If coronary artery disease is a plumbing problem, then atrial fibrillation is faulty wiring. While other types of heart disease involve blocked blood flow, atrial fibrillation (also known as AFib) involves abnormal electrical activity in the heart that causes an irregular heartbeat.
Atrial fibrillation is not directly life threatening, but it commonly puts people at risk for stroke. The condition is not curable but it can be effectively treated, allowing patients to maintain a positive quality of life.
What is Atrial Fibrillation?
“Atrial fibrillation is an abnormal rhythm of the upper two chambers of the heart,” said Dr. Michael Eskander, a cardiac electrophysiologist at WWMG. AFib is the most common type of heart arrythmia – experienced by 8-10 million people in the U.S. – and is becoming more prevalent as our population ages.
AFib starts out with brief intermittent episodes, then progressively gets worse in duration and frequency over time. Once atrial fibrillation becomes persistent, medical intervention is required to restore a normal heartbeat.
Left untreated, atrial fibrillation is one of the leading causes of stroke, because it contributes to the formation of blood clots. Knowing the symptoms can help patients seek help at the first sign of a problem.
Symptoms of Atrial Fibrillation
The most characteristic symptom of atrial fibrillation is a rapid, irregular heartbeat that patients may describe as fluttering or quivering. It can be painful like a heart attack, but especially in the early stages, arrhythmia is not always noticeable.
Additional symptoms of AFib may include:
- shortness of breath
- fatigue, and
- dizziness
Patients may experience any combination of these symptoms, or even none at all. Dr. Eskander has seen patients who didn’t notice anything wrong until their smart watch or fitness tracker revealed irregularities.
Although the symptoms of AFib are both variable and vague, they should never be ignored. Atrial fibrillation may have symptoms similar to other cardiac and pulmonary emergencies.
Causes and Risk Factors for AFib
The primary cause of atrial fibrillation is aging. Rare in patients younger than 40, it mostly occurs in people over the age of 65. “Abnormal electrical signaling in the upper two chambers of the heart or scarring in the heart tissue itself tends to happen to all of us as we age,” said Eskander.
In addition to aging, other risk factors for AFib include:
- obesity
- high blood pressure/ hypertension
- diabetes
- hyperthyroid
- smoking
- heavy alcohol use
- heart disease
- lung disease
- obstructive sleep apnea, or
These contributing factors cause the heart to work harder, essentially speeding the cardiac aging process. Eliminating these risk factors is the best way to prevent atrial fibrillation from occurring.
Diagnosis of Atrial Fibrillation
“It’s really important for individuals that “just don’t feel well,” especially those that have risk factors for atrial fibrillation, to seek out medical care urgently,” said Eskander.
Diagnosis begins with a thorough physical examination and the identification of an irregular pulse which will be confirmed by an EKG. Wearable tech like the Apple watch and Kardia Mobile are patient-enabled tools that can monitor for atrial fibrillation.
Treatment and Management of AFib
Although there is no cure for atrial fibrillation, it can be managed with the help of an experienced cardiologist. Eskander describes four pillars of atrial fibrillation management:
Risk Factor Control
The same steps that help to prevent AFib’s development can slow its progression. Patients with atrial fibrillation who also have sleep apnea should seek treatment. Additionally, they must work to maintain heart health and a healthy body weight.
“Even after being diagnosed with atrial fibrillation, a 10% weight loss can result in a 33% decrease in recurrence of atrial fibrillation,” said Eskander.
Anticoagulation
Atrial fibrillation allows blood to pool in the heart’s upper two chambers. This pooled blood can form clots and cause a stroke. Blood thinners are prescribed to prevent the formation of clots in high-risk patients such as those over age 65, those with diabetes or high blood pressure, and those with a history of cardiac events.
Heart Rate Control
For adults, 60-100 bpm is considered a normal resting heart rate. Atrial fibrillation can lead to a resting heart rate of 120 bpm or more.
“Their heart is running a marathon when they are sitting perfectly still,” said Eskander. Besides being uncomfortable, this can contribute to scarring that increases the risk of heart failure. Medication can control the heart rate and keep it in a normal range that matches the level of activity.
Heart Rhythm Control
Rhythm control is becoming an increasingly important part of atrial fibrillation treatment. Procedures like electrical cardioversion or catheter ablation may be most beneficial in the earliest stages of atrial fibrillation. Medication can also help the heart maintain a regular rhythm and prevent recurrence of AFib.
Where to Seek Help for Atrial Fibrillation
If you are experiencing any of the symptoms of AFib, contact WWMG’s Cardiology department to request an appointment. Early detection and proactive management can slow the progression of atrial fibrillation, prevent recurrence of episodes, and support your quality of life.