Table of Contents
I. What is Atrial Fibrillation?
What is Atrial Fibrillation?
AFib is the most common type of heart arrhythmia. It is also known as atrial fibrillation or AF. An arrhythmia occurs when the heart beats too slowly, too fast, or in an irregular way. There are an estimated 2.7 to 6.1 million people in the United States who have atrial fibrillation. The U.S. population also has a steadily aging population, so the number of AFib cases is likely to increase. [1]
The heart is a complicated organ and requires seamless coordination of its chambers for it to beat correctly. When atrial fibrillation occurs, the heart’s two upper chambers (the atria) beat chaotically and out of coordination with the lower chambers (the ventricles). An average heart rate ranges from 60 to 100 beats per minute, but those with AFib can have a heart rate of 100 to 175 beats a minute. AFib can happen in brief episodes, and it may become permanent. Read on to learn more about this serious condition and how it can be treated.
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Symptoms of AFib
Atrial fibrillation can be a dangerous disorder because you may not know you have it. Some people may not experience any symptoms, so it is vital to attend yearly check-ups. If you do experience symptoms, they may include:
- Weakness
- Fatigue
- Lightheadedness
- Chest pain
- Reduced ability to exercise
- Palpitations (sensations of a racing, uncomfortable, or irregular heartbeat in the chest)
a. Variations of AFib
Atrial fibrillation can present itself in many different ways. The types of AFib can include:
Occasional: This type is also called paroxysmal atrial fibrillation. Symptoms may come and go and last for a few minutes to hours. Episodes of AFib may occur for as long as a week and happen repeatedly. These symptoms may go away on their own, but medical treatment is needed if they don’t resolve themselves.
Persistent: Your heart rhythm does not go back to normal with this type of AFib. Electric shock treatment or prescription drugs are needed to normalize the heart’s rhythm.
Long-standing persistent: This version of atrial fibrillation is long-lasting and occurs continually for more than 12 months.
Permanent: This is the most severe type of AFib. In this case, your heart rhythm cannot be restored, and the condition is stable. Treatment is limited to medications that help control heart rate and reduce blood clots. [2]
Causes
There are several possible causes of atrial fibrillation. This condition most often occurs due to structural damage or abnormalities to the heart. AFib can start at any age, and those with the following conditions are at a higher risk:
- Heart attack
- High blood pressure
- Lung diseases
- Previous heart surgery
- Viral infections
- Sleep apnea
- Sick sinus syndrome (improper functioning of the heart’s natural pacemaker)
- An overactive thyroid
- Congenital heart defects
- Abnormal heart valves
- Coronary heart disease
Atrial flutter may also develop into atrial fibrillation over time. Atrial flutter has similar symptoms to AFib but is less severe in most cases. A flutter is less chaotic than AFib, but it can develop into the more serious atrial fibrillation, especially in those who have a history of stroke. [3]
Risk factors
As described above, numerous conditions can lead to the development of atrial fibrillation. Some risk factors of AFib can include:
Drinking alcohol: Binge drinking can put you at a higher risk for developing AFib. Binge drinking involves having five drinks in two hours for men or four drinks for women. Researchers have found that alcohol affects the vagus nerve in the neck. Alcohol consumption triggers increased vagal activity. The spike in this nerve can spark an AFib event. [4]
Advanced age: The prevalence of AFib increases with age and is the most common arrhythmia in people over 65 years old. Lifestyle choices such as exercising regularly and avoiding smoking can lower your chances, but the heart is more prone to abnormalities as it ages. [5]
Athletes: Athletes typically have good cardiac health, but it may work against them in some cases. Studies suggest that there is a link between endurance exercises and a higher risk of AFib. [6]
Underlying heart disease: Underlying heart problems are the most common cause of AFib. Valve problems, acute coronary syndrome, Wolff-Parkinson-White (WPW) syndrome, and a history of heart attack puts you at higher risk.
Sleep apnea: Over half of patients with AFib also have sleep apnea. This condition occurs when breathing stops or becomes critically shallow during sleep. Sleepless nights are typical with sleep apnea because the body wakes up when the brain does not receive enough oxygen. [7]
Diagnosis
Diagnosis for AFib may be challenging if it doesn’t present itself with symptoms, but there are several tests your doctor can perform to determine if you have atrial fibrillation. Along with reviewing your medical history, your doctor may perform the following tests:
Blood and Stress tests: Blood tests are performed early on in the diagnosis process to rule out thyroid problems. Doctors may also have you undergo an exercise test to see how your heart reacts to physical activity.
Electrocardiogram (ECG): This test is frequently used to diagnose AFib. An ECG involves attaching small sensors to the chest and arms to sense and record electrical signals as they travel through your heart.
Event recorder: This is a portable ECG intended to monitor your heart rate activity over several weeks or months. When you experience symptoms of a fast heart rate, you can push a button, and the device will record your heart rate for your doctor to examine.
Echocardiogram: An echocardiogram uses sound waves to create moving pictures of your heart. This device is guided down your throat to the esophagus to diagnose any structural issues with the heart.
Chest X-ray: An X-ray of the chest can help your doctor examine the state of your lungs and heart. This will allow the doctor to determine if there is any structural damage to the heart and diagnose AFib. [8]
Treatment
The goal of atrial fibrillation treatment is to restore the heart’s rhythm and prevent blood clots. The prevention of blood clots is integral to treatment because clots can lead to cardiac events as well as stroke and deep vein thrombosis (DVT). Your treatment depends on numerous factors, including the trigger of your AFib, as well as your overall medical condition.
Blood thinners are prescribed quickly after an AFib diagnosis. Before electric shock treatments are administered, a person must go on blood thinners like Xarelto for several weeks to reduce the risk of blood clots and strokes. Blood clots occur when blood cells (platelets) clump in the vessels and stick to the arterial wall. Severe injury or death can occur if these clumps shear off the arterial wall and travel to the heart, brain, lungs, or legs. Xarelto prevents the formation of the clotting factor (thrombin) in the blood.
Cardioversion is the procedure used to regulate the heart’s rhythm. This procedure can be done electrically or with medications. In the electrical procedure, an electric shock is delivered to the heart through paddles or patches placed on the chest. These shocks stop the heart’s electrical activity for a short time, which then restores the heart’s normal rhythm. Medications called antiarrhythmics can also be used to restore normal rhythm. Some examples of these drugs include dofetilide, sotalol, or flecainide. These drugs are typically administered in the hospital so your doctor can monitor your heart.
If cardioversion is not successful, more invasive procedures may be necessary. These surgeries may include:
Catheter ablation: This procedure involves inserting a tube into the groin and guiding it to the blood vessels in the heart. The tip of this tube is equipped with extreme heat or cold to destroy areas of the heart tissue that are causing AFib problems. This procedure is typically used for those without prior heart problems.
Maze Procedure: A maze procedure can involve a scalpel or an instrument that emits extreme heat or cold. These instruments are used to create a pattern of scar tissue that is intended to interfere with the erratic electrical impulses that cause AFib. This procedure often has a high initial success rate, but AFib may come back. Maze procedures involve open-heart surgery, so it is typically done during a coronary artery bypass or heart valve repair.
Atrioventricular (AV) node ablation: This procedure is often a last resort. AV node ablation involves using a catheter to deliver radiofrequency energy to the AV node that connects the upper and lower heart chambers. It destroys small areas of the heart tissue, and a pacemaker will need to be implanted to keep the ventricles beating correctly. [9]
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