Atrial Fibrillation

What is afib?

A normal heart beats rhythmically, about one contraction every second. Atrial fibrillation (afib) is a type of arrhythmia that causes the heart to beat erratically. When this happens, the two upper chambers of the heart (the atria) begin to flutter weakly instead of pushing blood forcefully into the lower chambers (the ventricles). Atrial fibrillation is a serious condition because it can allow blood to pool and clot in the atria. These clots might then circulate through the blood vessels to the lungs causing a pulmonary embolism or to the brain causing a stroke.

Afib results from a malfunction of the heart’s electrical system. Doctors can diagnose afib based on a person’s medical history, risk factors, and heart test results, such as EKG (electrocardiogram, or ECG), a Holter monitor, and other cardiac diagnostic and imaging tests.

Not everyone with afib experiences common symptoms like heart palpitations or feeling faint. If you don’t have symptoms, you may not require treatment. Sometimes the symptoms of afib occur only intermittently, a condition called paroxysmal atrial fibrillation. While any adult can develop atrial fibrillation, some people are at higher risk due to coexisting conditions like heart failure or having rheumatic fever as a child. The risk of afib increases with age—about 2% of the U.S. population younger than 65 have it compared to 9% of people older than 65, according to the Centers for Disease Control and Prevention.

When diagnosed early, afib often can be successfully treated with medications or minimally invasive procedures. Afib treatments include prescription medicine, cardioversion, and procedures to eliminate clusters of cells in the heart tissue causing the erratic contractions. With active monitoring and successful treatment of afib, most people can significantly reduce their risk of blood clots and other serious complications of afib.

What are the symptoms of atrial fibrillation?

Some people never develop afib symptoms, while others exhibit the classic signs and symptoms of this common arrhythmia.

Common symptoms of afib

People with afib may experience these symptoms:

• Feeling like your heart is beating too hard or skipping a beat (heart palpitations)

• Rapid heartbeat or irregular pulse

• Dizziness or fainting

• Shortness of breath, particularly when exercising

• General unexplained weakness

• Unexplained fatigue

If any of the symptoms of afib are accompanied by chest pain, seek emergency medical attention—dial 911. Also call 911 if you or someone you are with experiences signs or symptoms of stroke—face drooping on one side, loss of feeling in your leg or arm on one side of your body, severe headache, and difficulty speaking.

What causes afib?

Incorrect electrical signaling in the heart causes atrial fibrillation. Sometimes the heart’s ‘pacemaker’ cells send impulses out of sequence, which disrupts the natural heartbeat. Other times, new cells develop in areas of the heart where they do not belong and send spurious signals for the tissue to contract prematurely. Many conditions can cause these types of rhythm disruption including:

• High blood pressure (hypertension)

• Coronary artery disease (due to atherosclerosis, or hardening of the arteries)

• Heart failure

• Valve conditions such as mitral valve prolapse

• Heart disease caused by rheumatic fever in childhood

What are the risk factors for atrial fibrillation?

One of the main risk factors for afib is age. This is largely because of accumulated heart damage from such conditions and lifestyle habits as:

• Binge drinking

• Coexisting heart disease

• Diabetes

• Hyperthyroidism (overactive thyroid gland)

• Sleep apnea

Afib also affects more men than women.

Reducing your risk of atrial fibrillation

You may be able to lower your risk of afib by:

• Treating existing heart disease including hypertension and other conditions that raise the risk of afib

• Controlling your blood sugar

• Engaging in a heart-healthy lifestyle

• Not smoking, which will reduce your risk of heart disease

How is atrial fibrillation treated?

Not everyone requires treatment for afib. Your doctor usually will treat the condition if you have severe or persistent symptoms or if you have other underlying heart disease.

Afib treatment may include:

• Medicine to restore a normal heart rhythm or reduce the risk of blood clots forming within the heart

• Electrical cardioversion, a noninvasive treatment that delivers electrical impulses to the heart to re-set the natural rhythm

• Cardiac ablation with a catheter, a minimally invasive procedure that selectively destroys heart cells that may be producing errant electrical signals

• Catheter-guided closure of the left atrial appendage—a pouch connected to the left atrium—to prevent thromboembolism—potential blood clots from entering the blood stream

• Pacemaker implantation, in cases where the surgeon removes the heart’s natural pacemaker node to correct the arrhythmia

• Heart valve surgery, in cases where a faulty valve is causing afib

• Maze surgery, which is an open-heart procedure to restore a normal heart rhythm by making strategic incisions in the atria

What are the potential complications of afib?

Complications of atrial fibrillation can range from inconvenient and annoying to serious and life threatening.

Potential complications of atrial fibrillation are:

• Blood clot that travels to the brain causing a stroke or lungs causing a pulmonary embolism

• Heart failure

• Persistent shortness of breath

• Anxiety

• Chronic fatigue

You can help minimize your risk of serious complications by following the treatment plan you and your health professional design specifically for you. If you need treatment for afib or confirmation of an afib diagnosis, see a cardiac electrophysiologist, a cardiologist who specializes in arrhythmias. A reputable arrhythmia specialist will have the most up-to-date knowledge and expertise in afib treatments, including correcting the arrhythmia and reducing blood clot formation.