Atrial Fibrillation

Atrial fibrillation is the most common type of irregular heart rhythm, affecting millions of people worldwide. While it can lead to serious complications like stroke and heart failure, proper treatment and lifestyle changes can help you stay active and manage the condition effectively.

Table of contents

• What Is Atrial Fibrillation?
• Symptoms of Atrial Fibrillation
• Causes and Risk Factors
• How Atrial Fibrillation Affects Your Health
• Diagnosis and Testing
• Treatment Options
• Living With Atrial Fibrillation

What Is Atrial Fibrillation?

Atrial fibrillation, often called AFib or AF, is the most common type of treated heart arrhythmia (a condition where the heart beats with an irregular rhythm)^[1][5]. When you have AFib, the normal beating in the upper chambers of your heart (called the atria) becomes irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers (the ventricles)^[5].

In a typical heart, a group of cells called the sinus node sends electrical signals that start each heartbeat. These signals travel across the upper heart chambers to another group of cells where they usually slow down, then continue to the lower chambers, causing them to squeeze and pump out blood^[1]. But in AFib, the electrical signals in the upper chambers become chaotic. Instead of sending signals in a steady pattern, your heart sends many different signals at the same time^[3]. This causes a fast and irregular heartbeat.

AFib episodes may come and go on their own (called paroxysmal atrial fibrillation) or they may last longer and stop after treatment (called persistent atrial fibrillation). Over time, some people develop permanent atrial fibrillation, where symptoms are always present^[6].

Symptoms of Atrial Fibrillation

Some people with AFib don’t know they have it and don’t experience any symptoms at all. In fact, about half of patients do not feel initial symptoms, and AFib may be discovered during a routine check-up or when having tests for something else^[6][7].

For those who do experience symptoms, they can include^[1][3][6]:

• A feeling of butterflies or a fish flopping in your chest, or the sensation that your heart is racing, pounding, or fluttering (heart palpitations)
• An irregular heartbeat, where your pulse is not steady
• A heartbeat faster than 100 beats per minute
• Extreme fatigue or feeling very tired
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain or tightness
• Finding it harder to exercise
• Fainting

Whether or not you feel symptoms, being in AFib is serious because it means your heart is out of rhythm. When your heart isn’t beating normally, you have a higher risk of dangerous blood clots forming in your heart and traveling to vital organs^[3].

Call emergency services immediately if you currently have a fast or irregular heartbeat and experience chest pain, severe shortness of breath, sweating, fainting or feeling like you might faint, severe headache, weakness or numbness on one side of your face or body, blurred vision, or confusion^[6].

Causes and Risk Factors

Changes to your heart’s tissue and electrical system cause atrial fibrillation^[3]. Anyone can develop AFib, but certain factors increase your risk.

Common Causes

Atrial fibrillation can happen on its own with the cause unknown (called idiopathic atrial fibrillation)^[18]. However, it is often associated with other medical conditions, including^[3][4][6]:

• High blood pressure
• Heart conditions such as heart failure, valve disease, coronary artery disease, or structural heart disease
• Previous heart attack
• Overactive thyroid (hyperthyroidism)
• Chronic kidney disease
• Diabetes
• Sleep apnea (a condition where breathing stops repeatedly during sleep)
• Lung diseases such as emphysema
• Heart surgery

Risk Factors

Several factors increase your likelihood of developing atrial fibrillation^[3][4][5][6]:

• Increasing age: Your risk for AFib goes up as you get older, especially after age 65. About 10% of people aged 80 or older have AFib^[4]
• Being male: Men are somewhat more likely to develop AFib than women
• Being of European descent: People of European ancestry are more likely to have AFib than people of other backgrounds^[5]
• Obesity or being overweight: Carrying excess weight increases your risk
• Excessive alcohol use: Drinking more than the recommended limit, including binge drinking, raises your risk
• Smoking: Using tobacco products increases your risk significantly
• Lack of physical activity: Not exercising regularly makes you more likely to develop AFib
• Certain medications: Some medicines such as levothyroxine, lithium, or certain asthma medicines like salbutamol can increase risk^[6]
• Endurance sports: Long-distance running, cycling, or skiing may increase risk^[6]
• Genetic variants: Certain gene changes are associated with AFib, which may explain some cases that begin at a younger age^[3]

How Atrial Fibrillation Affects Your Health

Stroke Risk

AFib significantly increases your risk of having a stroke. When your heart doesn’t beat normally, blood flow through the heart becomes turbulent and has a high chance of forming a thrombus (blood clot), which can break loose and travel to your brain, causing a stroke^[4]. AFib causes about 1 in 7 strokes^[5]. When standard stroke risk factors are accounted for, AFib is associated with approximately a five-fold increased risk of stroke^[5]. Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes^[5].

Other Complications

Beyond stroke, AFib can lead to other serious health problems. The irregular heart rhythm can cause heart failure, as your heart may not pump blood effectively over time^[1][7]. Some people who don’t feel symptoms initially may develop other symptoms within days or weeks, such as feeling tired, being short of breath with exertion, lacking energy, or having swelling in their feet. These delayed symptoms are related to heart failure as a result of the irregular heart rate and rhythm^[7].

More than 454,000 hospitalizations with AFib as the primary diagnosis happen each year in the United States, and the condition contributes to about 158,000 deaths annually^[5].

Diagnosis and Testing

To diagnose atrial fibrillation, your healthcare provider will examine you, listen to your heart, and ask questions about your medical history and symptoms^[8]. If your doctor thinks you could have AFib, you may be referred to a heart specialist called a cardiologist^[6].

Several tests may be done to diagnose AFib and check your heart rhythm^[6][8]:

• Electrocardiogram (ECG or EKG): This is the main test for diagnosing AFib. It’s a quick and painless test that shows how your heart is beating. Sticky patches with sensors attach to your chest and sometimes your arms and legs. Wires connect the sensors to a computer that records your heart’s electrical activity
• Blood tests: These look for health conditions or substances that may affect the heart or heartbeat
• Echocardiogram (echo): This uses sound waves to create pictures of your heart
• Chest X-ray: This creates images of your chest to check for other problems
• Holter monitor: This is a small, portable ECG device that you wear for a day or two while doing your regular activities to record your heart’s activity continuously
• Event recorder: Similar to a Holter monitor but worn for up to 30 days, it records only at certain times when you have symptoms or when an irregular rhythm is detected
• Implantable loop recorder: This device can be placed under your skin to record your heartbeat continuously for up to three years^[8]

Treatment Options

Atrial fibrillation is treated with lifestyle changes, medicines, and procedures to help prevent blood clots, control your heart rate, or restore your heart’s normal rhythm^[9]. There is currently no cure for AFib, but with proper treatment and management, you can continue to lead a long and active life^[6][20].

Medications

Your healthcare provider may prescribe several types of medications^[6][9]:

• Rate control medications: Drugs such as beta-blockers, calcium channel blockers, or digoxin help slow down your heart rate during episodes of AFib. Slowing the heart rate is important because it gives your ventricles enough time to fill with blood completely
• Rhythm control medications: Anti-arrhythmic drugs help maintain your heart in its normal rhythm and prevent episodes of AFib
• Blood thinners (anticoagulants): These medications lower your risk of blood clots and stroke. Most people with AFib may need to take prescription blood thinners to prevent clots from forming

Medications are not a cure for AFib, but they help make symptoms less bothersome and provide important protection against complications^[12]. For medications to work properly, they must be taken regularly and according to instructions.

Procedures and Surgery

Several procedures are available to treat AFib^[6][9][12]:

• Cardioversion: This procedure uses electricity to reset your heart rhythm to normal
• Catheter ablation: This is a procedure that locates and destroys abnormal electrical pathways in the heart that cause the irregular heartbeat. A thin tube is inserted through blood vessels to reach the heart. Recent studies show that early catheter ablation can be beneficial for select patients and is now considered a first-line therapy for certain individuals^[14]
• Maze procedure: This is a surgical option that creates electrical blocks or barriers in the upper heart chambers to redirect abnormal electrical signals and restore heart rhythm^[12]
• Pacemaker or implantable cardioverter defibrillator (ICD): These devices may be fitted to help control heart rhythm
• Left atrial appendage closure: This procedure can help reduce stroke risk in some patients

Your healthcare team will work with you to determine which treatment approach is best for your individual situation.

Living With Atrial Fibrillation

Making positive lifestyle changes is an essential part of managing AFib. These changes not only help control symptoms but also reduce your risk of complications^[9][17].

Healthy Eating

Follow a heart-healthy diet that emphasizes fresh fruits, vegetables, whole grains, and foods low in salt, sugar, and saturated fats^[16][17]. Limit caffeine, as it can make your heart race in some people^[16]. If you take the blood thinner warfarin (also called Coumadin), be careful about eating foods high in vitamin K, such as broccoli, spinach, or lettuce. Try to eat about the same amount of these foods each day, as vitamin K affects how well your medicine works^[16].

Alcohol and Smoking

Limit or avoid alcohol, as it can trigger AFib episodes. Large amounts of alcohol in a short period (binge drinking) can weaken your heart muscle and make you more susceptible to AFib^[9][17]. If you smoke, quitting is one of the best things you can do for your heart. The nicotine in tobacco can make AFib worse and damages your blood vessels^[16].

Physical Activity

Stay physically active with regular exercise such as walking, cycling, or gardening. Aim for at least 150 minutes of moderate exercise per week^[6][17]. Regular activity makes your heart stronger, helps control your weight, improves your sleep, and reduces stress. Work with your healthcare provider to develop a safe and effective exercise plan. If your heart goes out of rhythm during a workout, stop and rest^[16].

Weight Management

Maintaining a healthy weight is important for managing AFib. When you are overweight, you have a higher chance of AFib, and it makes AFib more likely to come back after treatment^[16]. If your doctor has told you that you need to lose weight, try to lose at least 10% of your body weight through diet and exercise.

Stress and Sleep

Manage stress through relaxation techniques such as deep breathing, meditation, yoga, or tai chi. Stress can trigger AFib episodes and make it harder to cope with the condition^[16][17]. Get adequate sleep each night—most adults need at least seven to nine hours. Poor sleep can trigger AFib^[16].

Other Important Tips

• Avoid triggers such as caffeine, spicy food, dehydration, and lack of sleep^[6]
• Take all prescribed medications exactly as directed. Don’t stop taking or change medications without talking to your healthcare provider first^[19]
• Know your stroke risk and recognize the warning signs of stroke so you can act quickly if needed^[19][22]
• Attend regular check-ups with your healthcare provider to make sure your treatment is working well^[22]
• Tell your healthcare provider about any new symptoms or if your current treatment isn’t controlling your symptoms
• Before taking any new prescription, over-the-counter drug, herbal medicine, or supplement, ask your pharmacist or healthcare provider about possible interactions with your current medications^[22]

A diagnosis of AFib will have lifelong effects, and you may have worries about what it means for your future. It’s normal to experience uncertainty, fear, anxiety, or low mood at this time^[20]. Research has shown that people who have a good understanding of their AFib report fewer symptoms, feel more in control of their condition, and feel less distressed by it^[20]. By learning about your condition, working closely with your healthcare team, making healthy lifestyle changes, and following your treatment plan, you can continue to lead a full and active life.