Atrial Fibrillation

Overview

Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm, also known as an arrhythmia. During AFib, the heart's upper chambers (atria) beat chaotically and irregularly, out of sync with the lower heart chambers (ventricles). This condition can lead to blood clots in the heart, increasing the risk of stroke, heart failure, and other heart-related complications. AFib may have no symptoms, or it can cause a fast, pounding heartbeat, shortness of breath, or light-headedness. Episodes of AFib may be occasional, persistent, or last for a few minutes to hours.

Understanding the disease

Symptoms

Symptoms of atrial fibrillation (AFib) may include feelings of a fast, fluttering, or pounding heartbeat (palpitations), chest pain, dizziness, fatigue, lightheadedness, reduced ability to exercise, and shortness of breath. Some people with AFib may not notice any symptoms, and the episodes may come and go or be persistent.

Risk Factors

The risk factors for developing atrial fibrillation (AFib) include:

1. Age: The risk of AFib increases as you grow older.
2. Obesity: People who have obesity are at higher risk of developing atrial fibrillation.
3. Other long-term health conditions: Diabetes, chronic kidney disease, lung disease, and sleep apnea may increase the risk of AFib.
4. Certain medicines and supplements: Prescription medicines and certain over-the-counter cough and cold remedies can cause irregular heartbeats.
5. Thyroid disease: Having an overactive thyroid gland can raise the risk of irregular heartbeats.
6. Family history: Some families have an increased risk of atrial fibrillation.
7. Heart problems or heart surgery: Coronary artery disease, heart valve disease, and heart problems present at birth increase the risk of AFib. A history of heart attack or heart surgery also makes a person more likely to get the condition.
8. High blood pressure: Having high blood pressure increases the risk of getting coronary artery disease, which can contribute to AFib.
9. Lifestyle habits: Drinking too much alcohol, smoking or using tobacco, and illegal drug use can trigger an AFib episode.

Development

Atrial fibrillation (AFib) can develop due to a variety of factors, mainly involving problems with the heart's structure and function. The most common cause of AFib is a problem with the heart's natural pacemaker, called sick sinus syndrome. Other causes include congenital heart defects, heart valve disease, high blood pressure, lung diseases, coronary artery disease, thyroid disease, infections from viruses, and sleep disorders such as obstructive sleep apnea. Additionally, certain lifestyle habits can trigger an AFib episode, such as excessive alcohol or caffeine consumption, substance abuse, smoking, and illegal drug use. In some cases, heart surgery or stress from surgery or sickness can also cause AFib. Lastly, some people with AFib have no known heart disease or heart damage. It's important to note that AFib may not always present symptoms, and when symptoms do occur, they can vary from person to person. These symptoms may include a fast, fluttering, or pounding heartbeat (palpitations), chest pain, dizziness, fatigue, lightheadedness, reduced ability to exercise, shortness of breath, and weakness.

Assessment and Diagnosis

Triage

If you suspect atrial fibrillation, you should see a doctor for a health checkup. If you experience symptoms such as chest pain, difficulty breathing, or sudden weakness, seek immediate medical help. If you have occasional or persistent atrial fibrillation, it's important to consult with a healthcare professional to determine the appropriate treatment and to manage any potential complications.

Diagnosis

The main test for diagnosing atrial fibrillation is an electrocardiogram (ECG or EKG). Other tests that may be used to diagnose AFib include blood tests, echocardiogram, exercise stress tests, and chest X-ray. To diagnose AFib, a healthcare provider will examine you, ask questions about your medical history and symptoms, and may perform these tests to check for conditions that can cause irregular heartbeats.

Management and Treatment

Complications

Potential complications of atrial fibrillation (AFib) include blood clots, stroke, heart failure, and other heart-related complications. Blood clots are a dangerous complication of AFib and can lead to stroke. The risk of stroke from AFib increases as a person grows older, and other health conditions such as high blood pressure, diabetes, heart failure, and some types of heart valve disease can also increase the risk of a stroke due to AFib. AFib itself is usually not life-threatening, but it is a serious medical condition that requires proper treatment to prevent stroke and manage other complications.

Treatment

Treatments for atrial fibrillation (AFib) may include medications, therapy to shock the heart back to a regular rhythm, and procedures to block faulty heart signals. Some of these treatments are:

1. Medications: Doctors may prescribe anti-arrhythmic medications to restore and maintain a regular heart rhythm, or blood thinners to prevent blood clots and reduce the risk of stroke.
2. Cardioversion: This is a procedure to shock the heart back to a normal rhythm using a brief electrical shock. It can be performed as a non-invasive or invasive procedure, depending on the severity of the condition.
3. Catheter ablation: This is a minimally invasive procedure where a thin, flexible tube is inserted through a vein in the leg and guided to the heart. Radiofrequency energy or cryotherapy is used to destroy the faulty heart tissue causing the irregular heartbeat.
4. Maze procedure: This is a surgical procedure to create a pattern of scar tissue in the atria, which disrupts the abnormal electrical signals causing AFib. The treatments for AFib and its related heart rhythm problem, atrial flutter, are similar. The choice of treatment depends on the type and severity of the condition, as well as the patient's age, health, and preferences. It's important to consult a healthcare professional for proper diagnosis and treatment recommendations.

Preparing for medical consultation

To prepare for an appointment for atrial fibrillation, follow these steps:

1. Be aware of any pre-appointment restrictions: When you make the appointment, ask if there are any special instructions you should follow, such as avoiding caffeine or alcohol, fasting for a specific period, or discontinuing any medications.
2. Write down any symptoms you're experiencing: Note when they started, how often they occur, and what you were doing when they started.
3. Gather personal information: Include any family history of heart disease, stroke, high blood pressure, or diabetes, as well as any major stresses or recent life changes.
4. Create a list of your current medications, vitamins, and supplements: Include the dosages and how often you take them.
5. Take someone along with you: Having a family member or friend accompany you can help you remember the information provided during the appointment and provide support.
6. Prepare a list of questions: Write down questions to ask your healthcare provider, such as the likely cause of your symptoms, recommended treatments, and any lifestyle changes you should make. Remember that the healthcare provider will examine you and may order tests to help diagnose atrial fibrillation. Following these preparation steps can help ensure you have a productive and informative appointment.