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What is atrial fibrillation

Atrial fibrillation, or AF, is the most common type of arrhythmia. Arrhythmias are a problem with the rate or rhythm of the heartbeat. In an irregular heartbeat, the heart can beat too fast or too slow, or with an irregular rhythm.

 

Atrial fibrillation occurs if the electrical signals are rapid and disorganized and reach two main chambers in the heart, called the atria, causing them to beat very quickly and irregularly.

In atrial fibrillation, blood is not completely pumped from the atria into the ventricles below. As a result, the heart’s upper (atria) and lower (ventricles) chambers do not work together as well as they should.

People with atrial fibrillation may not feel any symptoms. However, atrial fibrillation can increase the risk of stroke. In some people, it can cause chest pain or heart failure, especially if the heart rhythm is very fast.

Atrial fibrillation may occur rarely or occasionally, or it may become an ongoing or long-term problem that the heart has suffered for years.

Atrial fibrillation may be a temporary condition, with symptoms that come and go and go away on their own. Or it may be an ongoing condition that requires treatment. Sometimes atrial fibrillation is permanent, and medications or other treatments cannot restore a normal heart rhythm.

People suffering from atrial fibrillation can lead normal, active lives. For some people, treatment can restore normal heart rhythms.

For people who have had permanent atrial fibrillation, treatment can help control symptoms and prevent complications. Treatments may include medications, medical procedures, and lifestyle changes.

Types of atrial fibrillation

Paroxysmal atrial fibrillation

In paroxysmal atrial fibrillation, the false electrical signals and a rapid heart rate start suddenly and then stop on their own. Symptoms can be mild or severe. It stops in about a week, but usually in less than 24 hours.

Persistent atrial fibrillation

Persistent atrial fibrillation is a condition that causes an abnormal heart rhythm to persist for more than a week. It may stop on its own, or it may stop with treatment.

Permanent atrial fibrillation

Permanent atrial fibrillation is a condition in which the normal heart rhythm cannot be restored through treatment. Both persistent paroxysmal atrial fibrillation may become more frequent and, over time, lead to permanent atrial fibrillation.

Causes of atrial fibrillation

Atrial fibrillation (AF) occurs if the electrical signals of the heart do not cause atrial fibrillation through the heart in a normal way. Instead, it becomes very fast and disorganized.

Damage to the heart’s electrical system causes atrial fibrillation. The damage is most often the result of other conditions that affect heart health, such as high blood pressure and coronary heart disease.

The risk of atrial fibrillation increases with age. Inflammation is also thought to play a role in causing atrial fibrillation.

Sometimes, the cause of atrial fibrillation is unknown.

Risk factors

Atrial fibrillation (AF) affects millions of people. Men are more likely than women to suffer from this problem. In the United States, atrial fibrillation affects more white Americans than African Americans or Hispanics.

The risk of atrial fibrillation increases with age. This mostly happens because the risk of heart disease and other conditions that can cause atrial fibrillation also increases with age. However, half of people with atrial fibrillation are under the age of 75.

Atrial fibrillation is uncommon in children.

Major risk factors

Atrial fibrillation is more common in people with:

  • High blood pressure.
  • Coronary heart disease (CHD).
  • Heart failure.
  • Rheumatic heart disease.
  • Structural heart defects, such as mitral valve prolapse .
  • Pericarditis (a condition in which the membrane or sac around the heart is inflamed).
  • Congenital heart defects.
  • Sick sinus node syndrome (a condition in which the electrical signals of the heart do not fire properly, the heart rate slows, and the heart rate sometimes changes between a slow rate and a fast rate).
  • Atrial fibrillation is also more common in people who have had a heart attack or who have had an operation.

Other risk factors

Other conditions that increase the risk of developing atrial fibrillation include hyperthyroidism (too much thyroid hormones), obesity, diabetes, and lung disease.

Certain factors also can increase the risk of atrial fibrillation. For example, drinking large amounts of alcohol, especially binge drinking. Even modest amounts of alcohol can trigger atrial fibrillation in some people. Psychological stress may also trigger atrial fibrillation in some people.

Some data suggests that people with sleep apnea are more likely to experience atrial fibrillation. Sleep apnea is a common disorder that causes one or more pauses in breathing during sleep.

Metabolic syndrome also increases the risk of atrial fibrillation. Metabolic syndrome is the name for a group of risk factors that increase the risk of developing multiple sclerosis and other health problems, such as diabetes and stroke.

Research suggests that people who receive high-dose steroid therapy are at an increased risk for atrial fibrillation. This treatment is used for asthma and some inflammatory conditions. It may act as a trigger in people who have other risk factors for atrial fibrillation.

Genetic factors also may play a role in causing atrial fibrillation. However, its role is completely unknown.

Screening and prevention

Adopting a healthy lifestyle and taking steps to reduce your risk of heart disease may help prevent atrial fibrillation (AF). These steps include:

  • Eat a heart-healthy diet that’s low in saturated fat and cholesterol. A healthy diet includes a variety of whole grains, fruits and vegetables daily.
  • Non-smoking.
  • Do physical activity .
  • Maintain a healthy weight.

If you already have heart disease or other risk factors that increase your risk of developing atrial fibrillation, you must work with your doctor to manage your condition. In addition to adopting the healthy habits above, which can help control heart disease, your doctor may recommend:

  • Follow an eating plan to help lower your blood pressure .
  • Maintain cholesterol and triglycerides at healthy levels with dietary changes and medications (if prescribed).
  • Limit or avoid alcohol.
  • Control your blood sugar level if you have diabetes.
  • Get medical attention and take your medications as prescribed.

Symptoms of atrial fibrillation

Atrial fibrillation causes the pinene to contract faster than usual.

When this happens, the ventricles cannot completely fill with blood. Consequently, they may not be able to pump enough blood into the lungs and body. This can lead to signs and symptoms such as:

  • Palpitations (feelings that your heart is beating fast).
  • Shortness of breath.
  • Weakness or problems with exercising.
  • pain in chest.
  • Dizziness or fainting
  • Tired.
  • confusion.

Complications of atrial fibrillation

Atrial fibrillation has two major complications: stroke and heart failure.

brain attack

During atrial fibrillation, the upper chambers of the heart called the atria, do not pump all of the blood into the ventricles. It leaves some blood in the atria. When this happens, a blood clot can form.

If the clot disintegrates and travels to the brain, it can cause a stroke. (A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus.)

Blood-thinning medications that reduce the risk of stroke are an important part of treatment for people with atrial fibrillation.

Heart failure

Heart failure occurs if the heart cannot pump enough blood to meet the body’s needs. Atrial fibrillation can lead to heart failure because the ventricles pump blood too quickly and cannot completely fill with blood. Consequently, they may not be able to pump enough blood into the lungs and body.

Fatigue and shortness of breath are common symptoms of heart failure. Fluid accumulation in the lungs causes these symptoms. Fluid can also accumulate in the feet, ankles, and legs, causing weight gain.

Lifestyle changes, medications, procedures or surgery (rarely, a mechanical heart pump or heart transplant) are the main treatments for heart failure.

Diagnosing atrial fibrillation

Atrial fibrillation (AF) is diagnosed based on your medical and family history, physical examination, and results of tests and procedures.

Sometimes atrial fibrillation does not cause signs or symptoms. Thus, it can be diagnosed during a physical examination or an electrocardiogram when done for another purpose.

If you have atrial fibrillation, your doctor will want to know what causes it. This will help him devise a better treatment plan for the condition.

Participating specialists

Primary care physicians are often involved in the diagnosis and treatment of atrial fibrillation. These physicians include family practitioners and internists.

Doctors who specialize in diagnosing and treating heart disease also may be involved, such as:

Cardiologists. These are the doctors who diagnose and treat heart disease and its problems.

A doctor who specializes in arrhythmias.

Study medical and family history

Your doctor is likely to ask questions about:

Signs and symptoms: What are your symptoms? Have you had palpitations? Do you feel dizzy or short of breath? Are your feet or ankles swollen (a possible sign of heart failure)? Do you have any chest pain?

Medical history: Do you have other health problems, such as a history of heart disease, high blood pressure, lung disease, diabetes or thyroid problems?

Family medical history: Is there anyone in your family who has a history of atrial fibrillation? Has anyone in your family had heart disease or high blood pressure? Has anyone had thyroid problems? Does your family have a history of other illnesses or health problems?

Healthy habits: Do you smoke or drink alcohol or caffeine?

Physical exam

Your doctor will perform a complete heart examination. He or she will listen to your heart rate and rhythm and a blood pressure reading. Your doctor will likely check for any signs of heart muscle or heart valve problems. He or she will listen to your lungs for signs of heart failure.

Your doctor will also check for swelling in the legs or feet and look for an enlarged thyroid gland or other signs of hyperthyroidism (too much thyroid hormones).

Diagnostic tests and procedures

 

Electrocardiogram

An electrocardiogram is a simple, painless test that records the heart’s electrical activity. It is the most useful test for diagnosing atrial fibrillation.

An electrocardiogram (ECG) shows how fast and rhythm your heart is (steady or irregular). It also records the strength and timing of the electrical signals that pass through your heart.

A standard ECG only records the heartbeat for a few seconds. It will not detect atrial fibrillation that does not occur during the test. To diagnose paroxysmal atrial fibrillation, your doctor may ask you to wear a portable ECG machine that can record the heartbeat for longer periods.

The two most common types of portable ECG devices are a Holter and an event monitor (event monitor).

A Holter monitor records the heart’s electrical activity for a full 24 or 48 hours. You will place small patches called electrodes on your chest. The wires will be connected to these spots and the portable recorder. The recorder can be put in your pocket, or hung around your neck.

You will be wearing a Holter monitor while performing your normal daily activities. This allows the monitor to record your heart for longer than a standard EKG.

The Event Monitor looks like a Holter screen. You can wear it to monitor symptoms while doing your normal activities. However, the Event Monitor only records your heart’s electrical activity at certain times while you wear it.

For many event monitors, you can press the button to start the screen when you feel symptoms. The device then starts up automatically when it senses abnormal heart rhythms.

You can wear an event monitor for weeks or until symptoms occur.

Stress test

Some heart problems are easy to diagnose when your heart is working too hard and beating fast. During a stress test, you can do exercises to get your heart to work hard and beat quickly while the heart tests are being done. If you can’t exercise, you may take medication to make your heart work harder and beat quickly.

Echocardiography

An echocardiogram (ECHO) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well the heart cavities and valves are working.

Echo can also identify areas of poor circulation and blood flow to the heart, areas of the heart muscle that do not contract normally, and previous injury to the heart muscle caused by poor blood flow.

This test is painless and noninvasive (no body equipment is inserted). For the test, a device called a transducer is moved back and forth over your chest. The device sends special sound waves through the chest wall to your heart.

Sound waves bounce off the structures of your heart, and a computer converts them into images on a screen.

Transesophageal echocardiography

It uses transesophageal echo or sound waves to create images of your heart through the esophagus. The esophagus is the passage from your mouth to your stomach. The upper chambers of the heart, known as the atria, are deep in your chest. It often cannot be viewed very well with a trans-thoracic echo. Your doctor can see the atria much better using transesophageal echocardiography.

During this test, a transducer is placed at the end of a flexible tube. The tube inserts down your throat and into your esophagus. You will likely be given medication to help you relax during the procedure.

Transesophageal echocardiography is used to detect blood clots that may have formed in the atria due to atrial fibrillation.

Chest x-ray

A chest X-ray is a painless test that creates images of the internal structures in your chest, such as your heart and lungs. This test can show fluid buildup in the lungs and signs of other ventricular fibrillation complications.

Blood tests

Blood tests check the level of thyroid hormone in your body and the balance of your body’s electrolytes. Electrolytes are minerals that help maintain fluid levels and the acid-base balance in the body. It is necessary for normal health and the functioning of the body’s cells and organs.

Treating atrial fibrillation

Treatment for atrial fibrillation (AF) depends on how often the symptoms come, how severe they are, and whether you really have heart disease. General treatment options include medications, medical procedures and lifestyle changes.

Treatment goals

The goals of treating atrial fibrillation include:

  • Preventing blood clots from forming, thus reducing the risk of stroke.
  • Control of the number of times the ventricles beat per minute. This is called rate control. Control of the rate is important because it gives the ventricles enough time to fill completely with blood. With this approach, the abnormal heart rhythm continues, but you will feel better and have fewer symptoms.
  • Restore a normal heart rhythm. This is called tempo control. Controlling the rhythm allows the atria and ventricles to work together to pump blood efficiently to the body.
  • Treating any underlying disorder can increase the risk of atrial fibrillation, for example, an overactive thyroid gland.

Who needs to treat atrial fibrillation?

People who have atrial fibrillation but do not have symptoms or related heart problems may not need treatment. Atrial fibrillation may return to a normal heart rhythm on its own. (This can also happen in people who have this problem along with symptoms.)

In some people with atrial fibrillation for the first time, doctors may choose to use an electrical procedure or medications to restore a normal heart rhythm.

Frequent occurrence of atrial fibrillation tends to cause changes in the heart’s electrical system, resulting in persistent or permanent atrial fibrillation. Most people with persistent or permanent atrial fibrillation need treatment to control the heart rate and prevent complications.

Certain types of treatment

Preventing clots

People with atrial fibrillation are at an increased risk of having a stroke. This happens because blood can pool in the heart’s upper chambers (atria), causing a blood clot to form. If the clot disintegrates and travels to the brain, it can cause a stroke.

Preventing blood clots from forming is probably the most important part of treating atrial fibrillation. The benefits of this type of treatment have been proven in multiple studies.

Doctors prescribe blood-thinning medications to prevent blood clots. These medications include warfarin, dabigatran, heparin, and aspirin.

People who take blood-thinning medications need regular blood tests to check how well the drugs are working.

Control the heart rate

Doctors may prescribe medications to slow the pulse rate of the ventricles. These medications help bring the heart rate within the normal range.

Rate control is the recommended treatment for most patients who have atrial fibrillation, although the heart rhythm is still abnormal and the heart is not working as it should. Most people feel better and would function well if their heart rates were well controlled.

Medicines used to control the heart rate include beta blockers (for example, metoprolol and atenolol), and calcium channel blockers (diltiazem and verapamil), and many other drugs are also available.

Control the rhythm of the heartbeat

Restoring and maintaining a normal heart rhythm is the recommended treatment approach for people who do not improve well with control heart rate therapy. This treatment may also be used for people who have recently had atrial fibrillation. The long-term benefits of controlling rhythm have not been conclusively proven yet.

Doctors use medications or procedures to control the heart rhythm. Patients often begin rhythm control therapy in the hospital so that their hearts are closely watched.

Restoring a normal rhythm also becomes less likely if the atria widen or if any underlying condition in the heart gets worse. In these cases, the chance that atrial fibrillation will recur is high, even if you take medication to help convert atrial fibrillation to a normal rhythm.

Medicines used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. Sometimes older medicines such as quinidine, procainamide, disopyramide are used.

Your doctor will carefully customize the dosage and type of medications he or she prescribes to treat your atrial fibrillation. This is because the medicines used to treat atrial fibrillation can cause a different type of irregular heartbeat.

These medications also can harm people with underlying diseases of the heart or other organs. This is especially true for patients who have an unusual heart rhythm problem called Wolff-Parkinson-White syndrome.

Your doctor may start you on a small dose of medication and then gradually increase your dose until symptoms are controlled. Medicines used to monitor rhythm regularly may be given by injection in a doctor’s office or hospital. Or, you may take the pills routinely to try to control or prevent atrial fibrillation from recurring.

If your doctor knows how you will react to the drug, he or she may prescribe a specific dose to take as needed if you have episodes of atrial fibrillation.

Doctors may use several procedures to restore a normal heart rhythm. For example, electrical cardioversion may be used to treat a fast or irregular heartbeat. For this procedure, you will be exposed to low-energy shocks to trigger your normal heart rhythm. You may be called to sleep temporarily before receiving shocks.

Electrical cardioversion is not the same as emergency cardioversion as we see it on TV shows. It is planned in advance and is done under carefully controlled conditions.

Before performing an ECG, your doctor may recommend a transesophageal echocardiogram. This test can rule out blood clots in the atria. If clots are present, you may need to take blood-thinning medications before the procedure. These medications can help get rid of clots.

Catheter ablation may be used to restore a normal heart rhythm if medications or electrical cardioversion do not work. For this procedure, a wire is inserted through a vein in the leg or arm attached to the heart.

Radio wave energy is sent through a wire to destroy abnormal tissues that may disrupt the normal flow of electrical signals. An electrophysiologist usually performs this procedure in a hospital. Your doctor may recommend a transesophageal echocardiogram before catheter ablation to check for blood clots in the atria.

Sometimes doctors use catheter ablation to destroy the AV node. This node is where the heart’s electrical signals travel from the atria to the ventricles (the lower chambers of the heart). This procedure requires the doctor to surgically implant a device called a pacemaker, which helps maintain a normal heart rhythm.

To date, research on the benefits of catheter ablation as a treatment for atrial fibrillation is ongoing.

Approach to address underlying causes and reduce risk factors

Your doctor may recommend treating the underlying cause of atrial fibrillation or to reduce risk factors. For example, he may prescribe medications to treat hyperthyroidism, to lower high blood pressure, or to manage high cholesterol.

Your doctor may also recommend lifestyle changes, such as eating a healthy diet, limiting salt intake (to help lower blood pressure), quitting smoking, and reducing stress.

Limiting or avoiding alcohol, caffeine, or other stimulants that may increase your heart rate can also help reduce the risk of atrial fibrillation.

Living with atrial fibrillation

People with atrial fibrillation (AF), even if it is permanent atrial fibrillation, can lead normal, active lives.

You must keep all of your medical appointments. Bring a list of all medications you take for each doctor or emergency room visit. This will help your doctor know exactly what medicines you are taking.

Follow your doctor’s instructions for taking medications. Be careful when taking over-the-counter medications, nutritional supplements, and allergy medications. Some of these products contain stimulants that can trigger a fast heart rhythm. Also, some over-the-counter medications can have harmful interactions with heart rhythm control medications.

Tell your doctor if your medications cause side effects, if your symptoms get worse, or if you have new symptoms.

If you are taking blood-thinning medications, you will need close monitoring. For example, you may need routine blood tests to check how the medications are working. Also, talk to your doctor about your diet. Certain foods, such as green leafy vegetables, may interact with warfarin, a medicine used to thin the blood.

Ask your doctor about physical activity, weight control, and alcohol consumption. Learn what steps you can take to manage your condition.

Source

National Heart, Lung, and Blood Institute, National Institutes of Health, United States Department of Health and Human Services.

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