Atrial fibrillation (AFib) is a common type of irregular heartbeat that affects an estimated five million Americans. This condition, which causes the heart to beat chaotically and out of sync, can increase the risk of other heart issues and complications, therefore, the new 2023 American Heart Association guidelines emphasize that maintaining a normal heart rhythm is important for lowering mortality rates for people with AFib.
AFib is a manageable condition, especially with early diagnosis and treatment. Thanks to advancements like ablation therapy, patients now have more options for improving their outcomes and overall quality of life.
What is Atrial Fibrillation (AFib)?
Atrial fibrillation (AFib) is a type of heart arrhythmia in which the upper chambers of the heart (the atria) beat irregularly and out of sync with the lower chambers. AFib is the most common type of treated heart arrhythmia.
When someone has AFib, instead of a steady rhythm, the heartbeat may feel fast, fluttering or erratic. This irregular heartbeat can lead to poor blood flow and, if untreated, increases the risk of health issues including clots, stroke, heart failure and other heart-related conditions.
What Does AFib Feel Like?
AFib can feel different for everyone. Some people may not notice any symptoms at all, while others experience noticeable discomfort. For some, AFib symptoms come and go (called paroxysmal AFib), while others experience persistent or chronic episodes.
Common AFib symptoms can include:
- A rapid, irregular heartbeat (heart palpitations)
- Shortness of breath, especially during physical activity
- Anxiety or a “fluttering” sensation in the chest
- Dizziness or lightheadedness
- Fatigue and weakness
- Chest pain or pressure
AFib vs. Flutter: What’s the Difference?
Atrial fibrillation is characterized by a rapid, irregular heartbeat where the atria quiver chaotically. It comes from the left atrium, where the veins that drain blood from the lungs connect. Atrial flutter involves a more organized but abnormally fast rhythm caused by a single electrical circuit in the right atrium that rotates around the tricuspid valve.
Both conditions can lead to similar symptoms like palpitations and fatigue, and increase stroke risk to a similar extent. Both AFib and atrial flutter can be effectively treated with ablation procedures.
What Causes AFib?
Several factors can contribute to AFib:
- Heart conditions: High blood pressure, coronary artery disease and heart valve issues
- Lifestyle factors: Excessive alcohol, smoking, obesity and sedentary lifestyle
- Other medical conditions: Hyperthyroidism, diabetes, sleep apnea and others
- Age: AFib is more common after age 60 and is more prevalent in older age groups
Is AFib Hereditary?
This condition can run in families, suggesting a genetic component, although other factors also usually play a role.
Can Stress Cause AFib?
While stress alone may not directly cause AFib, it can exacerbate symptoms and increase the likelihood of episodes. Chronic stress can trigger the release of stress hormones like cortisol and adrenaline, which can elevate heart rate and blood pressure, creating conditions that make AFib episodes more likely.
Additionally, stress often leads to unhealthy habits such as poor sleep, excessive alcohol consumption or reduced physical activity, all of which may contribute to the development or worsening of AFib over time.
Is AFib Dangerous?
AFib can be serious if left untreated. One of the primary risks is the development of blood clots, which can travel to the brain and cause a stroke. With AFib, not enough blood is pumped out of the atria, causing blood to pool in an area called the Left Atrial Appendage (LAA), which can then cause a dangerous clot to form.
Other potential complications can include a higher risk of heart failure and reduced life expectancy.
It’s important to seek medical attention if you experience an irregular heartbeat lasting more than a few minutes or if you have accompanying chest pain. Even if you have no symptoms, it’s important to treat AFib to prevent problems in the future.
What is a Dangerous Heart Rate with AFib?
A heart rate above 100 beats per minute during AFib, known as AFib with RVR (rapid ventricular response), can be particularly concerning.
In this condition, the lower chambers of the heart beat too quickly, reducing the heart’s efficiency in pumping blood. This can cause symptoms like severe fatigue, dizziness and shortness of breath, which sometimes require emergency care.
Should I Go to the ER With AFib?
You should seek emergency care if you experience the symptoms below, especially if you have a history of AFib with RVR or other heart conditions:
- Chest pain or pressure
- Shortness of breath that worsens
- Severe dizziness or fainting
- A rapid heart rate that doesn’t slow down
How is AFib Diagnosed and Treated?
If you suspect you might have AFib, visit your healthcare provider for an evaluation.
Diagnosing AFib typically involves the following:
- Electrocardiogram (ECG or EKG): A test that records the heart’s electrical activity to detect irregular rhythms. On an ECG, AFib appears as a chaotic, irregular baseline without the usual P waves (which indicate a normal heartbeat).
- Extended Holter or Mobile Cardiac Telemetry (MCT) monitor: A portable ECG worn for up to 30 days to capture irregularities over time.
- Imaging tests: Echocardiograms and stress tests may be used to assess the heart’s structure and function.
What is the Recommended Treatment for AFib?
Treatment for atrial fibrillation focuses on managing symptoms, preventing complications and restoring a normal heart rhythm. Common treatment approaches include:
Medications
- Blood thinners (like direct oral anticoagulants such as Eliquis® or Xarelto®; or Coumadin®): These can help reduce the risk of stroke. About 15 to 20 percent of people who have strokes have AFib.
- Patients who can’t take blood thinners due to bleeding or risk of falling/injury are candidates for left atrial appendage closure with the WatchmanTM or AmuletTM device. Patients stop blood thinners immediately after the device is placed, and then take aspirin and Plavix® for six months, followed by long-term treatment with aspirin alone.
- Rate control medications (such as beta-blockers or calcium channel blockers): These are used to slow the heart rate.
- Antiarrhythmic drugs: These are used to restore normal heart rhythm.
Ablation for AFib
Ablation is now considered a first-line therapy for many patients. This minimally invasive procedure targets and destroys small areas of heart tissue that cause irregular electrical signals where the veins that drain blood from the lungs connect to the left atrium (pulmonary vein isolation, PVI). Other areas in the left or right atrium are targeted if necessary.
The goal of ablation is to reduce the burden of AFib episodes, leading to improved long-term outcomes. Some patients may need more than one ablation, but the procedure can significantly improve quality of life and lower the risk of serious complications. New technologies, such as pulsed field ablation (PFA), have made the procedure even faster and safer.
Pacemaker Implantation
A pacemaker may be necessary in some patients with a slow heart rate, but it does not directly treat AFib.
How Can You Prevent AFib?
Prevention of AFib focuses on maintaining a heart-healthy lifestyle and addressing underlying risk factors that might be contributing to the condition.
Ways to lower your risk for heart-related issues include:
- Exercise regularly: Aim for at least 150 minutes of moderate aerobic activity per week, such as walking, cycling or swimming.
- Manage stress: Incorporate practices like yoga, meditation, and breathing exercises into your routine to manage anxiety and help you relax.
- Maintain a healthy diet and lose weight: Reduce processed foods and added sugar, limit alcohol intake, quit smoking, and prioritize eating whole foods like fruits, vegetables, nuts, fish and legumes.
- Get enough sleep: Focus on getting enough sleep (7 to 9 hours each night). Treat conditions like sleep apnea, which can contribute to AFib.
- Visit your provider for regular check-ups: Monitor your blood pressure, cholesterol and any pre-existing heart conditions by visiting your doctor at least yearly.
There is now good evidence that following these guidelines can improve the success rates of treatments for AFib. This is the best way that you can take control of your heart health.
If you experience any symptoms of AFib or have concerns about your heart health, it’s essential to consult a healthcare provider to develop a personalized treatment plan. For expert care, contact Stony Brook Heart Institute’s Heart Rhythm Center to learn more about your options, including advanced diagnostic tools, medication plans and innovative procedures like AFib ablation.
For more information, visit heart.stonybrookmedicine.edu. For appointments with a heart rhythm specialist, call (631) 44-HEART (444-3278).
In this episode of HEALTH Yeah!, cardiac electrophysiologists (cardiologists who specialize in diagnosing and treating abnormal heart rhythms) from Stony Brook Heart Institute come together to discuss signs and symptoms of AFib, as well as risk factors, treatments and more.
