Atrial Fibrillation of the Valve: Symptoms, triggers, and further details
Valvular Atrial Fibrillation (AF) is a heart condition that affects the top chamber of the heart, known as the atrium. It is often caused by a heart valve disorder or an artificial heart valve.
For individuals with valvular AF, particularly those with mechanical valves or significant mitral stenosis, warfarin remains the standard recommended anticoagulant. Direct oral anticoagulants (DOACs) like Eliquis (apixaban) are contraindicated due to lack of efficacy and safety data or demonstrated harm in trials.
However, the scenario changes for Non-Valvular Atrial Fibrillation (NVAF). DOACs are now preferred over warfarin for NVAF because of better safety and similar or superior efficacy. Apixaban is often favoured among DOACs. For NVAF patients undergoing left atrial appendage occlusion (LAAO), some protocols suggest initial DOAC use post-procedure for 45 days until device endothelialization, then switching to antiplatelet therapy.
Current guidelines reinforce these points. Warfarin with INR monitoring is strictly recommended for valvular AF, especially with mechanical valves or significant mitral stenosis. DOACs like Eliquis are recommended for stroke prevention only in non-valvular AF. For valvular AF patients who cannot take warfarin, LAAO may be considered as an alternative to long-term anticoagulation, but careful multidisciplinary evaluation is advised.
Treatment for valvular AF often includes medication, particularly anticoagulants, to reduce the risk of stroke. Other treatment options may include catheter ablation, a procedure to destroy the tissue causing the fibrillation, or electrical cardioversion, a procedure that uses low-energy shocks to restore a normal heart rhythm.
Lifestyle changes can also help reduce a person's risk of stroke. Stopping smoking, getting regular exercise, managing stress, and maintaining a moderate weight are all lifestyle changes that can contribute to a lower risk of stroke.
Rheumatic fever is the most frequent cause of mitral valve stenosis, which can lead to valvular AF. An artificial or mechanical heart valve can also cause valvular AF.
Diagnosing valvular AF involves a physical exam, medical history, and tests such as an electrocardiogram, echocardiogram, blood tests, and cardiac MRI scan.
The outlook for valvular AF varies depending on whether a person receives proper treatment. Proper treatment and lifestyle changes can significantly reduce the risk of stroke. It's important to consult with a healthcare professional for accurate diagnosis and treatment.
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