Understanding Atrial Fibrillation: A Comprehensive Guide for Patients

Atrial fibrillation (AFib), also known as AF, stands as one of the most prevalent types of arrhythmias, impacting millions worldwide. It's essential for patients diagnosed with AFib to have access to comprehensive and understandable educational materials to manage their condition effectively. This article aims to provide a detailed overview of AFib, its causes, symptoms, potential complications, and available treatment options.

What is Atrial Fibrillation?

Arrhythmias, in general, are problems with the rate or rhythm of your heartbeat. In the case of AFib, the heart beats irregularly, sometimes much faster than normal. This happens because the upper and lower chambers of the heart do not work together as they should. When this happens, the lower chambers do not fill completely or pump enough blood to your lungs and body. During atrial fibrillation, the heart's upper chambers, called the atria, beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles.

AFib may manifest in brief episodes, or it may be a permanent condition. A person with atrial fibrillation also may have a related heart rhythm disorder called atrial flutter. In atrial flutter, the heart beats too fast, but mostly continues to contract in a regular rhythm. AFib is a closely related condition in which the atria contract in a chaotic manner, or "quivers." This creates an irregular heart rhythm that is also usually too fast.

Types of Atrial Fibrillation

AFib is classified into several types based on its duration and how often it occurs:

Occasional (Paroxysmal) Atrial Fibrillation: AFib symptoms come and go. The symptoms usually last for a few minutes to hours. Some people have symptoms for as long as a week. The irregular heartbeat can happen again and again. Symptoms might go away on their own.
Persistent: The irregular heartbeat is constant. The heart rhythm does not correct itself. Irregular rhythm lasting for longer than seven days.
Long-Standing Persistent: This type of AFib is constant and lasts longer than 12 months.
Permanent: The irregular heart rhythm can't be reset and requires medication and external assistance to regulate it. The irregular heart rhythm can no longer be restored.

Causes and Risk Factors

AFib is most often caused by changes to the heart's tissue or the electrical signaling that helps the heartbeat.

Read also: Understanding Asthma

Electrical Signaling in a Healthy Heart

Inside the upper right heart chamber is a group of cells called the sinus node. The signals move across the upper heart chambers. Next, the signals arrive at a group of cells called the AV node, where they usually slow down. In a healthy heart, this signaling process usually goes smoothly.

Electrical Signaling in AFib

But in atrial fibrillation, the signals in the upper chambers of the heart are chaotic. As a result, the upper chambers tremble or shake. The AV node is flooded with signals trying to get through to the lower heart chambers.

Conditions and Factors Contributing to AFib

These changes can happen due to different conditions and factors, such as:

Age: The risk of atrial fibrillation increases with age, with individuals over 65 being the most common patients.
Family history and genetics: AFib can run in families. So can heart disease, which raises your risk of AFib.
Heart conditions or heart surgery: Coronary artery disease, heart valve disease and heart conditions present at birth increase the risk of AFib. Heart surgery or stress due to surgery or sickness also may cause AFib.
High blood pressure: Over time, high blood pressure may cause part of the heart to become stiff and thick.
Obesity.
Other long-term health conditions.
Thyroid disease.
Some medicines and supplements.
Some lifestyle choices.
Race.
Recent surgery.
Changes in the level of body minerals: Minerals in the blood called electrolytes help the heart beat. They include potassium, sodium, calcium and magnesium.
Caffeine, nicotine or illegal drug use: Caffeine, nicotine and some illegal drugs - such as amphetamines and cocaine - can cause your heart to beat faster.
Drinking too much alcohol.

Signs and Symptoms

Some people who have AFib don't have any symptoms and don't know they have it. When symptoms are present, they may include one or more of the following:

Pulse that feels rapid, racing, pounding or thumping, fluttering, irregular, or too slow.
Sensation of feeling the heart beat (palpitations).
Confusion.
Dizziness, lightheadedness.
Fainting.
Fatigue.
Weakness.
Loss of ability to exercise.
Shortness of breath and anxiety.
Sweating.
Chest pain or pressure, which may be a sign of a heart attack.

If you do have symptoms, you may only notice them once in a while. Or you may have symptoms that are more frequent. And in some cases, the symptoms might be severe. If you have heart disease, you are more likely to notice your symptoms. To help prevent these problems, it's important to contact your health care provider if you are having symptoms.

Read also: Navigating Patient Care

When to Seek Medical Attention

If you have symptoms of atrial fibrillation, make an appointment for a health checkup. If you have chest pain, get emergency medical help right away.

Diagnosis

Your health care provider may hear a fast heartbeat while listening to your heart with a stethoscope. Your pulse may feel fast, uneven, or both.

The normal heart rate is 60 to 100 beats per minute. In Afib or flutter, the heart rate may be as high as 250 to 350 beats per minute and is very often over 100 beats per minute. Blood pressure may be normal or low.

An ECG (a test that records the electrical activity of the heart) may show AFib or atrial flutter. If your abnormal heart rhythm comes and goes, you may need to wear a special monitor to diagnose the problem.

Complications of Atrial Fibrillation

A possible complication of atrial fibrillation (AFib) is blood clots. The risk of stroke from AFib increases as you grow older. Other health conditions also may increase the risk of a stroke due to AFib.

According to the American Heart Association (AHA), at least 2.7 million Americans are living with A-Fib.

Treatment Options

Treatment can often control this disorder. Many people with AFib do very well with treatment.

Cardioversion

Cardioversion treatment may be used to get the heart back into a normal rhythm right away. There are two options for treatment:

Electric shocks to your heart
Medicines given through a vein

These treatments may be done as emergency methods, or planned ahead of time.

Medications

Daily medicines taken by mouth are used to:

Slow the irregular heartbeat and maintain normal heart rhythm: These drugs may include beta-blockers, calcium channel blockers, digoxin, and anti-arrhythmics.
Prevent blood clots: Blood-thinning medicines are often given to reduce the risk of blood clots that can result from ongoing irregular heart rhythms. Blood thinner medicines include heparin, warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) and dabigatran (Pradaxa). Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. However, blood thinners increase the chance of bleeding, so not everyone can use them.
Prevent AFib from coming back: These drugs work well in many people, but they can have serious side effects. AFib returns in many people, even while they are taking these medicines.

Procedures

Catheter ablation: Catheter ablation, which scars the tissue that is causing the arrhythmia. A procedure called radiofrequency ablation can be used to scar areas in your heart where the heart rhythm problems are triggered. This can prevent the abnormal electrical signals that cause AFib or flutter from moving through your heart. You may need a heart pacemaker after this procedure.
Left atrial appendage closure: Left atrial appendage closure, a surgery on a small sac in the muscle wall of your left atrium (the upper left chamber of your heart). It helps prevent blood clots and can reduce your risk of stroke. Another stroke prevention option for people who cannot safely take blood thinner medicines is the Watchman Device, which has recently been approved by the FDA. This is a small basket-shaped implant that is placed inside the heart to block off the area of the heart where most of the clots form.

Lifestyle Modifications

Following a heart-healthy eating plan that limits saturated fats, salt, and cholesterol.

Prevention

Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib).

Get good sleep.
Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter.

Managing AFib at Home

All people with AFib will need to learn how to manage this condition at home. Regular symptom surveys allow patients to check in with their healthcare providers while giving direct feedback about their condition and health status.

Resources

Apart from the educational videos listed above, we also have an extensive video library that helps with patient education on a wide range of topics. At HRS, we can provide you with the resources you need to help educate and monitor your atrial fibrillation patients through our telehealth and RPM services.

Outlook (Prognosis)

AFib tends to return and get worse.

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