What Is Atrial Fibrillation?
Atrial Fibrillation (AF) is an irregular and often rapid heart rate that
commonly causes poor blood flow to the body. During Atrial Fibrillation,
the heart’s two upper chambers (the atria) beat chaotically and
irregularly—out of coordination with the two lower chambers (the
ventricles) of the heart. Atrial Fibrillation symptoms include heart palpitations,
shortness of breath, and weakness.
Episodes of Atrial Fibrillation can come and go, or you may have it continually.
Although Atrial Fibrillation itself usually isn’t life-threatening,
it is a serious medical condition that sometimes requires urgent treatment.
Types of Atrial Fibrillation
Paroxysmal Atrial Fibrillation refers to Atrial Fibrillation that occurs occasionally and then stops.
The Atrial Fibrillation stops by itself and the heart returns to normal
rhythm. The Atrial Fibrillation may last for seconds, minutes, hours,
or days before the heart returns to its normal rhythm. People with this
type of Atrial Fibrillation usually have more symptoms than others. As
the heart goes in and out of Atrial Fibrillation, the pulse rate may change
from slow to fast and back again in short periods of time.
Persistent Atrial Fibrillation is when the Atrial Fibrillation does not stop by itself. Medications or
a special type of electrical shock (called a cardioversion) is used to
help the heart return to normal rhythm.
Permanent Atrial Fibrillation is when the Atrial Fibrillation cannot be fixed. Medications and controlled
electrical shock have failed to return the heart to normal rhythm, and
the patient will remain in Atrial Fibrillation for the long term.
A heart in Atrial Fibrillation doesn’t beat efficiently. It may not
be able to pump enough blood out to your body with each heartbeat. Many
people with Atrial Fibrillation have no symptoms and are unaware of their
condition until it’s discovered during a physical examination.
Those who do have Atrial Fibrillation symptoms may experience:
- Palpitations *
- Decreased blood pressure
- Shortness of breath
- Chest pain
* Palpitations are sensations of a racing, uncomfortable, irregular heartbeat
or a flopping in your chest.
Possible Causes of Atrial Fibrillation
Abnormalities or damage to the heart’s structure are the most common
cause of Atrial Fibrillation.
Possible causes of Atrial Fibrillation include:
- High blood pressure
- Heart attacks
- Abnormal heart valves
- Heart defects you’re born with (congenital)
- Overactive thyroid gland or other metabolic imbalance
- Exposure to stimulants (such as medications, caffeine, or tobacco) or to alcohol
- Sick sinus syndrome (improper functioning of the heart’s natural
- Emphysema or other lung diseases
- Previous heart surgery
- Viral infections
- Stress due to pneumonia, surgery or other illnesses
- Sleep apnea
Risk Factors for Atrial Fibrillation
Age. The older you are, the greater your risk of developing Atrial Fibrillation.
Heart disease. Anyone with heart disease, including valve problems and a history of heart
attack and heart surgery, has an increased risk of Atrial Fibrillation.
High blood pressure. Having high blood pressure, especially if it’s not well controlled
with lifestyle changes or medications, can increase your risk of Atrial
Other chronic conditions. People with thyroid problems, sleep apnea, and other medical problems
have an increased risk of Atrial Fibrillation.
Drinking alcohol. For some people, drinking alcohol can trigger an episode of Atrial Fibrillation.
Binge drinking (having five drinks in two hours for men or four drinks
for women) may put you at higher risk.
Family history. An increased risk of Atrial Fibrillation runs in some families.
Complications Caused from Atrial Fibrillation
Sometimes Atrial Fibrillation can cause the following complications:
Stroke. In Atrial Fibrillation, the chaotic rhythm may cause blood to pool in
your heart’s upper chambers (atria) and form clots. If a blood clot
forms, it could dislodge from your heart and travel to your brain. There
it might block blood flow—causing a stroke. The risk of stroke in
Atrial Fibrillation depends on your age (you have a higher risk as you
age) and on whether you have high blood pressure, diabetes, or a history
of heart failure or previous stroke, and other factors. Medications called
blood thinners can greatly lower your risk of stroke or damage to other
organs caused by blood clots. Your doctor will discuss whether you need
blood thinning medications, such as Coumadin or Pradaxa, as part of your
Heart failure. Atrial Fibrillation, especially if not controlled, may weaken the heart,
leading to heart failure—a condition in which your heart can’t
circulate enough blood to meet your body’s needs.
Preparing for Your Appointment
If you think you may have Atrial Fibrillation, it is critical that you
make an appointment with your doctor. If Atrial Fibrillation is found
early, your treatment may be easier and more effective.
Here’s some information to help you get ready for your appointment,
and what to expect from your doctor:
Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s
anything you need to do in advance, such as restrict your dietary intake.
You may need to do this if your doctor orders blood tests.
Write down any symptoms you’re experiencing, including any that may seem unrelated to Atrial Fibrillation.
Write down key personal information, including any family history of heart disease, stroke, high blood pressure,
or diabetes, and any major stresses or recent life changes.
Make a list of all medications, as well as any vitamins or supplements that you’re taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to understand and remember
all the information provided to you during an appointment.
- Write down questions to ask your doctor.
Questions to Ask Your Doctor
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests will I need?
- What’s the best treatment?
- What foods should I eat or avoid?
- What’s an appropriate level of physical activity?
- How often should I be screened for heart disease or other complications
of Atrial Fibrillation?
- What are the alternatives to the primary approach that you’re suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you’re prescribing?
- Are there any brochures or other printed material that I can take home with me?
- What websites do you recommend visiting?
What to expect from your doctors?
Your doctor is likely to ask you a number of questions. Being ready to
answer them may save time to go over any points you want to spend more time on.
Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Tests & Diagnosis
To diagnose Atrial Fibrillation, your doctor may do tests that involve
Electrocardiogram (ECG). In this noninvasive test, patches with wires (electrodes) are attached
to your skin to measure electrical impulses given off by your heart. Impulses
are recorded as waves displayed on a monitor or printed.
Holter Monitor. This is a portable machine that records all of your heartbeats. You wear
the monitor under your clothing. It records information about the electrical
activity of your heart as you go about your normal activities for a day
or two. You can press a button if you feel symptoms, so your doctor can
know what heart rhythm was present at that moment.
Event Recorder. This device is similar to a Holter monitor except that not all of your
heartbeats are recorded. There are two recorder types: One uses a phone
to transmit signals from the recorder while you’re experiencing
symptoms. The other type is worn all the time (except while showering)
for as long as a month. Event recorders are especially useful in diagnosing
rhythm disturbances that occur at unpredictable times.
Echocardiogram. In this noninvasive test, sound waves are used to produce a video image
of your heart. Sound waves are directed at your heart from a wand-like
device (transducer) that’s held on your chest. The sound waves that
bounce off your heart are reflected through your chest wall and processed
electronically to provide video images of your heart in motion, to detect
underlying structural heart disease.
Blood Tests. These help your doctor rule out thyroid problems or other substances in
your blood that may lead to Atrial Fibrillation.
Chest X-Ray. X-ray images help your doctor see the condition of your lungs and heart.
Your doctor can also use an X-ray to diagnose conditions.
Treatment for Atrial Fibrillation
Treatment of Atrial Fibrillation is complex and depends on whether you
are currently experiencing symptoms, how long you have been in Atrial
Fibrillation, your overall health, and the size and function of the heart’s chambers.
Generally, the goals of treating Atrial Fibrillation are to:
- Control your heart rate
- Reset the rhythm back to normal
- Prevent blood clots
The strategy you and your doctor choose depends on many factors, including
whether you have other problems with your heart and if you’re able
to take medications that can control your heart rhythm. Your treatment
plan will likely first consist of medications to slow your heart rate
and blood thinners to prevent clots. Some of these medications can also
reset your heart back to its normal rhythm.
When medications do not work to correct or control Atrial Fibrillation,
or when medications are not tolerated, a procedure may be necessary to
treat the abnormal heart rhythm. These procedures include electrical cardioversion and
cardiac catheter ablation. Your doctor will discuss which treatments are best for you.
Lifestyle & Prevention
You may need to make lifestyle changes that improve the overall health
of your heart, especially to prevent or treat conditions such as high
Your doctor may suggest that you:
- Eat heart-healthy foods
- Use less salt, which can help lower blood pressure
- Increase your physical activity
- Quit smoking
- Avoid drinking more than one drink of alcohol for women or more than two
drinks a day for men
The Heart Rhythm Society for information on A-Fib. Click on "AF 360".
A support group for patients and others interested in A-Fib.
Excellent articles, research, and expert medical opinions on A-Fib.
The American Heart Association Web site for heart disease information.
HCMA — the Hypertrophic Cardiomyopathy Association for the heart
disorder HCM. 25 to 30 percent of those with the genetic condition HCM
experience Atrial Fibrillation sometime during their lives.
A health search engine.
The federally sponsored health site for general medical research.