Question 1

What is atrial fibrillation?

Accepted Answer

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia — where rapid, disorganised electrical impulses in the atria cause an irregular, often fast heart rhythm. The atria quiver rather than pump effectively, causing blood stasis — particularly in the left atrial appendage — leading to thrombus (clot) formation and risk of cardioembolic stroke. AF affects 37 million people globally and is a leading cause of preventable stroke, heart failure and death.

Question 2

What causes atrial fibrillation?

Accepted Answer

The major risk factors and causes of AF: age (prevalence doubles with each decade over 50 — the most important factor); hypertension (most common cause of AF globally); heart failure; coronary artery disease; valvular heart disease (especially mitral stenosis); sleep apnoea (present in >50% of AF patients); obesity (adipose tissue promotes atrial fibrosis and ectopic pulmonary vein triggers); alcohol (holiday heart syndrome — acute AF after binge drinking); hyperthyroidism; and genetic predisposition.

Question 3

How does AF cause stroke?

Accepted Answer

In AF, the atria do not contract effectively — blood pools in the left atrial appendage (LAA), forming clots (thrombi). These clots can dislodge into the systemic circulation, travel to cerebral arteries, and cause ischaemic stroke. AF-related strokes are typically more severe than atherosclerotic strokes (because cardioemboli are larger), more likely to cause significant disability, and more likely to be fatal. Up to 25% of ischaemic strokes are AF-related.

Question 4

What anticoagulants prevent AF strokes?

Accepted Answer

DOACs (direct oral anticoagulants) are the preferred anticoagulants for stroke prevention in non-valvular AF. The four approved DOACs — apixaban (twice daily), rivaroxaban (once daily), edoxaban (once daily), dabigatran (twice daily) — all reduce stroke risk by approximately 65-70% vs placebo and are generally safer than warfarin (lower risk of intracranial haemorrhage). Warfarin remains indicated for AF with mitral stenosis or prosthetic heart valves.

Question 5

When is anticoagulation not needed?

Accepted Answer

Anticoagulation is not recommended for AF patients at low stroke risk — men with CHA2DS2-VASc score 0, or women with score 1 (sex category is the only risk factor). All other eligible AF patients benefit from anticoagulation. The major barrier to treatment is bleeding risk — particularly in older patients on multiple medications, those with falls risk, or those with kidney dysfunction. A structured risk-benefit assessment using CHA2DS2-VASc and HAS-BLED scores guides decisions.

Question 6

What is catheter ablation?

Accepted Answer

Catheter ablation for AF involves threading thin flexible catheters through the femoral vein to the left atrium, where energy (radiofrequency heat or cryotherapy cold) is delivered to electrically isolate the pulmonary veins (where AF triggers arise in most patients). Pulmonary vein isolation (PVI) restores sinus rhythm in 60-80% of paroxysmal AF patients — with better results than antiarrhythmic drugs. ESC guidelines now recommend early ablation as a Class I indication for symptomatic paroxysmal AF.

Question 7

Can AF be prevented?

Accepted Answer

Risk factor modification can reduce AF risk and recurrence: blood pressure control (hypertension is the most modifiable AF risk factor); weight loss ≥10% dramatically reduces AF burden; treating sleep apnoea; alcohol reduction; and physical activity (paradoxically, extreme endurance sport increases AF risk — an exercise "U-curve"). The RACE 3 targeted therapy trial showed that intensive risk factor management reduced AF recurrence significantly compared to conventional care.

Question 8

What is "silent AF"?

Accepted Answer

Silent or asymptomatic AF — occurring without palpitations, breathlessness or other symptoms — is increasingly recognised through wearable devices (smartwatches with ECG function), opportunistic pulse checking and long-term cardiac monitoring. Up to 30% of AF is asymptomatic. Silent AF is particularly dangerous because it causes strokes without warning, in patients not on anticoagulation. Consumer wearables (Apple Watch, Fitbit) detecting irregular rhythms have created a new diagnostic paradigm — but also challenges of managing incidentally detected AF.

Question 9

How does AF relate to heart failure?

Accepted Answer

AF and heart failure have a bidirectional, mutually reinforcing relationship — each promoting the other. AF causes heart failure through uncontrolled ventricular rate and loss of atrial contractile contribution. Heart failure promotes AF through atrial dilation, fibrosis and elevated pressure. Together they are the most common cardiac diagnoses in older adults and together dramatically increase mortality risk. Rate and rhythm control, and treatment of both conditions simultaneously, is essential.

Question 10

How does GMJ News cover atrial fibrillation?

Accepted Answer

GMJ News covers ESC and AHA AF guidelines, DOAC approval and access data, ablation outcomes, AF detection through wearables and the stroke prevention treatment gap. AF is a major cardiovascular concern in Georgia — with an ageing population and high rates of hypertension — directly relevant to PHIG's cardiac health programme and the Georgian Medical Journal.

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