Atrial Fibrillation

What is Atrial Fibrillation?

Atrial Fibrillation(AF) is the most common type of irregular heartbeat.  About 2.2 million Americans have atrial fibrillation, and it increases with age.  With AF, the impulses in the heart do not travel in a conventional way through the atria.  Instead, these impulses begin simultaneously and spread through the atria and compete for a chance to travel through the AV node.  As a result, the heart pumps less efficiently, reducing blood flow to the body and to the heart muscle itself.   AF is not usually life threatening, however, people with AF are at an increased risk of developing a life threatening stroke.  If the heart rate is fast and uncontrolled over a long period of time, AF can damage the heart and lead to a heart attack or congestive heart failure.

What Are the Symptoms of Atrial Fibrillation?

Many people with AF don’t notice that their heart is beating irregularly and may not experience symptoms.  Others may have symptoms such as:

Heart palpitations (a sudden pounding, fluttering, or racing feeling in the chest)

Lack of energy (feeling over tired or weak)

Dizziness (feeling faint and light-headed)

Chest discomfort (pain, pressure, or discomfort in the chest)

Shortness of breath (difficulty breathing during normal activities or during rest)

Because atrial fibrillation increases your risk for stroke and many people do not have symptoms, the National Stroke Association recommends that everyone, particularly those age 55 or older, check their heartbeats once a month. To learn how to check your pulse, see taking your pulse. If you notice your heartbeat does not have a regular rhythm, talk to your doctor.

What Causes Atrial Fibrillation?

The most common cause of atrial fibrillation is long-standing uncontrolled high blood pressure.  Other conditions associated with AF include:

  • High blood pressure
  • Coronary artery disease
  • Heart valve disease
  • Having undergone heart surgery
  • Chronic lung disease
  • Heart failure
  • Cardiomyopathy
  • Congenital (present at birth) heart disease
  • Pulmonary embolism

Atrial fibrillation may be caused by other medical conditions, such as hyperthyroidism, chronic obstructive pulmonary disease (COPD), and pneumonia. Excessive alcohol consumption, caffeine and stimulant drug use can also trigger atrial fibrillation.It may also occur in people with otherwise normal hearts. This is known as lone atrial fibrillation.

How Is Atrial Fibrillation Treated?

In some people, atrial fibrillation returns to a normal rhythm on its own.  About 50% of people with recent-onset AF return to a normal state within 24 – 48 hours.  For those whose rhythm does not return back to normal, a doctor may try to convert their hearts back to a normal rhythm with medication, or a low-voltage electrical shock.  When AF is long-standing, it is more difficult to covert the heart back to a normal rhythm.

Many options are available to treat AF, including medication, lifestyle changes, procedures and surgery. The choice of treatment for you is based on your rhythm and symptoms. The goals of AF treatment are to:

  • Regain normal heart rhythm (sinus rhythm)
  • Control the heart rate
  • Prevent blood clots
  • Reduce the risk of stroke

How Are Medications Used to Treat Atrial Fibrillation?

Medications prescribe to manage AF depend on the overall treatment goal.  If the goal is to restore a normal rhythm, a drug called an antiarrhythmic is prescribed.  It it is not possible to do this, doctors will try to manage the disease by slowing down the heart rate.  In both cases, you may be prescribed medications called anticoagulants to decrease blood clot formation.

To restore normal heart rhythm – medications available include:

  • Quinidex (quinidide),
  • Pronestyl (procainamide),
  • Norpace (disopyramide phosphate),
  • Tambocor(flecainide acetate),
  • Rythmol (propafenone),
  • Betapace (sotalol), Tikosyn (dofetilide), and
  • Cordarone (amiodarone).

These medications are successful 30% – 60% of the time, but they may loose thier effectiveness over time.  You may have to stay in the hospital while first taking these drugs so that your heart can be monitored.

Heart rate control – Rate control medications include

  These medications do not control heart rhythm.

Blood thinners (anticoagulation drugs) – Drugs like Coumadin (warfarin), reduce the risk of blood clots and stroke.   Even though anticoagulant or antiplatelet drugs reduce the risk of stroke, they do not eliminate the risk. Regular blood tests are required when taking Coumadin to evaluate the effectiveness and minimize the risks of the drug. Some people may be treated with aspirin instead of Coumadin. Talk to your doctor about the anticoagulant medication that is right for you.

Many of these medications have side effects and interactions with other medications. A person taking any of these medications should be in good communication with his or her health professional.

How does one diagnose Atrial Fibrillation?

An electrocardiogram is the easiest and most efficient way to determine if you have atrial fibrillation.  An electrocardiogram is a recording on the electrical activity in your heart.  It is usually done along with a medical history and physical exam.  During the exam, your doctor will take your blood pressure to determine if you have high blood pressure.  They will also listen to your heart to see if you have a heart murmur.

How do I cope with Atrial Fibrillation?

Because AF is usually the result of a heart condition, making changes to improve your heart condition will usually improve your overall health.  Some changes may include:

Quitting smoking and avoiding second-hand smoke – this is the most important step you can take to prevent coronary artery disease

Controlling your cholesterol – This can be done with diet and exercise, and sometimes medicines

Controlling your blood pressure – Increase your exercise, and follow a low sodium, low fat diet.  Decrease your intake of alcohol, and take medicines to control your blood pressure if needed

Eating fish – Experts suggest that adults must eat at least two servings of fish each week, especially salmon, tuna, or trout, in order to maintain a healthy heart.  In addition, eating backed or broiled fish may reduce your risk of developing AF

Avoid getting the flu – have a flu shot every year

Watch out for sleep apnea – many people with atrial fibrillation also have obstructive sleep apnea

Avoiding alcohol, caffeine, or stimulants – some nonprescription medicines, especailly cold and herbal remedies, contain stimulants that can trigger atrial fibrillation.  Talk to your doctor before taking new medicines.

What can I expect if I have Atrial Fibrillation?

High blood pressure and other underlying heart diseases are common causes of atrial fibrillation. Seen mostly in people over 65, atrial fibrillation due to underlying heart disease is often the most complicated to treat. Initially, episodes of atrial fibrillation typically come on suddenly and last a short time before subsiding on their own. This is called paroxysmal atrial fibrillation.Over time, episodes of atrial fibrillation usually become longer and more frequent, and eventually the irregular heartbeat becomes persistent, meaning that it no longer resolves on its own. Your doctor may attempt to convert to a normal rhythm by a procedure called cardioversion, using either medication or electrical cardioversion. The longer atrial fibrillation has been present, the less likely cardioversion will result in a lasting normal rhythm.

Atrial fibrillation frequently occurs after cardiac surgery and can increase the risk of complications, such as stroke. Treatment usually results in conversion to a normal rhythm within 6 weeks after leaving the hospital.In rare cases, the underlying cause of atrial fibrillation cannot be determined. Lone atrial fibrillation usually occurs in people under 65. It often stops on its own or it can be treated easily. Lone atrial fibrillation progresses to permanent atrial fibrillation in about 20% of cases.