patient only needs to dodge the circumstances that engage the symptoms rather than being on particular antiarrhythmic drugs or antiarrhythmic drug therapy.
Here the paroxysmal AF occurs and stops on its own. This is also comprehended as intermittent A-fib as well as drug-refractory atrial fibrillation. And sometimes, the symptoms of Paroxysmal A-fib can last for 24 hours to a week at most. This disease influences more than two to three million people. Paroxysmal A-fib can occur in people with age, and this can be serious if the patient is not kept under proper care.
The most common reason for paroxysmal A-fib is that a patient has recently undergone heart surgery. The symptoms might not last long, but the patient has to be checked even if they don’t feel discomfiting as the fibrillation has to be treated before it turns to persistent or permanent atrial fibrillation. High blood pressure and diabetes can also be risk factors for paroxysmal A-fib. Alcohol and other abusive drugs can also increase the chances of this condition.
Atrial fibrillation, in most cases, is a progressive illness if it’s not stopped at the primary level. Here, fibrillation symptoms last more than seven days, and it doesn’t stop unassisted. The doctor has to put the patient on medication or go through some type of therapy or surgery to get the disease under control. And thus, paroxysmal A-fib can develop into persistent A-fib. Persistent fibrillation can develop with age and long-term cardiac conditions, as proven by several clinical trials. This is also known as recurrent atrial fibrillation.
Dizziness, fatigue ness, and dyspnoea are the symptoms of Persistent A-fib. With this type of A-fib, the patient can notice the symptoms regularly, and if not rushed into the emergency quickly, this can turn into a fatal disease very quickly. But the disease is much complex as it can be asymptomatic. Congenital and high blood pressure are core causes of the disease and other cardiac diseases. Lung infections, as well as obesity, can also cause problems to appear.
The symptoms of the long-standing persistent A-fib last more than a week to a full year, and thus the symptoms of the disease are more chronic atrial fibrillation than the previous two. This disease mostly doesn’t show manifestation, and the leading cause is a family history of cardiac diseases. As such, the patient has to be under proper medication. The first treatment is the medication; beta-blockers or calcium channel blockers are the first ones to be used. If the prescription is used correctly, the condition can be subdued and not become permanent.
Other than beta-blockers, which usually clear out the blocks in the arteries, there are blood thinners like apixaban and heparin. This diminishes the possibility of blood clots. Apart from the medication, there is no permanent answer for curing the long-standing persistent V-fib, and it has to be the patient’s life transition to stay healthy and make sure that the disease does not advance with time.
This is the final and last step of the progressed atrial fibrillation from paroxysmal and persistent A-fib. This alters the function and structure of the heart permanently and can be known as atrial myopathy. The progression of the disease in permanence should be avoided as it is much more extreme and has life-threatening arrhythmic effects.
The uncontrollable ventricular rate and left ventricular dysfunction are some of the consequences of permanent A-fib. Medication and surgery are the recourses that are applied. But the most effective one is to change the patient’s quality of life as early as feasible. If not treated beforehand, the permanent AF can progress into complex diseases.
Life-threatening arrhythmias like the atrial fibrillation (A-fib) symptoms can be observable with pain and distress in the patient. But in some cases, mostly in long-standing persistent V-fib and permanent atrial fibrillation, the symptoms ate not visible, and it can cause a much more complex lead to suppress the disease. If the symptoms are not observed in the primary stage of A-fib, it will progress to some deadly attack and quickly lead to cardiac failure. The disease does not damage the patient like sudden cardiac arrest. As this is a progressive disease, the victim can be treated with medicines and check-ups. The symptoms are comparable to other heart diseases like ventricular tachycardia and ventricular fibrillation. Thus it needs to be diagnosed first to reach an end.
Atrial fibrillation is a complicated disease as its symptoms are not quite visible, and sometimes, they are pretty similar to other cardiac conditions like VT and atrial arrhythmias. As such, the causes of the disease are also quite discreet, and they can not be pinpointed for one reason. There can be the causes of cardiac conditions, other medical conditions, and certain habits like smoking and alcohol. The causes of A-fib are vast, and, in most cases, they develop into atrial fibrillation from other medical conditions.
If the systolic pressure is more than 140mm of Hg and the diastolic pressure is more than 90mm Hg, and if the pressure of the vessels remains constant at higher points rather than ideal pressure (80 mm Hg and 120mm Hg), then the patient is said to have high blood pressure. High blood pressure increases the chance of cardiac diseases, and atrial fibrillation is one of the consequences of that disease. Due to hypertension, the arteries get more pressure than they can handle, which triggers the heart’s aortic part to be inconsistent. If hypertension is not kept in restraint with medicines like ACE inhibitors, it causes atrial fibrillation with additional diseases.
This is a situation where the routes are clogged with fats and plaques, and thus they can not pass the possible blood to the heart. Thus, the heart will not have enough blood to pass on to the body’s other organs. First, the plaques only narrow down the direction of the blood flow. But with time, the plaques turn to form blood clots, which leads to blockage in the arteries. They do not exhibit any symptoms at first, but it has a drastic outcome with strokes and cardiac arrest. But the optimal blood flow to the heart can cause VT as well as A-fib. Peripheral atrial fibrillation can block the blood flow to the legs and causes leg pain. To avoid the high risks, the patients have to minister for high cholesterol and high blood pressure.
Congenital heart diseases can progress to atrial fibrillation with age. If a child already has a family background of heart conditions like down syndrome or rubella, they can get heart conditions quickly. Children usually show the symptoms of heart conditions in the early years. Rapid heartbeat and breathing, swelling, tiredness, etc., are the early symptoms. The congenital heart conditions can not be mended, but they are concealed from developing into other diseases. Septal flaws and transposition of the prominent arteries are one of the causalities of A-fib. The diseases are controlled with proper medications, and the patients are often kept under close observation throughout their life.
Cardiomyopathy is related to the muscles of the heart. Hypertrophic cardiomyopathy is when the main heart muscles get stiff, and thus the blood pressure moves to the back, which expands the effect of A-fib. Here the patient’s heart wall is thickened and stiff, and they can not function ideally. This can be a congenital heart condition or a condition that can develop from hypertension and later develop into valvular disease and atrial fibrillation or ventricular arrhythmias. Cardiomyopathy holds an elevated risk of heart failure and cardiac arrest. Both adults and children can develop these conditions, and the best way to control them is to make a difference in lifestyle.
Pericarditis can cause atrial fibrillation, and here the pericardium layer of the heart is involved. Pericarditis can raise the body’s temperature and cause intense pain in the chest, neck, and arms. The pain is much more severe than the condition itself. The pain lasts more than 15 minutes in some cases.
Here the amount of sugar in the blood is pretty high. If diabetes is too high and not kept checked, it can lead to stroke, heart disease, and A-fib. Diabetes can also cause nerve damage and vision problems if not checked. This condition heightens the sugar and cholesterol in the blood. This leads to high blood pressure and heart diseases, ultimately leading to ventricular arrhythmias.
With age and mostly in women, an overactive thyroid can cause heart problems leading to atrial fibrillation. Here thyroid glands secrete more thyroid hormone, and thus this leads to increased heart rhythm and temperature rise in the body. Weakness, tiredness, difficulties in sleeping, mood swing, and weight loss are the common symptoms of this condition.
If the lungs have defected, damaged, and narrowed, this affects difficulties in breathing. Smoking is the leading cause of COPD. Cough and chest infections are some of the main symptoms of pulmonary diseases. And if the condition is not treated immediately, the condition gets worse and can affect the heart. Atrial fibrillation or VF is also an outcome of pulmonary diseases.
If a person is exposed to too much carbon monoxide, it leads to poisoning. The monoxide mixes in the bloodstream, and the hemoglobin and oxygen form carboxyhemoglobin. When the condition gets severe, the blood can not carry enough oxygen, which fails the tissues and cells of the body. The poisoning can cause an unstable mental state and angina and, with time, develop into a heart attack and A-fib or ventricular arrhythmias.
The case of ventricle fibrillation and atrial fibrillation coexisting is relatively uncommon, but this is possible. A patient with a previous record of A-fib and fast pulse of the ventricles is not included in the structural heart diseases. Here the ventricles and atrium of the heartbeat are very fast and inconsistently. If the existing A-fib is overlooked or not treated properly, then the risk of ventricular fibrillation increases. This is due to an accessory pathway that can generate problems in the ventricles. Young people, especially in their thirties, tend to develop this issue. The electrical pulse from the atrium reaches the atrioventricular valve. If the pulse rate is fast in the atrium node, the ventricular conduction changes and rises to a high heart rhythm.
Parkinson’s white syndrome has symptoms of atrial fibrillation with a heart attack or ventricular fibrillation. The defibrillation process in the case of these diseases is quite tricky. Here the defibrillator’s shock can not restore the irregular heartbeat. Instead, the shock converts the heart rhythm to A-fib. And another set of shocks is required to regulate the fast heart rhythms to normal sinus rhythm. 200J of electrical shock and multiple sets are required for the Defibrillation process. Again, the rate of energy varies in different patients. But it is possible that atrial and ventricular fibrillation can coexist, and one can induce another.
Atrial fibrillation is associated with ventricular tachycardia, flutter, and other sorts of ventricular arrhythmias. Ventricular tachycardia itself isn’t very dangerous, but it is progressive. This can lead to atrial fibrillation and sudden heart attack or heart failure. A-fib can arrive from family history or cardiomyopathy in some cases, which are also genetic. These genetic disorders can also affect the heart’s ventricles, leading to a variation of ventricular arrhythmia such as ventricular tachycardia. The presence of both VT and A-fib can increase the rate of heart failure, and the defibrillators that are used are much more responsive and works both as a pacemaker and an ICD simultaneously.
People who have a prior history of heart conditions or situations such as heart surgery or heart attack have more possibilities of having coexisting ventricular tachycardia and atrial fibrillation. Sustained ventricular tachycardia and A-fib can be lethal concurrently and even further problems if not treated beforehand.
Artery or blood vessel blockage is the initial reason for ventricular and atrial fibrillation. There are not much research and resources concerning the electrical shock and the atrial nodes. The defibrillation process is mostly famous in the sector of ventricular defibrillation.
Though the research regarding ventricular defibrillation is pretty vast, there is a difference between ventricular and atrial defibrillation. This is due to the difference in tissues and intermolecular space of the two parts of the heart. Thus, the electrical signal of the two heart chambers is also different. And the electrical properties of the separating chamber membrane are different as well. The exact electrical conductivity and mechanism remain a mystery.
Defibrillation works with repolarization and depolarization of the heart consequently. The critical mass tissue in the chambers has to be polarized to stable the heart. In this case, potassium chloride is mainly used through the left artery to repolarize the heart and stabilize the heart from ventricular fibrillation. Here the voltage potential is created, and the potential gradient gets rid of the fibrillation of the ventricles.
The electrical field with 5V is applied to the chest, which can exhibit some or no response. If it produces some sort of response, the myocardium produces another potential. An electrical field of more than 5V produces a response that affects the refractory cells (affected cells). This response is the combination of action potential and refractions. The electrical signal here interacts with the accountable cells and increases the period of restrictions, and thus the prolonged time ceases the fibrillation.
When the shock is produced to the atria, four different kinds of shocks have been recorded by far immediate response, single post-shock response, immediate stoppage of the cardiac activity, and single post-shock starting. These responses took less than a second to organize. If we incorporate both the responses from the ventricles and atriums, it can be concluded that both the chambers have a reasonable impact due to the electric pulses. The effects of the electric signals might be a bit different, but they work in both cases.
Both monophasic and biphasic defibrillators can be used in the case of atrial fibrillation. The biphasic defibrillators are of superior efficacy as they have peak voltage and energy delivered. Thus, the rate of cardioversion is much better in the case of biphasic defibrillators. If the victim requires transvenous low-energy cardioversion, monophasic defibrillators are a better choice. The defibrillators do not have any functional changes, but the biphasic cardioverters offer a longer duration of rhythm and high energy waves. But the biphasic can be risky as it tends to burn the patient’s skin. Biphasic defibrillators are used when the heart defies the function of a monophasic wave.
Both monophasic and biphasic are used as counterparts. If the heart doesn’t respond to monophasic waves, switching to a biphasic waveform and cardioverter is wiser. Anteroposterior or Anteroapical composition provides electric shocks to the heart. Though which path the current proceeds through is still unknown.
Though the implantable cardioverter defibrillators are now one of the most popular defibrillators in the market, other defibrillators are utilized widely. The external defibrillators are used in various vital locations like schools, airports, and clubs as a first aid kit. The defibrillators are quite exclusive to treating patients encountering a cardiac situation. Even the ambulances are equipped and packed with an automated and semi-automated external defibrillator. They are designed to treat arrhythmias, and the shock wave of the defibrillator is variable.
This is a portable and flexible, lightweight defibrillator that can be used everywhere. Patients with unpredictable arrhythmia and pulseless arrhythmia can use this defibrillator to measure their heartbeat and convey a suitable electric shock. As the defibrillators are completely automated, a bystander only has to apply the electrode pads in the correct position on the skin, and they will provide the shock. The sensors connected to the sticky pad work as an electrocardiogram and measure the heart rate. If it finds an irregular heartbeat, it signals to repolarize the heart. Some automated external defibrillators can also give automated instructions to the attendees who are with the patient with CPR guidance through visual and verbal instructions.
ICD is placed on the left side of the heart, right under the collarbone, to treat patients with atrial fibrillation. Here ICD is built with microprocessors and sensors. The sensors are situated on the electrodes. Here the electrodes perceive the irregular heartbeat and convey it to the processor. The Capacitor analyses the crisis and delivers an electric shock to the heart to stabilize it. ICD can supply both high and low energy shock if the heart beats faster or slower than usual, unlike the external defibrillator. The implementable cardioverter-defibrillator starts the electric shocks with lower energy and increases their energy with time. The electrodes of ICD can be attached to different chambers of the heart. Not every ICD is placed to deliver a shock, but some are installed to monitor the heart rhythm. They have memory chips inside the processor, which can record the heart’s position.
This is not as complicated as the ICD. They work as both the external defibrillator and the internal defibrillators. As the adhesive electrodes are connected to the skin, the main body of the defibrillator can be handheld, or they are positioned at the waist of the person. The wearable cardioverter defibrillator can produce both low and high-energy shocks. It can also be sported as a vest. One can turn off the machine if one wants to, and the machine has an alert system to notify the patient. The defibrillators are usually worn by patients admitted to the hospital and facing a short-term arrhythmic situation. Patients can also wear them on the waiting list for the ICD implants. They are lightweight and easy to carry. The function of the defibrillator can be changed if needed, and such it makes a very clean possibility of treating a cardiac condition.
The automated external defibrillator for AFIB or external cardioversion is not used though it can be used in emergency cases. But the electrical cardioversion therapy is used in atrial fibrillation, and this one is derived from the concept of an external defibrillator. The cardioversion technique for A-fib is a semi-invasive procedure. The control rate of these shock therapies is much more sophisticated than the other procedures like catheter ablation and implanted cardioverter or atrial defibrillator as internal cardioversion.
The success rate of a procedure entirely depends on the patient. If the cardioversion procedure works on a patient, they avoid the invasive procedure. Medications like beta-blockers, blood thinners, and rhythm controllers are usually used on patients at first. But with such medication, the rate of lung toxicity also increases. And this is why doctors proceed to the electrical cardioversion or defibrillation process. The electrical signal is conveyed to the patient using electrodes but is very controlled. In AED, the shock is placed in a large portion, and electrical cardioversion provides a shock to the selected and relatively more minor portion of the heart. After the electrical cardioversion, the atrial arrhythmia returns to 20-30% normal coronary sinus heart rhythm. The rate is increased with different medications and therapies.
An implantable cardioverter-defibrillator (ICD) is one of the invasive approaches to stabilize the heart suffering from atrial fibrillation. This disease is one of the most critical and complex heart conditions that are prominent in the hearts of older people in general. Among the treatments like surgical ablation, atrioventricular ablation, and permanent and semi-permanent pacemakers, the atrial implantable cardioverter-defibrillators have also increased the chances of positive reforming the irregular and erratic heartbeat. Though heart failure patients can not be treated this way, they need more extreme measures.
The permanent internal atrial defibrillators here are designed based on the cardioversion process. In the case of cardioversion, the electric signals are provided in a specific spot, and the signal’s energy depends on the test results and monitoring. Likewise, the electrodes and wires on the defibrillator have been designed to provide medical assistance without the victim being hospitalized or monitored. Here the atrial defibrillator provides signals to the heart with repeated cardioversion. Defibrillation prevents electrophysiological remodeling that can derive from spontaneous atrial fibrillation and repeated fibrillation impacts. Implantable atrial defibrillators work similar way to the implantable cardioverter-defibrillator.
Implantable cardioverter defibrillator can eliminate,
Here the primary fibrillation is terminated almost entirely while treated with an ICD. And the persistent V-fib is terminated and suppressed by a more significant number. The ICD implantation makes the patient safer from the progression of the disease to something more complex. And this also relieves the progression to heart attack, heart failure, and sudden cardiac death.
The pacing algorithm and programs are introduced in the device, so it is beneficial against arrhythmia of any sort. The high percentage of atrial pacing helps avoid the progression rate of atrial fibrillation. Here the atrial pacing is more than ninety percent, and it doesn’t affect the regular activity of the heart. And with this, the program can reduce A-fib to eighty percent.
This implantable cardioverter-defibrillator monitors both the supraventricular arrhythmia and the ventricular arrhythmias. The ICD sensors work on the predictive value by surveying the difference in two chambers, which is almost valid in patients. And the algorithm works on the difference between the two areas. Atrial tachyarrhythmias, as well as fibrillation, are treated via dual-chamber devices.
The pacing interval between arithmetic cycles of the ICD is about 220ms. Anticardia pacing conveys about 50Hz bust, and though it is an advantageous rate, it is pretty effective in mild atrial fibrillation. As the fibrillation episodes occur in-between moments, the Anti tachycardia pacing interval was also reduced with the recent developments.
The conventional ICD may supply inappropriate shock as they do not observe both heart points. But in the case of dual defibrillators, the high effectiveness and security of the device due to the control of the sensors leads to much more tolerable and reliable treatments. The automatic shock in the ICD can be a bit risky for extreme patients, but with the dual features, the condition of atrial fibrillation stays in control.
Implantable cardioverter-defibrillators can have two or three leads. In the case of two leads, they are stated at the right atrium and right ventricle. And in the case of three leads, the leads are placed in the right atrium, right ventricle, and left ventricle. The conventional ICD can give up to 800V as a maximum voltage.
The atrial defibrillator gives the electrical shocks for atrial fibrillation: 160 to 400V.
For ventricular fibrillation, the electric shocks: 120 joules to 200 joules and a maximum of 300 joules.
ICD implantation is mainly a surgical procedure. But with the new and developed devices, the ICD implantation is much easier and sufficient, and the patient will need to stay at the hospital for a night to make the procedure smooth. Apart from the transplant, there are other things that a patient has to do during implantation. In A-fib, usually, a dual-chamber implantable atrial defibrillator is used to monitor both the upper and lower part of the heart.
Though ICD implantation is a surgical procedure, it is not a critical or significant process that can cause harm. With experts leading the processes, it’s easy and less time-consuming. But as it is a surgical operation, there are always some risks involved that can be fatal to some patients, and sometimes they are pretty easy to overcome. They are:
When you are diagnosed with A-fib or any other cardiac disease, the first thing to do is make sure that the disease doesn’t progress. And that’s why the most crucial step is to engage in proper medications and medical assistance to treat life-threatening arrhythmias. Medications help suppress the disease’s growth to severe and avoid any surgical procedure. The patient has to engage in optimal physical activities to keep them fit, and weight has to be controlled to avoid further damage. Implanted devices perform cardioversion while maintaining sinus rhythm as a form of stroke prevention.
But if the patient has to have an implantable device like an ICD, the first thing to do is educate oneself about the process. There are certain things and rules that they have to go through and maintain to keep fit. With ICD implantation, the patient is given an ICD identification card which they should always keep close. Driving and extreme physical exercises should be avoided for a few days. Patients should be careful about their health problems and notify the doctor almost presently if something goes wrong. Defibrillator patients should avoid magnets and magnetic devices completely as the magnetic field interferes with the signal of the device.
Besides all these, defibrillators for atrial fibrillation are safe and sound procedures that don’t have any back draws and are effective in the long run.
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