Definition
What is atrial fibrillation?
Atrial fibrillation (also called AFib) is a heart condition characterized by a fast, irregular heartbeat, or arrhythmia.
Sinus rhythm is the name used to denote a normal heart rhythm. In a healthy heart, the beat is regulated by an intricate electrical system that ensures the upper and lower chambers, known as the atria and ventricles, work harmoniously. This synchronized action results in an effective, steady heartbeat ranging from 60 to 100 beats per minute for an average adult. Normal sinus rhythm allows the heart to optimally fill with blood and efficiently pump it to feed the body's tissues, providing much-needed oxygen, nutrients, and hormones while also removing any waste products.
In contrast, a heart with AFib experiences chaotic electric signals which causes the atria to quiver or "fibrillate" instead of contracting normally. While the ventricles also attempt to keep pace with these rapid signals, they typically can't, resulting in a fast, irregular heartbeat. With atrial fibrillation, heart rates can race up to 150 beats or even higher per minute. Because AFib impairs the heart’s effectiveness in pumping blood, a person may experience symptoms such as fatigue, breathlessness, and palpitations. If left untreated, it can lead to blood clots, stroke, heart failure, and other heart-related complications.
How common is atrial fibrillation?
Atrial fibrillation is one of the most common heart rhythm disorders, affecting millions of people worldwide, with estimates suggesting that around 2-3% of the global population has AFib.
Facts about AFib in America:
- In 2020, an estimated 6-8 million Americans had AFib
- By 2030, projections indicate 12.1 million people will have AFib
- Nine percent of people 65-plus have been diagnosed with AFib, versus two percent of those younger than 65.
- The Caucasian population has a higher incidence of AFib
Symptoms & Causes
What are the symptoms of atrial fibrillation?
Symptoms for AFib can vary widely and present differently among individuals. Some people may have severe and frequent episodes, others less so or intermittent, and some may not experience any symptoms at all.
Common symptoms of AFib include:
- Palpitations
- Fatigue
- Shortness of breath
- Chest discomfort
- Fainting
- Dizziness or lightheadedness
What are the causes and risks of atrial fibrillation?
AFib is often caused by a combination of conditions and risk factors. While it may occur without any identifiable cause in some cases, the following list of factors can contribute to its development.
Medical Conditions commonly associated with the development of AFib include:
- Hypertension
- Coronary Artery Disease (CAD)
- Valvular heart disease
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Pericarditis
- Hyperthyroidism
- Sleep apnea
- Chronic kidney disease
Other Risk factors that can increase the likelihood of developing AFib are:
- Age: chances increase as we age, especially in individuals over 60 years old
- Unhealthy lifestyle: excessive alcohol consumption, smoking, obesity, and lack of physical activity
- Stress: chronic stress and anxiety may contribute to its development or exacerbation
- Certain medications: such as stimulants, some asthma medications, and certain types of cancer treatments
- Electrolyte imbalances: Abnormal levels of electrolytes in the blood (such as potassium, magnesium, or calcium)
Sometimes AFib occurs in younger patients with structurally normal hearts and no obvious causes.
What are the side effects of atrial fibrillation?
AFib can lead to various complications and side effects, some of which can be serious or life-threatening. These include:
- Stroke: Increases the risk of blood clots which can cause a stroke.
- Heart failure: Can weaken the heart muscle over time and lead to heart failure.
- Atrial remodeling: This can cause structural changes to the heart's atria, making it more difficult to restore and maintain normal heart rhythm even with treatment.
- Increased risk of other heart rhythm disorders: AFib can trigger or worsen other heart rhythm disorders, such as atrial flutter or ventricular arrhythmias.
- Cognitive impairment: It can increase the risk of cognitive decline and dementia.
- Decreased quality of life: Symptoms can limit daily activities and reduce overall well-being.
- Emotional impact: Persistent symptoms can lead to anxiety and depression.
Diagnosis & Treatment
How is atrial fibrillation diagnosed?
AFib is definitively diagnosed through an Electrocardiogram (EKG).
If your AFib is sporadic and difficult to capture at your physician’s office, we can record your heart activity for a more extended period using at-home diagnostic testing, such as:
- Holter Monitor/ambulatory EKG
- Portable Event monitors
- Pulse check
- Smartphone applications, smartwatches, and fitness trackers
- Remote monitoring systems: often used in conjunction with implanted cardiac devices such as pacemakers or implantable cardioverter-defibrillators (ICDs) to continuously monitor the heart's electrical activity and detect AFib episodes.
Are there different AFib classifications that determine its severity?
While there is no standard, universal staging system for AFib, it’s often classified by type based on its duration, persistence, and the presence of structural heart disease. Commonly used classifications include:
- Paroxysmal AFib: This type is characterized by sporadic episodes that last seconds or longer, usually resolve within 24-48 hours, and do not last longer than seven days. While treatment may include medications, lifestyle changes such as reducing caffeine or stress may be sufficient.
- Persistent AFib: This type is defined as lasting more than seven days and less than one year. It requires intervention (medication or electrical cardioversion) to restore normal sinus rhythm.
- Long-standing persistent AFib: This type refers to AFib that has lasted continuously for more than one year. Invasive treatment, such as a pacemaker implantation or catheter ablation, is generally required.
- Permanent AFib: The patient’s AFib is now considered a chronic condition. Treatment decisions no longer include attempts to restore or maintain normal sinus rhythm, but, instead, focus solely on controlling symptoms and preventing complications.
How is atrial fibrillation treated?
MemorialCare’s cardiac team is recognized as a leader in the diagnosis and treatment of all types of arrhythmia. Our physicians carefully evaluate each patient’s condition to design and implement a treatment plan that meets their individual needs. Treatments focus on controlling symptoms, restoring normal heart rhythm when possible, preventing complications such as stroke and heart failure, and improving quality of life.
Treatment options may include:
- Medications such as antiarrhythmic drugs and beta-blockers: May stop the arrhythmia from occurring, lower blood pressure, or regulate heart rhythms
- Blood thinners: Help keep blood clots from forming
- Electrical cardioversion: Uses electrical shocks to restore the heart to a normal rhythm
- Catheter ablation: Uses heat or cooling to destroy the abnormal heart tissue
What should one expect during and after AFib treatment?
For patients being treated with medication therapies, general follow-ups with their provider usually occur every 3-6 months to review health and adjust treatment, with additional monitoring for symptom changes or other health conditions. Additionally, routine blood tests to monitor organ function are necessary.
For patients undergoing a surgical procedure, they may need to recover in the hospital for a few days so their pain can be managed, and their heart continuously monitored. Initially, their activity will be restricted, followed by a gradual reintroduction of light activities. Medications, including antiarrhythmics and anticoagulants, may be continued to maintain heart rhythm and prevent complications. Regular follow-up appointments with their cardiologist will be recommended, starting frequently and then less often, and include ECGs and other tests to monitor heart function. Long-term follow-up every 6-12 months is generally necessary, and ongoing medication use may be required to reduce the risk of stroke or AFib recurrence.
Additionally, treating AFib long-term involves adopting a heart-healthy lifestyle with a balanced diet, regular exercise, and avoiding triggers like alcohol and smoking. Participation in cardiac rehabilitation and emotional support through counseling or support groups may be recommended and include educating patients on recognizing symptoms that need immediate medical attention.
Prevention
Can atrial fibrillation be prevented?
Preventing AFib entirely may not always be possible, as some risk factors, such as age and genetic predisposition, cannot be modified. However, there are steps one can take to reduce the risk of developing it and minimize the likelihood of AFib-related complications. Here are some strategies for AFib prevention:
- Maintain a healthy lifestyle
- Manage underlying health conditions
- Monitor and control heart rhythm
- Manage stress
- Limit alcohol and caffeine intake
- Get regular medical check-ups
- Follow treatment recommendations
Is atrial fibrillation curable?
AFib is generally not considered curable, but it can be effectively managed. The goal of treatment is to control symptoms, reduce the risk of complications such as stroke, and improve quality of life.
For some individuals, treatment strategies such as medications or procedures (e.g., catheter ablation) may be successful in restoring and maintaining normal sinus rhythm, effectively eliminating AFib episodes.
For others, it can be more challenging, as AFib may recur despite treatment efforts. In these cases, treatment strategies focus on managing the condition by controlling symptoms, reducing the frequency and severity of AFib episodes, and preventing complications such as stroke and heart failure.
It’s important to note that many individuals living with AFib can achieve effective symptom control and lead active, fulfilling lives with appropriate treatment and lifestyle modifications. Regular follow-up with your doctor is recommended to monitor the condition, adjust treatment as needed, and address any new symptoms or complications.
FAQ About Atrial Fibrillation
While age is one of the most important risk factors for atrial fibrillation, it can affect individuals of all ages. The prevalence of AFib increases significantly with age, with the majority of individuals diagnosed over the age of 65. Plus, the incidence of AFib increases significantly with each decade of life beyond this age.
However, although rarer, AFib can also develop in children and younger adults, particularly in those with predisposing risk factors, such as genetics, unhealthy lifestyle choices (e.g., excessive alcohol, caffeine, stress), medical conditions (e.g., hyperthyroidism, diabetes), or underlying heart conditions (e.g., structural heart abnormalities, congenital heart defects). When a younger person is diagnosed with AFib, it is often referred to as ‘lone atrial fibrillation.’
A person can have atrial fibrillation and experience no symptoms. Various studies have estimated that about a third of AFib patients present asymptomatic. They may even be unaware they have AFib as they do not experience the characteristic symptoms of this condition, such as palpitations, shortness of breath, or fatigue. Instead, it is usually only discovered during routine medical examinations, diagnostic tests or cardiac monitoring.
It’s important to note that even without noticeable symptoms, asymptomatic AFib can be just as dangerous – or more so if not treated – and lead to the same cardiovascular complications as symptomatic AFib.
It is important to continuously monitor your AFib for any changes. While symptoms can vary from person to person, some common signs that may indicate that your AFib is worsening or becoming more symptomatic include the following: a significant increase in heart palpitations or significant fluctuations in your heart’s rhythm; any new symptoms that arise, such as shortness of breath, chest pain, fatigue, dizziness or fainting; greater difficulty exercising; or a rise in symptoms associated with heart failure or stroke, such as weakness or numbness on one side of the body, difficulty speaking, swelling legs or abdomen or fluid retention.
If you notice any concerning changes in your symptoms, it’s important to discuss them with your doctor. If you are experiencing symptoms associated with a stroke, go to the hospital since, left untreated, a person with AFib is five times as likely to suffer a stroke, heart failure, or other heart-related complications.
People with AFib face a higher risk of having a stroke. When the heart’s contractions become irregular, as they do with AFib, normal blood flow is disrupted, creating ideal conditions for blood to pool and clot in the atrium. These clots become dangerous as they can break off, travel to the brain, and block the flow of oxygen and nutrient-rich blood essential to brain function.
While blood thinner medications can help reduce a person’s chances, the risk of stroke in any one AFib patient is related to associated medical conditions, including coronary artery disease, high blood pressure, age, diabetes, atherosclerosis, and a history of previous stroke.
One common stroke risk calculator we use is CHADS2-VASC score. The patient's risk score will determine which blood thinner medication, if any, should be prescribed.
Blood thinners include:
• Warfarin (Coumadin)
• Rivaroxaban
• Apixaban
• Dabigatran
If a patient is not a candidate for long-term blood thinners because of previous bleeding or risk of falls, then we offer alternative stroke prevention solutions such as the WATCHMAN™ or surgical AtriClip.
The most common procedure for atrial fibrillation is catheter ablation. This procedure involves inserting thin, flexible tubes (catheters) into the blood vessels and guiding them to the heart, where they are used to target and disrupt abnormal electrical pathways or triggers that cause AFib. Through techniques such as radiofrequency energy, cryotherapy, or pulse field ablation, small scars or lesions are created in the heart tissue to restore normal sinus rhythm. Catheter ablation is widely used because it is minimally invasive and has demonstrated effectiveness in many patients with AFib.
It is always important to speak with your doctor about any limitations, as they can base it on your condition. In general, one should be aware of the following:
Foods/Drinks: Some foods and drinks, such as salt, caffeinated beverages, alcohol, grapefruit, and herbal supplements, may interact with medications or affect AFib management. For those taking warfarin, maintaining a diet rich in vitamin K foods is recommended as it helps stabilize the drug's effect. Additionally, Potassium-rich foods, such as bananas, may help lower the risk of an AFib incident.
Medications: Certain AFib medications can interact with other commonly used medications, including vitamins, aspirin, birth control pills, erectile dysfunction (ED) medications, and many others.
Activities: Your doctor can help you understand which types of activities or exercises are best and how strenuous they should be, or whether you should still drive. While the majority of people with AFib can drive a car safely, if you are prone to dizziness or fainting, you may need to stop driving.