Meaning of atrial fibrillation, symptoms, causes, prevention, Diagnosis and treatment in 2022

Meaning of atrial fibrillation, symptoms, causes, prevention, Diagnosis and treatment in 2022

What Is Atrial Fibrillation? Symptoms, Causes, Diagnosis, Treatment, and Prevention in 2022

Atrial fibrillation (AF or AFib) is a type of heart rhythm disorder, or arrhythmia. It causes your heart to beat irregularly and can significantly increase the heart rate, leading to your heart’s upper and lower chambers not working together properly, according to the National Heart, Lung, and Blood Institute.

AFib begins in the upper chambers of your heart, known as the atria. Fibrillation refers to a rapid, irregular heartbeat.

While a normal resting heart rate is 60 to 100 beats per minute (bpm), atrial fibrillation can cause your atria to beat 300 to 600 times per minute, per the Cleveland Clinic.

Atrial fibrillation can lead to a number of symptoms, including fatigue, dizziness, chest pain, shortness of breath, and heart palpitations. However, in some people, the condition doesn’t cause any symptoms.

Regardless of whether or not it causes symptoms, AFib can put you at higher risk for a stroke. As a result, it’s important to get treatment for AFib and manage your condition to try to prevent dangerous complications.

What are the signs and symptoms of atrial fibrillation?

While not everyone experiences symptoms of afib, signs can include heart palpitations, chest pain, weakness, fatigue, reduced ability to exercise, difficulty breathing, dizziness or fainting, lightheadedness, and confusion.

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When is AFib considered a problem?

Atrial fibrillation is considered to be a dangerous health condition, even if it doesn’t cause symptoms. If you have afib, it’s important to work with your doctor on a treatment plan to prevent future complications

What happens if AFib isn’t treated?

Afib can put you at risk for future problems, including making it easier for blood clots to form and reducing the heart’s ability to pump blood. If left untreated, over time afib can weaken the heart and could lead to stroke or heart failure.

How is AFib treated?

Typically, doctors first recommend lifestyle changes, including following a heart-healthy diet, exercise, reducing stress, and limiting alcohol. If lifestyle changes aren’t enough, medications may be prescribed. Various surgical and nonsurgical procedures may also be used.

How to prevent AFib in summer 

Signs and Symptoms of Atrial Fibrillation

Atrial fibrillation causes noticeable symptoms in many people, but some experience no symptoms at all.

If you do experience symptoms, they may include:

  • Heart palpitations (racing or pounding heart, noticeably irregular heartbeat)
  • Chest pain
  • Weakness
  • Fatigue
  • Reduced ability to exercise
  • Difficulty breathing, especially while lying down or during activity
  • Dizziness or fainting
  • Lightheadedness

Your symptoms may range from subtle to very noticeable, and they may change over time.

The timing and details of your symptoms can be important to help your doctor diagnose and treat your afib. It’s important to keep track of your symptoms by noting when they occur, how long they last, how severe they are, and what you were doing when they started.

Causes and Risk Factors of Atrial Fibrillation

With a normal heartbeat, the two upper chambers of your heart (known as the atria) electrically activate and contract, then the two lower chambers (ventricles) do the same.

This allows your atria to pump blood into your ventricles, and for your ventricles to pump blood to your lungs (right side) and the rest of your body (left side).

In atrial fibrillation, many different electrical impulses happen all at once in your atria, which causes very fast and disorganized contractions. This means your atria can’t pump blood effectively into your ventricles.

Because of the disorganized electrical impulses that begin in your atria, your ventricles can also contract very quickly and irregularly. As a result, they don’t pump blood as effectively to your body

Many people with afib have an underlying heart condition or have experienced a past event that has altered the heart’s electrical or mechanical function. These conditions include:

  • High blood pressure
  • Heart valve disease
  • Coronary artery disease (CAD)
  • Heart attack
  • Heart surgery
  • Congenital heart defects

Other health conditions may also increase the risk of developing afib, including: 

  • Chronic kidney disease
  • Diabetes
  • Hyperthyroidism (overactive thyroid)
  • Lung diseases
  • Obesity
  • Sarcoidosis (inflammatory disease that affects organs)
  • Sleep apnea
  • Venous thromboembolism (blood clot)
  • Viral infections

In some people with AFib, an underlying cause is never identified.

Some factors you can’t control may increase the risk of developing afib, including the following:

  • Older age (especially 65 or older)
  • Family history of afib
  • European ancestry

Certain aspects of your lifestyle may also contribute to afib, such as: 

  • Drinking alcohol
  • Smoking
  • Using recreational stimulant drugs (such as cocaine)
  • Extreme exercise
  • Lack of physical activity
  • Stress

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How Is Atrial Fibrillation Diagnosed?

Your doctor will diagnose or rule out afib based on:

  • Your symptoms and medical history
  • A physical exam
  • Diagnostic tests

In addition to asking about your symptoms, your doctor will probably ask you about your family history of heart conditions, your diet and exercise habits, and other risk factors for heart disease.

If your doctor suspects that you have afib or another serious heart condition, you can expect to undergo an examination of your heart and lungs.

In this examination, your doctor will:

  • Listen to your heartbeat and breathing
  • Check your pulse (heart rate)
  • Measure your blood pressure
  • Check for swelling in your legs and feet (possible signs of heart failure or an enlarged heart)
  • Look for signs of hyperthyroidism (overactive thyroid), such as an enlarged thyroid gland

To help diagnose atrial fibrillation, your doctor may order a number of tests. Most of these tests are designed to analyze your heart rhythm or heart rate in a specific way.

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Tests for diagnosing AFib may include:

Electrocardiogram (ECG or EKG)

This test involves wearing sensors on your chest and arms to record the electrical activity of your heart.

An ECG is the main test for diagnosing afib. It can be done in your doctor’s office in a matter of minutes, and your doctor will usually be able to analyze your results right away.

Holter Monitor

This is a type of portable ECG. It involves wearing sensors that connect to a device, which you carry in your pocket or wear attached to a shoulder strap.

A Holter monitor records your heart’s activity, most commonly for 24 to 48 hours, giving your doctor a more complete picture of your heart rhythm.

Event Recorder or Ambulatory Telemetry Monitor These are other types of portable ECGs that are typically worn for a much longer period, from a few weeks to a month.

Whenever you experience symptoms that may indicate a fast or irregular heartbeat, you push a button on the recorder that activates its data storage function. A few minutes of your heart’s electrical activity, both before and after you press the button, are then stored.

Echocardiogram This is an ultrasound of your heart, which uses sound waves to create a video image for your doctor to analyze.

Your doctor or another healthcare professional will hold a device called a transducer over your chest, which both sends and receives sound waves as they bounce off your heart. You won’t feel these sound waves.

Less commonly, your doctor may recommend an echocardiogram that involves inserting a flexible tube containing a tiny transducer down your throat. This is known as a trans-esophageal echocardiogram.

This type of echocardiogram can produce more detailed images of your heart, which may help your doctor detect blood clots or other problems.

Blood Tests Your doctor may order blood tests to check for thyroid problems or other conditions that could contribute to afib.

Chest X-Ray Your doctor may order an X-ray of your heart and lungs to check for other conditions that might be causing or contributing to your symptoms. (2,3)

Prognosis of Atrial Fibrillation

While atrial fibrillation is always considered a serious condition, it sometimes resolves on its own and doesn’t lead to any complications.

At the other end of the spectrum, atrial fibrillation may be permanent and resistant to treatment, leading to a high risk of serious complications.

If you’re diagnosed with afib, your outlook may depend on known or suspected causes, how often you experience it, and whether it causes noticeable symptoms

Duration of Atrial Fibrillation

In some people, atrial fibrillation goes away on its own. In others, it’s a problem that lasts for years, and it may get worse over time.

Afib can be intermittent (known as paroxysmal), coming and going in a way that seems random or only when you do certain activities.

An episode of this kind of afib usually lasts less than 24 hours, but may last as long as a week.

You may need treatment for paroxysmal atrial fibrillation, or it may happen infrequently enough that your doctor recommends just monitoring your condition.

Afib can also be persistent, meaning that it lasts for longer than a week. This kind of afib usually requires treatment.

Long-term persistent atrial fibrillation is defined as an abnormal heart rhythm that lasts over a year without interruption.

If a normal heart rhythm can’t be restored after multiple treatments, your afib may be considered permanent. In this case, you may need to take medication to prevent the heart rate from being too fast.

Treatment and Medication Options for Atrial Fibrillation

Potential treatments for afib include lifestyle changes, medication, nonsurgical procedures, and heart surgery.

To help treat your afib, your doctor is likely to recommend lifestyle changes, like following a heart-healthy diet, getting enough moderate exercise, reducing stress when possible, and limiting or avoiding alcohol and other drugs.

If lifestyle changes aren’t enough, your doctor may prescribe medication to help control your heart rate or rhythm, or to reduce your risk of developing afib complications.

Various surgical and nonsurgical procedures may also be used to treat your afib. These procedures aim to reset your heart rhythm — sometimes by destroying tissue that’s sending abnormal signals or by rerouting signals that spread abnormally in your heart.

Medication Options

Medications to treat afib may be used to help reset or control your heart rhythm, to keep your heart rate in check, or to help prevent complications.

Heart rhythm control medications (anti-arrhythmic drugs) include:

  • Pronestyl (procainamide)
  • Norpace (disopyramide)
  • Tambocor (flecainide acetate)
  • Rythmol (propafenone)
  • Betapace (sotalol)
  • Tikosyn (dofetilide)
  • Cordarone (amiodarone)

Heart rate control medications include the following:

  • Beta-blockers
  • Calcium channel blockers
  • Lanoxin (digoxin)

To reduce the risk of blood clots and stroke, your doctor may also prescribe an anticoagulant (blood thinner), such as:

  • Apixaban
  • Xarelto
  • Edoxaban
  • Dabigatran
  • Warfarin
  • Heparin

Blood thinners carry a risk of increased bleeding, and you may not need to take them if your doctor believes you aren’t at increased risk for a stroke.

Surgical and Other Procedures

Procedures to help control afib range from noninvasive treatments to surgery, and include the following:

Electrical Cardioversion

In this procedure, you’re given a sedative, and an electrical shock is delivered through paddles or patches on your chest to try to reset your heart’s normal rhythm.

Catheter Ablation

A long, thin tube is inserted into a blood vessel and guided to your heart, where energy, heat, or extreme cold is applied to destroy heart tissue that’s causing your arrythmia.

Maze Procedure

Different variations of this procedure use a scalpel, radio waves, or extreme cold to create a pattern of scar tissue in the heart that helps control stray electrical signals.

Atrioventricular (AV) Node Ablation

This procedure, which may be considered if other treatments don’t work, destroys the pathway that connects the upper and lower heart chambers. It requires fitting a pacemaker to keep the lower chambers beating, and you’ll still need to take blood thinners.

Left Atrial Appendage Closure

This procedure closes off a small sac in the left atrium that can contribute to blood clots forming in the area.

Prevention of Atrial Fibrillation

A number of lifestyle changes may help prevent atrial fibrillation, or help treat the condition if you have it already. These steps include: 

  • Avoiding activities that trigger your afib
  • Following a heart-healthy diet
  • Not smoking
  • Getting enough exercise
  • Maintaining a healthy weight
  • Limiting alcohol
  • Limiting caffeine
  • Reducing or coping with stress
  • Using cough and cold medications with caution (they may contain stimulants)

You should also make sure you’re effectively treating or controlling existing health conditions that may lead to afib, such as sleep apnea, diabetes, or high blood pressure.

Diet and Atrial Fibrillation

Following the right diet may help you decrease the frequency of afib episodes, or reduce your risk of developing the condition in the first place.

Eating too much salt, for example, can raise your blood pressure, putting you at greater risk for afib.

Caffeine is also a common culprit, as it can raise your heart rate and make your heart’s impulses more erratic.

Alcohol, even in quantities that don’t seem excessive, can trigger an afib episode and should be consumed in moderation or avoided altogether.

Even foods with a healthy reputation, such as leafy green vegetables and kimchi, may cause problems depending on the specifics of your heart health.

Mental Health and Atrial Fibrillation

It’s well known that people with afib are at higher risk for depression and anxiety, possibly due at least in part to the stress and uncertainty of living with the condition.

But the link between afib and depression may also work in the opposite direction, with symptoms of depression raising the risk for developing afib in the future.

It’s possible that taking steps to address your mental health and well-being — including both professional help and self-care measures, like yoga and exercise — may reduce your risk of afib and other heart conditions.

If you think you might be depressed, a mental health professional can help make sure you get the evaluation and treatment you need.

Complications of Atrial Fibrillation

Atrial fibrillation is considered a dangerous health condition, even if it doesn’t cause immediate chest pain, heart palpitations, or other troubling symptoms.

Many people live for years without developing noticeable problems from their afib, but it can put you at risk for future problems in a couple of different ways, such as making it easier for blood clots to form and reducing your heart’s ability to pump blood.

Two of the most common complications of atrial fibrillation include:

Blood Clots When blood pools in the heart because it isn’t pumped effectively due to afib, it can form clots that may travel to other areas of the body. These clots may block blood flow to organs.

Heart Failure If afib reduces your heart’s ability to pump blood, your body may not get all the blood it needs.

Other possible complications from afib include: 

  • Stroke (when a blood clot travels to the brain)
  • Heart attack
  • Sudden cardiac arrest

READ MORE ON ATRIAL FIBRILLATION

Research and Statistics: How Many People Have Atrial Fibrillation?

It’s estimated that about 5.3 million people in the United States have atrial fibrillation, according to a study published in April 2018 in the journal PLoS One. (4) Nearly 700,000 of these cases are undiagnosed.

The rate of afib is about 10 percent in adults ages 65 and older, and just under 1 percent in adults ages 18 to 64.

Because the risk for afib increases as you get older, and women tend to live longer than men, more women than men have the condition.

Black Americans and Atrial Fibrillation

The risk for atrial fibrillation is higher in Americans of European descent than in African Americans, according to the Centers for Disease Control and Prevention (CDC).

In a study published in July 201 in JAMA Cardiology, researchers tracked more than 15,000 participants over decades and found that the risk of afib was 8.1 per 1,000 person-years for white participants, and only 5.8 per 1,000 person-years for Black participants. (6) But among Black participants who did develop afib, there was a higher risk of stroke, heart failure, and death.

In another study of the same participants, published in July 2018 in Circulation: Arrhythmia and Electrophysiology, researchers found that the lifetime risk for afib was 36 percent for white men, 30 percent for white women, 21 percent for African American men, and 22 percent for African American women

Related Conditions of Atrial Fibrillation

Atrial fibrillation is a type of arrhythmia, or irregular heart rhythm. Other arrythmias include:

Atrial Flutter

This condition is similar to afib, except the rhythm in the heart’s upper chambers is somewhat more organized. Atrial flutter can become atrial fibrillation, and vice versa.

Supraventricular Tachycardia

This broad term refers to many arrhythmias that can develop above the heart’s lower chambers, which may cause episodes of heart palpitations that start and end suddenly.

Ventricular Fibrillation

This condition is similar to afib, but affects the heart’s lower chambers (ventricles). Since these chambers pump blood to the entire body, it’s extremely serious and can be fatal if normal rhythm isn’t restored within a few minutes.

Long QT Syndrome

This heart disorder carries a risk of fast, chaotic heartbeats, which may cause fainting and may be life-threatening, according to the Mayo Clinic.

Favorite Websites for Essential Afib Information

American Heart Association

The American Heart Association is a leading patient and physician organization in the United States for heart disease and stroke prevention and treatment. This site has information to help you understand an afib diagnosis, treatment options, and lifestyle changes that can help get the condition under control.

StopAfib.org

Founded by heart disease survivor Mellanie True Hills, StopAfib.org provides atrial fibrillation prevention and treatment information and resources.

Favorite Afib Online Support Networks

MyAFibExperience

This online community, supported by the American Heart Association and StopAfib.org, helps people with afib meet others like them and share their experiences, along with prevention and treatment strategies. It hosts forums on a variety of afib-related topics.

Atrial Fibrillation Support Forum

If you’re on Facebook, you can join this open group where people share experiences and the latest afib news. This discussion group is a great place to find online support and a community of people living with Afib.

Favorite App to Detect Afib

FibriCheck

FibriCheck is an easy-to-use smartphone app to detect atrial fibrillation that was cleared by the U.S. Food and Drug Administration (FDA) in 2018. A registration fee and annual subscription is required to use the app. Some insurers may reimburse some or all of the cost.

What is atrial fibrillation diagnosis?

During an episode of atrial fibrillation, your heart rate will be irregular and over 100 beats per minute. If you have an episode of atrial fibrillation during an ECG, your abnormal heart rate will be recorded. This will confirm the diagnosis of atrial fibrillation and rule out other conditions.

What is the main cause of atrial fibrillation?

Problems with the heart’s structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include: Coronary artery disease. Heart attack.

What is the most common treatment for atrial fibrillation?

  • Heart rate medicines: The most common way to treat atrial fibrillation is with drugs that control your heartbeat.
  • Potassium channel blockers, which slow the electrical signals that cause AFib:
  • Amiodarone (Cordarone, Nexterone Pacerone),
  • Dofetilide (Tikosyn)
  • Sotalol (Betapace, Sorine, Sotylize)

What is the first line treatment for atrial fibrillation?

Beta-blockers and calcium channel blockers are first-line agents for rate control in AFib. These drugs can be administered either intravenously or orally. They are effective at rest and with exertion. Intravenous diltiazem or metoprolol are commonly used for AFib with a rapid ventricular response.

What are the risks of atrial fibrillation?

If you have atrial fibrillation (Afib), your heart has episodes when it beats irregularly. The condition can cause troubling symptoms and serious medical complications, including blood clots that can lead to stroke and heart failure. Afib is a type of arrhythmia, or abnormal heart rhythm.

What are the six signs of AFib?

It Doesn’t Always Cause Symptoms

Typical symptoms of AFib for those who do experience them include chest pain, heart palpitations, dizziness, shortness of breath, weakness, fainting, fatigue, and sweating. 

How long can atrial fibrillation last?

paroxysmal atrial fibrillation – episodes come and go, and usually stop within 48 hours without any treatment. persistent atrial fibrillation – each episode lasts for longer than 7 days (or less when it’s treated) permanent atrial fibrillation – when it’s present all the time.

What are the symptoms of AFib getting worse?

If you notice that your AFib episodes happen more often, last longer, or your medication doesn’t help as much, your condition is probably getting worse. As AFib progresses, you might notice some signs. You might feel more weak, tired, lifeless, and anxious about the condition

Which drugs cause atrial fibrillation?

New-onset AFib has been associated with cardiovascular drugs such as adenosine, dobutamine, and milrinone. In addition, medications such as corticosteroids, ondansetron, and antineoplastic agents such as paclitaxel, mitoxantrone, and anthracyclines have been reported to induce AFib. 

What is the safest medication for AFib?

For years, warfarin (Coumadin) was the only oral blood thinner available for preventing strokes caused by AFib, but newer medications called direct oral anticoagulants (DOACs) may be a better choice. In most people with AFib, the DOACs are the first-choice medication

What medications should be avoided with atrial fibrillation?

Atrial Fibrillation Drugs to Avoid

  • Warfarin (also known as Coumadin and Jantoven)
  • Apixaban (also known as Eliquis)
  • Rivaroxaban (also known as Xarelto)
  • Aspirin.
  • Enoxaparin (also known as Lovenox)
  • Clopidogrel (also known as Plavix)
  • Heparin.
  • Dabigatran (also known as Pradaxa)

Should I go to the hospital for atrial fibrillation?

When to Call the Doctor or 911. If an AFib episode lasts 24 to 48 hours with no break or if symptoms worsen, call your physician, Armbruster says. Call 911 or go to the emergency room immediately if you experience any symptoms of a stroke, which are sudden weakness or numbness or difficulty speaking or seeing.

How do I stop atrial fibrillation at night?

There are several maneuvers that can help stop an atrial fibrillation episode at night including deep breathing exercises, yoga, biofeedback, and taking additional medications as directed by your doctor.

How do you know if your heart is in AFib?

When you have atrial fibrillation, you might notice a skipped heartbeat, and then feel a thud or thump, followed by your heart racing for an extended amount of time. Or you might feel heart palpitations or fluttering or jumping of your heart. Or you might experience sweating or chest pain, mimicking a heart attack.

Is atrial fibrillation a serious condition?

Atrial fibrillation isn’t usually life-threatening or considered serious in people who are otherwise healthy. However, atrial fibrillation can be dangerous if you have diabetes, high blood pressure or other diseases of the heart. Either way, this condition needs to be properly diagnosed and managed by a doctor.

Does sleeping position affect AFib?

Your sleeping position could be part of the problem if you have paroxysmal AFib. One study found that people who slept on their left sides reported more symptoms. This position may put more stress on your heart. What you eat and drink – and when – can affect your sleep with AFib.

What happens if you stay in AFib too long?

Untreated persistent AFib can lead to permanent AFib. Having any form of AFib, including persistent AFib, increases your risk for stroke, heart attack, and death. The best way to prevent complications from AFib is to carefully manage and treat it.

can atrial fibrillation be caused by anxiety?

Stress can contribute to heart rhythm disorders (arrhythmias) such as atrial fibrillation. Some studies suggest that stress and mental health issues may cause your atrial fibrillation symptoms to worsen. High levels of stress may also be linked to other health problems.

How do you know if you are in AFib or anxiety?

The pattern or rhythm of a heart beat can also tell you what’s going on: a panic attack typically brings a constant rapid heart rate, while AFib causes an erratic heart rate. If your heart seems to be skipping beats, or speeding up then slowing down and speeding up again, it’s more likely that AFib is to blame.

Non cardiac causes of atrial fibrillation

Atrial fibrillation (AFib) may be caused by many cardiac and non-cardiac conditions, including hypertension, valvular disease (in particular, of the mitral valve), (ischaemic) car- diomyopathy, diabetes mellitus, and thyroid disease.

Can AFIB happen for no reason?

The exact cause of atrial fibrillation is unknown, but it’s more common with age and affects certain groups of people more than others. Atrial fibrillation is common in people with other heart conditions, such as: high blood pressure (hypertension) atherosclerosis.

What diseases can cause atrial fibrillation?

  • Age.
  • Genes.
  • Heart disease.
  • Sick sinus syndrome.
  • Heart attack.
  • High blood pressure.
  • Lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema, or a blood clot in your lung (pulmonary embolism)
  • An overactive thyroid gland (hyperthyroidism)

Atrial fibrillation treatment in elderly

Two alternatives are possible: restoration and maintenance of sinus rhythm, or control of ventricular rate, leaving the atria in arrhythmia. Pharmacological options include antiarrhythmic drugs, such as class III agents, beta-blockers and class IC agents.

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