Atrial Fibrillation

Basic Facts

  • Atrial fibrillation (AF or A-fib) is a type of arrhythmia, or electrical disturbance in the heart’s rate or rhythm. AF is caused by abnormal electrical activity in of the upper chambers (atria) of the heart, causing them to quiver — sometimes more than 600 times per minute — without contracting. The ventricles (the lower chambers of the heart) do not receive regular impulses and contract out of rhythm, and the heartbeat becomes irregular and often rapid. 
  • It is the most common atrial arrhythmia, and 85% of people who experience it are older than 65 years.  
  • Atrial fibrillation can cause a blood clot to form inside the heart, which can enter the bloodstream and result in a stroke.  
  • Underlying heart disease, hypertension, and diabetes increase the risk of stroke from atrial fibrillation, as does age.
  • For this reason, medications called anticoagulants are used to help prevent clotting (commonly referred to as “blood thinners”). 

Atrial fibrillation may be: 

  • Paroxysmal (intermittent) – lasts from a few minutes to a few hours and resolves on its own. 

  • Persistent - lasting days, weeks, to months and requires treatment to resolve it. 

  • Permanent (chronic) - heart remains in AF and treatment is not successful to convert back to a normal rhythm. 

 

The symptoms of atrial fibrillation can vary from person to person, from none to activity-limiting symptoms, and can include:

  • Shortness of breath (dyspnea),
  • Palpitations
  • Weakness
  • Lightheadedness
  • Shortness of breath
  • Chest Pain
  • Fatigue
  • Obesity (increases your risk by ~40%) 
  • Sleep apnea, especially if untreated 
  • Dehydration
  • Alcohol use
  • Stimulant use, including nicotine, cocaine, amphetamines, excessive caffeine (over 400mg in a day), and cold and cough medications that contain pseudoephedrine or phenylephrine  
  • Heart valve disease
  • Hypertension (high blood pressure)
  • Hyperthyroidism
  • Overeating
  • Pericarditis (inflammation of the membrane surrounding the heart) 
  • Pulmonary embolism (blood clot in the lung) 
  • Sick sinus syndrome (another type of heart arrhythmia) 

Atrial Fibrillation is diagnosed by documenting it on an electrocardiogram (ECG), sometimes with a holter monitor (wearable ECG worn for days). 

 

Treatment often includes one or more of the following: 

  • Medication(s) to control the rate and/or rhythm, such as a beta-blocker, certain calcium channel blockers, and/or anti-arrhythmics 
  • Medication to prevent blood clots leading to stroke (anticoagulants) 
  • Cardioversion – under sedation, an electrical current is applied to restore the heart’s normal rhythm 
  • Ablation – creating scarring of the areas in the heart that are causing the abnormal heart rhythm. 
  • Pacemaker implantation – controls the speed of the heart, but does not correct the AF.  
  • Maze procedure – a surgical ablation performed during an open heart surgery.