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Atrial Fibrillation

Atrial fibrillation (also called AFib) is an irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. At least 2.7 million Americans are living with AFib.

Normally, your heart contracts and relaxes to a regular beat to move blood into the ventricles. The sinus node, a group of cells in the upper right chamber of your heart (right atrium), produces the signal that starts each heartbeat. The signal travels through a connecting pathway between the upper and lower chambers called the atrioventricular (AV) node. The movement of the signal causes your heart to squeeze (contract), sending blood to your heart and body.

In atrial fibrillation, the upper chambers of the heart (the atria) beat irregularly and inefficiently. As a result, the AV node is bombarded with impulses trying to get through to the ventricles. The ventricles also beat rapidly, but not as rapidly as the atria, because not all the chaotic impulses can get through. This inefficiency can cause blood clots to form. Blood clots can cause a stroke. About 15-20 percent of people who have strokes have AFib. Many patients with this condition are put on blood-thinning medications to prevent clots from forming.

Even though untreated atrial fibrillation doubles the risk of heart-related deaths and is associated with a five-fold increased risk for stroke, many patients are unaware that AFib is a serious condition.

What happens once you have atrial fibrillation?

Sometimes people with AFib have no symptoms, and their condition is only detectable upon physical examination. Others may experience one or more of the following symptoms:

  • Sweating.

  • Dizziness.

  • Weakness.

  • General fatigue.

  • Chest pain or pressure.

  • Faintness or confusion.

  • Fatigue when exercising.

  • Rapid and irregular heartbeat.

  • Shortness of breath and anxiety.

  • Fluttering or “thumping” in the chest.

What causes atrial fibrillation?

Abnormalities or damage to the heart's structure is the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:

  • Lung diseases.

  • Viral infections.

  • Sleep apnea.

  • Heart attack.

  • High blood pressure.

  • Abnormal heart valves.

  • Previous heart surgery.

  • Coronary artery disease.

  • Heart defects you're born with (congenital).

  • Stress due to surgery, pneumonia, or other illnesses.

  • An overactive thyroid gland or other metabolic imbalance.

  • Exposure to stimulants, such as medications, caffeine, tobacco, or alcohol.

  • Sick sinus syndrome—improper functioning of the heart's natural pacemaker.

However, some atrial fibrillation people don't have any heart defects or damage; a condition called lone atrial fibrillation. In lone atrial fibrillation, the cause is often unclear, and serious complications are rare.

What types of tests are used to diagnosis atrial fibrillation?

Your doctor may review your signs and symptoms, medical history and conduct a physical examination to diagnose atrial fibrillation. Your doctor may order several tests, including:

  • Blood tests: These will detect thyroid problems or other substances in your blood that may lead to atrial fibrillation.

  • Chest X-ray: X-ray images show the health of your lungs and heart and any other conditions that may cause AFib.

  • Echocardiogram: This test uses sound waves to create moving pictures of your heart. It can show structural heart disease or blood clots.

  • Electrocardiogram (EKG): An EKG uses small sensors (electrodes) to record electrical signals in your heart. This is a primary tool for diagnosing atrial fibrillation.

  • Event recorder: This portable EKG device monitors your heart activity over a few weeks to a few months. Your doctor can determine your heart rhythm at the time of your symptoms, not just during a doctor's visit.

  • Holter monitor: This portable EKG device records your heart's activity for 24 hours or longer. This provides a longer look at your heart rhythms.

  • Stress test: Stress testing involves measuring your heart while you're exercising.

What types of treatments and procedures are used to treat atrial fibrillation?

Your atrial fibrillation treatment will depend on how long you've had it, how bad your symptoms are, and the underlying cause. Generally, the treatment goals are to:

  • Prevent a stroke.

  • Reset the rhythm of your heart rate.

Medications are the first line of defense to control your heart rhythm. If that doesn't work, you may need a medical procedure using catheters or surgery.

One procedure is called cardioversion. Cardioversion can be done in two ways:

  • Electrical cardioversion: An electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock reset's its normal rhythm.

  • Cardioversion with drugs: Medications called antiarrhythmics to help restore normal sinus rhythm.

Sometimes medications or cardioversion don't work. In those cases, your doctor may recommend a procedure to destroy the area of heart tissue that's causing the erratic electrical signals and restore your heart to a normal rhythm. These options can include:

  • Atrioventricular (AV) node ablation: This involves using a catheter to deliver radiofrequency energy to the pathway (AV node) connecting the upper and lower heart chambers. The procedure destroys a small area of heart tissue, preventing abnormal signaling. You'll still need a pacemaker to be implanted and to take blood thinners.

  • Catheter ablation: During this procedure, a doctor uses a catheter (long thin tube) to destroy areas of heart tissue that are causing irregular heartbeats—scar tissue forms, which helps to signal a return to normal.

  • MAZE procedure: The doctor may use a scalpel, radiofrequency (cardiac ablation) or extreme cold (cryotherapy) to create a pattern of scar tissue that interferes with stray electrical impulses.

What can I do to support my health when I have atrial fibrillation?

Take your medications as prescribed and have regular follow-up appointments with your doctor. Tell your doctor if your symptoms worsen.You may need to make lifestyle changes that improve the overall health of your heart, especially to prevent or treat conditions such as high blood pressure and heart disease. 

Lifestyle changes you can make to improve your heart health include:

  • Reduce salt in your diet.
  • Maintain a healthy body weight.
  • Never smoke, or stop smoking.
  • Drink only moderate amounts of alcohol, if any. This means an average of one to two drinks per day for men and one drink per day for women.
  • Eat a healthy, well-balanced diet, rich in fresh fruit and vegetables but low in saturated fats, processed sugar, and salt.
  • If you have diabetes, work closely with your doctor to make sure it is controlled.
  • Get at least 150 minutes of moderate to intense physical exercise every week.

Why choose Presbyterian for atrial fibrillation?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options; these may include lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.