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You feel fatigued, and you tire out more easily, unable to do some of the things you used to do. You might attribute your symptoms to any number of health problems, but then you notice a fluttering sensation in your chest. You have atrial fibrillation.
Fatigue, heart palpitations, progressive weakness, shortness of breath, and lightheadedness are the typical signs of this most common irregular heartbeat (arrhythmia). However, some people with atrial fibrillation, or Afib, experience few or no symptoms and, without knowing it, could be at risk of serious complications.
For this reason, it’s imperative to understand your risk of atrial fibrillation, work with your doctor to minimize your risk of complications, and explore treatments that can help restore your heart rhythm and your quality of life.
A Heart Out of Sync
In atrial fibrillation, irregular electrical impulses cause the heart’s two upper chambers, the atria, to beat rapidly and erratically instead of contract and relax in a normal synchronized fashion to push blood to the lower pumping chambers, the ventricles. In a similar condition, atrial flutter, the impulses travel in a single large loop around the atria, which beat rapidly but not erratically. With either condition, blood isn’t fully pumped out of the heart, but instead pools in the atria, where it can clot.
By themselves, atrial fibrillation and atrial flutter are not life threatening, but they both can have serious ramifications. The clots that form in the atria may break free and travel toward the brain. If they block an artery in the brain or one leading to the brain and supplying it with blood, a stroke occurs. The American Heart Association (AHA) notes that atrial fibrillation increases the risk of stroke by fivefold, and that as many as one in five people who suffer a stroke have Afib.
Also, over time, uncontrolled atrial fibrillation can damage the heart, impair its function, and lead to heart failure. Some people experience paroxysmal atrial fibrillation, an irregular heartbeat that lasts for seconds to days before returning to normal. Others have persistent Afib, which occurs continuously and requires treatment to correct the arrhythmia. (Paroxysmal Afib can develop into persistent Afib.)
Atrial Fibrillation Risk Factors
The most common heart arrhythmia, atrial fibrillation affects at least 2.7 million Americans, according to the AHA, and the risk of the disease increases with age and a family history of Afib. Other risk factors for atrial fibrillation include:
- Heart problems, including coronary heart disease, heart-valve disorders, hypertrophic cardiomyopathy, and a history of heart attack or heart surgery. (See our post “Mild Heart Attack Symptoms: What Do They Mean?“)
- Hypertension, especially high blood pressure that has gone uncontrolled for a long time
- Other chronic diseases, such as diabetes, lung disease, obstructive sleep apnea, and overactive thyroid (hyperthyroidism)
- Binge drinking, defined by the AHA as consuming five alcoholic drinks in two hours for men and four for women.
Oftentimes, atrial fibrillation is detected incidentally during a physical exam and then confirmed using an electrocardiogram. So, schedule regular visits with your physician, and work with your doctor to stop smoking and control your blood pressure, cholesterol, blood sugar, and weight. Your doctor should check your thyroid function and may inquire about sleep apnea and your overall sleep health.
Focus on Stroke Prevention
The first goal of Afib treatment is to prevent stroke. To gauge your stroke risk and determine the level of stroke prevention you require, your doctor will use the CHA2DS2-VASc score, an acronym for the risk factors Congestive heart failure, Hypertension, Age (75 or older), Diabetes, Stroke history, Vascular disease, Age (65 to 74), and Sex category (female sex).
Based on the results, you may need only to make healthy lifestyle changes or take a mild blood thinner like aspirin. Or, your physician may prescribe a more potent prescription blood-thinning drug, such as warfarin (Coumadin) or the novel oral anticoagulants apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).
Furthermore, if you’re at greater risk of developing blood clots from atrial fibrillation, your doctor may recommend that you undergo one of several minimally invasive procedures to close off the left atrial appendage, a small sac in the muscle wall of the left atrium where Afib-related blood clots often develop.
Treatments to Restore Your Rate and Rhythm
You and your doctor will determine whether your heart rate and rhythm require immediate treatment. If your heart rate is too rapid, your physician can prescribe medications such as beta blockers or calcium channel blockers to slow it down.
QUESTIONS TO ASK
If you have atrial fibrillation (Afib), consider these questions for your physician:
- Could a thyroid problem, sleep apnea, heart-valve problem, or other cardiac disorder be responsible for my Afib?
- What is my risk for stroke, and what are the pros and cons of the drugs and procedures available to reduce my risk?
- Is my heart rate adequately controlled?
- What is the best way to deal with my symptoms?
- Is catheter ablation an option for me, and when should I consider it?
- If you recommend catheter ablation, how many procedures for Afib have you done, and what are your results?
On the rhythm side, initial treatment with antiarrhythmic drugs or electrical cardioversion can return your heart to normal rhythm and see how you respond. From there, you might be prescribed an antiarrhythmic medication—such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), dronedarone (Multaq), flecainide (Tambocor), propafenone (Rythmol), and sotalol (Betapace)—to help you maintain normal heart (sinus) rhythm. However, these drugs may have side effects ranging from fatigue to dangerous ventricular arrhythmias. As such, patients require close monitoring, particularly when first starting these medications, and some may require a short hospital stay.
Patients who cannot tolerate, don’t want to take, or do not respond adequately to antiarrhythmic drugs can consider a type of surgery known as a maze procedure. This operation, performed as open-heart surgery or a minimally invasive operation, entails the cutting of maze-like lesions into the atria to block the signals that cause Afib.
More and more, doctors are treating atrial fibrillation with catheter ablation, in which thin, flexible tubes that are inserted into an artery and fed to the heart target sections of atrial tissue around the pulmonary veins and other areas where the abnormal electrical signals that cause Afib often originate. Using radio frequency energy, heat, or extreme cold, catheter ablation eventually creates scar tissue that blocks the electrical impulses. The procedure carries a risk of bleeding, stroke, and possible narrowing in the veins where ablation was done. If your risk of stroke from Afib warranted treatment with blood-thinning medications, you’ll need to keep taking them after catheter ablation.
Also, some patients who undergo the procedure eventually develop recurrent Afib that requires another ablation treatment or antiarrhythmic medical therapy.
Keep in mind that if your symptoms are tolerable and your quality of life isn’t greatly diminished by atrial fibrillation, any benefits of controlling your heart rhythm and rate might be outweighed by the risks posed by medications, surgery, and catheter ablation. So, carefully consider the pros and cons of all your treatments with your doctor, and make the decision that’s best for you.
Prevention Is the Best Medicine
As with any medical condition, the best treatment for atrial fibrillation is prevention. So, to reduce your risk of Afib, optimize your cardiovascular health. Here’s how:
- Work with your healthcare team to manage your blood pressure, cholesterol, diabetes, and weight, all factors that increase your risk of heart disease and thus Afib.
- Take any blood pressure, cholesterol, or diabetes medications exactly as your doctor prescribes them.
- Adopt a heart-healthy diet—such as a Mediterranean-style diet or the Dietary Approaches to Stop Hypertension (DASH) diet—rich in fruits, vegetables, whole grains, and lean protein, and low in fatty meats, baked goods, added sugars, and processed foods.
- Walk, bike, or do other moderate-intensity exercise at least 30 to 45 minutes a day on most, if not all, days of the week.
- If you smoke, discuss cessation strategies with your physician.
Limit your alcohol consumption to two standard drinks or fewer per day for men and one a day for women. (A standard drink equals one 12-ounce bottle of beer, one 5-ounce glass of wine or 1½ ounces of 80-proof distilled spirits.) Binge drinking can trigger atrial fibrillation.
Originally published in 2017, this post is regularly updated.