Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation (AFib or AF) is a common type of heart arrhythmia. "Arrhythmia" means an abnormal heart rhythm or beat. It's caused by the electrical signals in the heart’s left upper chamber (left atrium) misfiring, which leads to the other chambers (the ventricles) beating off rhythm. The heartbeat becomes irregular and sometimes speeds up.

Atrial Flutter (AFL) is a similar condition, but the abnormal electrical signal originates from the other atria, the right upper chamber (right atrium).

You can have one of the conditions or both simultaneously. They are usually diagnosed by an electrocardiogram (an EKG), which tracks the electrical activity of the heart. Sometimes, the electrocardiogram does not catch the AF or Atrial Flutter, so there are tests that can look for arrhythmias at home, such as a Holter Monitor or event monitor.

Atrial fibrillation symptoms

Common symptoms of AFib and AFL include a sudden rapid or irregular heartbeat. Some people never notice any symptoms and only learn that they have AFib or AFL while getting an EKG for another medical issue.

Main symptoms

Fast or irregular heart beating sensation. Sometimes can feel like the heart is fluttering or skipping beats.

• Heart palpitations (heart-pounding sensation)
• Lightheadedness
• Difficulty breathing or catching your breath
• Chest discomfort or pressure, typically in the middle or left side of the chest

Risk factors for AFib and AFL

• Older than age 60
• Obesity
• Sleep apnea
• Diabetes mellitus
• High blood pressure
• Coronary artery disease or prior heart attack,
• Structural heart disease (e.g., valve problems)
• Thyroid disease
• Chronic lung disease (e.g., emphysema)
• Heavy alcohol use
• A sudden condition like a pulmonary embolism, surgery, infection,
• Certain medications (e.g., some chemotherapies or inhalers for asthma)

Next steps

If you think you are having AFib or AFL, get immediate medical attention.

If you have severe symptoms or feel like you are about to pass out,  call 911.

If you have mild symptoms that are not interfering with your daily life, either go to urgent care or call your primary doctor.

Afib and AFL need to be treated. Otherwise, it can lead to complications like stroke or blood clots, low blood pressure, or congestive heart failure.

What is the best treatment for atrial fibrillation?

Your doctor will want to reduce your risk of stroke with blood thinners. They may try to get the electrical rhythm back to normal. Or decide to leave the heart in atrial fibrillation/flutter but control the heart rate.

They will also address any other condition you may have (like lung disease or an infection) that increases your risk of developing AFib.

Medication

Some medications that are prescribed for AFib.

• Blood thinners or anticoagulants (like apixaban, rivaroxaban, dabigatran, edoxaban, warfarin, and minorly, aspirin) help with stroke prevention, especially for those with higher risks for stroke (e.g. those with existing cardiovascular disease, smokers, diabetes, etc.). With AFib, when the lower chambers (ventricles) have irregular contractions, blood pools in those ventricles. When blood flow stagnates, a blood clot can form, which can then travel to the brain and cause a stroke. These medicines thin the blood and make clots less likely to form. But while they decrease the risk of strokes,  they increase the chance of excess bleeding.
• Beta blockers (e.g. metoprolol), calcium channel blockers (e.g. diltiazem), and digoxin help keep the heart rate (pulse) down.
• Antiarrhythmic drugs (e.g., flecainide, propafenone, dofetilide) maintain a normal heart rhythm to stop atrial fibrillation/flutter. Medications may need to be taken daily. Or sometimes only during a flare-up.
• Amiodarone is another type of antiarrhythmic medication. It has side effects including causing thyroid, liver, and lung abnormalities. Taking long-term will require regular monitoring by your doctor.

Surgery

In cases where medication is not helping, doctors may suggest catheter ablation. The procedure is generally considered minimally invasive (small and few incisions). It does not always require an overnight hospital stay.

A cardiac electrophysiologist threads a catheter (a long, thin tube) into the heart through blood vessels in the leg. The heart tissue that has misfiring electrical currents is either burned or frozen.

Pacemaker

Pacemakers are not necessary for all cases of AFib or Atrial Flutter. They are, however, useful for patients with AFib who have bradycardia, or an abnormally slow pulse. In situations where the pulse is slow, the pacemaker sends shocks to the heart and leads to faster contractions. This is often necessary for patients with AFib who are on anti-arrhythmics that can cause further dysfunction of the heart's electrical system.

AFib prevention

Make lifestyle changes to improve your heart health.

• Keep your body active - mlifaintain an active and healthy lifestyle that includes at least 150 minutes per week of moderate-intensity aerobic exercise.
• Avoid smoking, e-cigarette use, and secondhand smoke.
• Avoid excess alcohol (more than 1 drink per day for women and more than 2 drinks per day for men).
• Eat heart-healthy meals. Mostly fruits, vegetables, whole grains, low-fat dairy, skinless poultry and fish, and nuts/legumes. Limit saturated fat, trans fat, sodium, red meat, sweets, and sugary drinks.
• Treat any other illnesses, like hypertension, high cholesterol, diabetes, chronic obstructive pulmonary disease, hyperthyroidism or sleep apnea.

Follow-up care

Continue to have your heart monitored by a primary care physician and a cardiologist. They will want to see how your medication is working, including checking for side effects like bleeding.

If you had an ablation, they will check for AFib or AFL and other complications. Sometimes, you will be asked to wear a patch monitor or similar device for one day to multiple days to check for abnormal heart rhythms.

Treating AF and Atrial Flutter is important as it reduces the serious risk of stroke, death, and heart failure, especially in older adults and someone with multiple comorbidities or a family history of cardiovascular disease. Work with a health care provider who can treat a person wholistically, as both AF and Atrial Flutter are challenging diseases to manage.