Atrial Fibrillation

A heart condition in which an irregular or fast heart rhythm occurs is called atrial fibrillation (AFib). However, irregular heart rhythm is another condition of the heart called arrhythmia. Atrial fibrillation may lead to blood clots in the heart as well as other conditions. These include heart failure, stroke, and others.

In people with AFib, the upper chambers of the heart (atria) beat irregularly and chaotically, and they do not sync with the lower heart chambers (ventricles). While most people with atrial fibrillation do not experience symptoms, some of them may notice a fast or pounding heartbeat, shortness of breath, or lightheadedness.

The episodes of this heart condition may come and go, or they can be persistent. Generally, this is not a life-threatening condition. Anyway, proper treatment is required to prevent complications (such as stroke).

Usually, treatment for atrial fibrillation includes medications, therapy that helps the heart return to a regular rhythm, and other procedures (used to block faulty heart signals). Commonly, people with AFib also have atrial flutter (a related heart rhythm problem) that is treated with the same options as atrial fibrillation.

Symptoms

Not everyone with atrial fibrillation experiences symptoms, but when they occur may include the following ones. Examples include:

Lightheadedness
Fatigue (extreme tiredness)
Dizziness
Chest pain
Decreased ability to exercise
Weakness
Shortness of breath
Palpitations (also known as a fast, fluttering, or pounding heartbeat)

Usually, people experience atrial fibrillation differently. This heart condition can be:

Occasional (also known as paroxysmal atrial fibrillation) – In such cases, the symptoms come and go and often last between several minutes to hours. However, not everyone with occasional atrial fibrillation needs treatment.
Persistent – In people with this type of AFib, the irregular heartbeat is constant, and the heart rhythm does not rest on its own. Therefore, treatment is required to return the heartbeats to a regular rhythm.
Long-standing persistent – People with this type of atrial fibrillation experience symptoms for long periods (sometimes longer than 12 months). However, the heart rhythm returns to normal with medicines and procedures.
Permanent – Those who suffer from permanent atrial fibrillation, irregular heart rhythm, cannot be reset. Hence, people should take medicines that control their heart rate for the rest of their lives to prevent blood clots in the heart.

If you or a loved one experiences any of the symptoms listed above, immediately contact your healthcare professional. You should also go to the nearest emergency room or call 911 in the U.S. if you experience sudden chest pain because it may indicate a myocardial infarction.

Causes

Normally, to understand why atrial fibrillation happens, we should know how the heart works in normal circumstances.

The heart has 4 chambers, the upper two called atria and the lower two called ventricles. Each heartbeat begins in the upper right chamber of the heart, where sinus nodes (a group of cells) are located. Thereafter, the signals go across the upper heart chambers and arrive at the AV node (a group of cells that slow the signals). Then these signals move to the lower heart chambers.

Usually, the heart rate is from 60 to 100 beats per minute when we rest.

In people with AFib, the signals that begin from the upper heart chambers are chaotic. Thus, the atria shake and tremble, and the AV node is flooded with signals that try to move through to the ventricles. As a result, an irregular heart rhythm occurs. Commonly, people with AFib have a heart rate that ranges from 100 to 175 beats per minute.

What Causes Atrial Fibrillation?

In most cases, people develop this heart condition due to problems with the heart’s structure. However, it may happen due to other health conditions or problems. Examples include:

Sleeping disorders (for example, obstructive sleep apnea)
Myocardial infarction
Hypertension (high blood pressure)
Problems with the heart’s natural pacemaker (known as sick sinus syndrome)
Congenital heart defects
Heart valve disease
Lung conditions (such as pneumonia)
Coronary artery disease (narrowed or blocked arteries)
Viral infections
Thyroid diseases (such as hyperthyroidism or hypothyroidism)

Atrial fibrillation may also happen due to heart surgery or stress caused by the surgery. Furthermore, some people with this condition do not have heart disease or heart damage. Check below for some factors that may trigger an AFib episode:

Illegal drug use
Heavy alcohol drinking
Smoking
Certain medicines that contain stimulants (such as cold and allergy medications)

Risk Factors

Healthcare providers have identified some factors that could elevate your risk of developing atrial fibrillation. Examples include:

Age – The risk of AFib increases with aging.
Caffeine, nicotine, or illegal drug use – The heart begins to beat faster when drinking caffeine, smoking, or using illegal drugs (such as amphetamines and cocaine). However, using previous substances for long periods may lead to a severe form of arrhythmia.
Heavy alcohol drinking – If you drink large amounts of alcohol, it may negatively affect the heart’s electrical signals, which increases the risk of AFib.
Body mineral level changes – These minerals are also called electrolytes. For example, Calcium, Magnesium, Sodium, Potassium, and others. Thus, too high or too low electrolyte levels may lead to irregular heartbeats.
Family history – If you have a sibling or parent with atrial fibrillation, your risk of developing it increases significantly.
Heart problems or heart surgery – Heart surgery or certain heart conditions (such as congenital heart defects or coronary artery disease) also increase the risk of AFib.
Hypertension (also called high blood pressure) – Those who experience this condition for a long time are at higher risk of irregular heartbeats. Over time, hypertension makes the heart muscle thick and stiff.
Obesity – Excessive body weight puts extra strain on the heart, which significantly increases the risk of AFib.
Chronic health conditions – People with long-term (chronic) conditions are more likely to develop AFib. These include lung disease, sleep apnea, chronic kidney disease, diabetes, and others.
Certain medications and supplements – Some over-the-counter (OTC) supplements and prescription medications may cause irregular heartbeats. Do not take any medicines or supplements without a doctor’s approval.
Thyroid conditions – The risk of irregular heartbeats increases significantly in people with an overactive thyroid gland (also called hyperthyroidism).

What Are The Possible Complications of Atrial Fibrillation?

One of the most serious complications of AFib is blood clots, which may lead to a stroke. Without treatment, this heart condition may cause some complications. For example:

Hypertension
Diabetes
Heart failure
Heart valve disease

In most cases, physicians prescribe blood thinners (also known as anticoagulants) for people with AFib to prevent blood clots.

How to Prevent Atrial Fibrillation?

Generally, a healthy lifestyle can reduce the risk of this heart condition. Check below for some tips that may help prevent atrial fibrillation:

Manage chronic health conditions (such as hypertension, diabetes, high cholesterol, and others)
Quit smoking or never begin. If you face problems with smoking cessation, discuss it with your healthcare professional.
Regular physical exercise (it is advised to aim for at least 30 minutes of physical exercise per day)
Get good sleep (normally, an adult should sleep from 7 to 9 hours per day)
Try to get and maintain a healthy weight
Reduce stress

Diagnosis

A lot of people have this condition but do not know about it because they do not experience symptoms. Therefore, atrial fibrillation is often found during examinations for other health conditions.

Usually, to diagnose this condition, doctors will perform a physical examination and ask some questions about your medical and family history. They may also perform some tests to check for an underlying condition as well as confirm AFib. Below are some tests often performed by doctors to diagnose this heart condition:

Blood tests – These tests are used to check for underlying conditions or substances that negatively affect the heart or heartbeat.
Electrocardiogram (ECG or EKG) – This is a quick test used to measure the heart’s electrical activity. During this test, certain sticky patches (electrodes) are placed on the arms, chest, and legs (sometimes). Thereafter, these electrodes are connected to a computer that displays the results of the test. An EKG may show irregular heart rhythms.
Holter monitor – This is a small device used to record the heart’s activity.
Event recorder – It is a device similar to a Holter monitor, but it records the activity of the heart in some cases only. Usually, this device is worn for approximately 1 month, and it automatically records an irregular heart rhythm when it occurs.
Implantable loop recorder – This is a specific device used to record heartbeats for years. Sometimes, it is called a cardiac event recorder. It may identify abnormal heart rhythms and how often you experience AFib episodes.

Additional Tests

Echocardiogram – This test uses sound waves to make images of the beating heart. It also shows how the blood flows through the heart and its valves.
Exercise stress tests – During this procedure, doctors will test the heart while you are walking on a treadmill or riding a stationary bike. It shows how your heart reacts to physical activity.
Chest X-ray – This is an imaging test used to check for heart and lung diseases.

Treatment

The treatment goal is to reset and control the heartbeat and prevent blood clots. However, treatments are different among people because they depend on how long you have had AFib, the severity of the condition, symptoms, age, and the exact cause of the heart disease. Healthcare professionals usually prescribe medicines, therapies to reset the heart rhythm (also called cardioversion), surgery, and other procedures.

If you ignore the symptoms and do not treat the condition, it may lead to life-threatening complications such as heart failure, stroke, and others.

Medicines

The following medicines are often prescribed by doctors to control heartbeats, restore heart rate, and prevent blood clots. Check below for some examples:

Beta-blockers – This group of medicines is used to slow the heart rate.
Calcium channel blockers – The following medicines are prescribed by doctors to control the heart rate. However, it is not allowed for people with heart failure or hypotension to use these medications. Doctors often recommend Diltiazem, Felodipine, Amlodipine, and Verapamil.
Digoxin – This is a medicine used to control the heart rate at rest. However, it is not effective during activity, and physicians may also recommend calcium channel blockers or beta-blockers.
Anti-arrhythmics – Medicines used to treat irregular heart rhythms.
Blood thinners (also called anticoagulants) – These medicines are used to prevent blood clots and decrease the risk of a stroke. Physicians usually recommend Warfarin, Apixaban, Dabigatran, Edoxaban, or Rivaroxaban.

Cardioversion Therapy

Some people may experience symptoms that interact with their daily activities. In such cases, physicians may recommend cardioversion to reset the heart rhythm. This procedure can be done in two ways. For example:

Electrical cardioversion – The electrical type involves small electrical impulses sent to the heart to reset the heart rhythm.
Drug cardioversion – In such cases, physicians try to reset the heart rate with intravenous (IV) medicines. Sometimes, they may recommend oral medications.

In most cases, cardioversion is done in the hospital under medical supervision. Furthermore, this procedure can be used in emergencies. When needed, people usually take blood thinners several weeks before cardioversion.

Most people after electrical cardioversion need medicines to control their heart rate for life to prevent AFib episodes. Unfortunately, episodes of this heart condition may occur even with medications.

Surgery and Other Treatments

Some people need cardiac ablation, a procedure used when other treatments (such as cardioversion or medicines) do not work. In more severe cases, cardiac ablation is the primary treatment.

This treatment involves heat or cold energy to make small scars in the heart. It helps disrupt irregular heart signals and restore heartbeats. During this treatment, surgeons will insert a catheter (a flexible tube) through an artery (commonly in the groin) and then guide it to the heart. Sometimes, multiple catheters are required.

There are multiple types of cardiac ablation. Check below for some examples:

Atrioventricular (AV) node ablation – This type involves applying heat energy to the heart tissue at the AV node. It destroys the electrical signal connection. People who choose this treatment usually need a pacemaker for life.
Maze procedure – This procedure involves cold or heat energy to make a pattern or maze of scar tissue in the atria (upper chambers of the heart). Scar tissue does not send signals, which makes the maze interfere with heart signals that cause atrial fibrillation. In some cases, the maze procedure is used to make a maze before an open-heart surgery.
Hybrid atrial fibrillation ablation – This treatment combines ablation with surgery. In most cases, doctors recommend this treatment for people with long-standing, persistent atrial fibrillation.
Pulsed field ablation – It involves high-energy electric pulses to make scar tissue in the heart. This treatment can be used for people with some types of continued AFib.

However, this condition may return after cardiac ablation. In such cases, doctors may recommend additional heart treatment or another ablation. In addition, people after cardiac ablation should take anticoagulants for the rest of their lives.

Home Remedies

The following tips may help prevent or treat the underlying conditions. For example:

Adopt a heart-healthy diet full of fresh fruits, vegetables, and whole grains. Limit sugar, salt, and saturated fats.
Regularly perform physical exercise (you should aim for at least 30 minutes of physical exercise per day).
Quit smoking
Maintain a healthy weight
Manage chronic health conditions (such as hypertension, diabetes, high cholesterol, and others)
Limit or avoid alcoholic drinks
Get good sleep

Frequently Asked Questions

Can you live with AFib without treatment?

Yes, but it is important to know that this condition significantly increases the risk of certain life-threatening conditions. These include heart failure, stroke, and others. If you suspect you have AFib, immediately visit a doctor.

What is the life expectancy of someone with atrial fibrillation?

As per studies, people with AFib show a reduced life expectancy (a loss of about 2.6 years) compared to people without this condition. In any case, those who suffer from AFib can still live normally with proper management.

What is the biggest trigger for AFib?

Generally, there are a lot of factors that may trigger an atrial fibrillation episode. However, people experience AFib episodes when drinking large alcohol amounts, especially in a short period. Other triggers include illegal drugs, dehydration, chronic health conditions, sleep disorders, and others. If you have additional questions, ask your healthcare provider.