Atrial Fibrillation

Overview

Atrial fibrillation (AFib) is a common form of abnormal heart rhythm (heart arrhythmia) that involves an irregular and often rapid heartbeat. Afib is rarely a life-threatening condition. However, the risk of stroke and other issues, such as heart failure, increases when the upper and lower chambers of the heart beat out of sync. 

Some people will experience Afib in short episodes. For others, especially people with damage to the heart structure or repeated Afib episodes, Afib can be a more permanent condition. When assessing risk for Afib, age remains the most significant factor. Afib is more common in men. However, women tend to experience Afib more than men because of their longer average lifespan.

The incidence of Afib has been steadily increasing over the last few decades. According to the CDC, in the United States more than 454,000 hospitalizations are recorded with AFib as the primary diagnosis each year.  

Causes

There are multiple factors that contribute to Afib. In general, the risk of Afib increases with age. People over 65 tend to be more at risk. The incidence of Afib among children remains extremely rare.

Certain common chronic health conditions that increase the risk for Afib, including high blood pressure, sleep apnea and obesity. In addition, acute conditions such as an overactive thyroid (hyperthyroidism), a clot in the lung (pulmonary embolism), and stress from pneumonia or other infections can result in Afib. Medications, stimulants (like caffeine and nicotine) and alcohol use can produce Afib. Afib can also run in certain families. Problems with heart structure, such as abnormalities in heart valves and heart function, can lead to Afib.  Finally, emotional stress and disruptions in sleep can make the heart vulnerable to Afib.

Afib Risk Factors 

• Age
• High blood pressure
• Sleep apnea
• Heart disease, particularly involving heart valves and heart function
• Heart infection/injury, such as myocarditis or pericarditis
• Heart surgery, such as bypass surgery
• Thyroid problems, particularly an overactive thyroid
• Family history of Afib 
• Alcohol consumption
• Drug use
• Smoking
• Heavy emotional or physical stress
• Weight

Symptoms

Heart palpitations (a quivering or fluttering heartbeat) are the most common symptom of Afib. Sometimes people have Afib without any symptoms and the condition is detected incidentally on physical examination.

If you are at increased risk for Afib, you should talk to your doctor. When Afib goes undiagnosed and untreated, the consequences can be fatal, as complications include stroke and heart failure.

Common Afib Symptoms

• Heart palpitations, including a flutter or a rapid irregular beat
• Tachycardia (increased  heart rate)
• General fatigue
• Difficulty breathing, especially when lying down or when exercising
• Chest pain
• Dizziness or fainting
• Low blood pressure
• Anxiety

Diagnosis

If you experience any of the symptoms listed above, or if you are at risk for developing Afib, talk to your doctor about a screening. In diagnosing Afib, your doctor will review your medical and family history while conducting a series of tests.

Afib testing typically includes a physical exam, a review of vital signs, including blood pressure and pulse, and an electrocardiogram (EKG). Additional testing often includes an ultrasound of the heart (echocardiogram) to evaluate any potential abnormalities in heart structure or function. A heart monitor may be used as well. Additionally, if you are having sleep problems such as sleep apnea, your doctor may recommend conducting a sleep study to see if your sleep activity is connected to your symptoms. 

If you are over 65, your doctor may incorporate Afib testing into your regular health screenings, even if you are without symptoms.

Treatment

If you are diagnosed with Afib, your doctor will likely prescribe specific lifestyle changes and medications to help reduce your risk of complications related to Afib. Surgery may be necessary to treat certain cases. In time, Afib treatments can return your heart rhythm to normal.

Lifestyle Changes

• Eating healthier
• Exercising
• Limiting alcohol consumption
• Losing weight
• Reducing stress
• Quitting drug use
• Quitting smoking
• Reducing stimulant consumption (caffeine, nicotine, etc.)

In addition to lifestyle changes, Afib treatment can include medications to either change the heart rhythm (anti-arrhythmic drugs) or simply slow a fast rhythm (beta blocker or calcium channel blockers). If you have certain factors that increase the possibility of stroke in Afib (age, gender, heart failure, high blood pressure, diabetes, vascular disease or prior stroke) blood thinners are necessary to reduce the risk.

In cases where lifestyle changes and medication are insufficient, Afib can be treated through surgery. Procedures such as catheter ablation and pacemaker implantation can help stop conditions causing arrhythmia and safeguard patients against Afib symptoms.