Chronic or persistent A-fib: What you need to know
Chronic A-fib is usually diagnosed once a person has had symptoms lasting for longer than 12 months. Episodes of A-fib symptoms may come and go over the course of this time.
People with chronic A-fib might not have any symptoms at all. Other people may experience some combination of the following symptoms:
Chronic atrial fibrillation, which may also be called long-standing, persistent A-fib, lasts longer than 12 months.
- fluttering feeling in chest
- chest pain
- shortness of breath
- general weakness
Anyone who experiences these symptoms for the first time should go immediately to the emergency room. These symptoms can be signs of another cardiac problem, including a heart attack.
Additionally, anyone diagnosed with chronic A-fib who notices a change in their symptoms should also seek immediate medical attention.
Anyone can develop chronic A-fib, even people who are otherwise healthy. However, several factors may put some people at higher risk than others for developing chronic A-fib.
These risk factors include:
- being over age 60
- high blood pressure
- history of heart attack
- lung disease
- thyroid problems
- previous open heart surgery
- untreated atrial flutter
- problems with the structure of the heart
- excess alcohol consumption
- coronary artery disease
- inflammation around the heart
- sick sinus syndrome
- a family history of atrial fibrillation
- other serious illnesses or infections
A-Fib can be difficult to diagnose because many people do not experience any symptoms. For these people, A-fib is often diagnosed during a routine physical or a checkup for another problem.
However, some people with symptoms should see a doctor for a diagnosis. In either situation, a doctor will likely ask about the person's medical history and order a series of tests, including:
A Holter monitor may be used to record the heart's electrical activity over a period of time.
- electrocardiogram (ECG)
- a Holter monitor
- mobile cardiac monitoring
- event monitor
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
Treatment of chronic A-fib aims to minimize the risk of blood clots and return the heart to a normal rhythm.
There are many treatment options for chronic A-fib, including:
- lifestyle changes
- pacemakers or similar electronics
- procedures to reset the heart's rhythm
A person with chronic A-fib should make lifestyle changes to ensure that they are living a heart-healthy life. Individuals should follow a diet that is good for their heart and do the recommended amount of exercise.
People with chronic A-fib may have to reduce their alcohol and caffeine intake or quit smoking as well.
Doctors typically recommend medications along with lifestyle changes to help manage the risks and symptoms of chronic A-fib. Commonly prescribed medications for chronic A-fib include the following:
- beta blockers or calcium channel blockers to slow an abnormally fast heart rate
- antiarrhythmics to restore the heart rate to normal
- blood thinners to reduce the risk of blood clots
- medications to treat related conditions, such as high blood pressure or thyroid problems
It may take some trial and error to find the right combination of medications to manage chronic A-fib. Some drugs, such as antiarrhythmics, can have serious side effects, and people should only begin taking these drugs under close supervision in a hospital.
For some people, medication may not improve their symptoms entirely, so they may need an electronic device to help manage the condition. These devices regulate the heart by delivering a controlled shock to the heart when the rhythm needs resetting.
These devices include pacemakers and implanted cardioverter defibrillators. Most often, a doctor will insert these devices into a person's chest.
Occasionally, a doctor may recommend a procedure to reset the person's heart rhythm using a cardioversion or a catheter ablation.
During a catheter ablation, a doctor will make a small incision in the groin or arm and slide a straw-sized tube through a blood vessel until it reaches the heart. They will then guide thin wires called electrode catheters through the tube into the heart.
The doctor will place the electrode where the abnormal cells are located and administer painless radiofrequency energy. This destroys the cells that were causing the irregular rhythm.
During a cardioversion, a brief electric shock resets the abnormal rhythm back to a normal rhythm.
In situations where A-fib is linked to another illness, treating the underlying condition should stop the A-fib.
It is not always possible to prevent A-fib, but there are steps a person can take to stay healthy and reduce the risk of developing the condition.
These steps include:
Quitting smoking can help prevent A-fib.
- exercising regularly
- controlling blood sugar levels
- eating a diet rich in omega 3s, fruits, whole grains, and vegetables
- avoiding trans and saturated fats
- quitting smoking
- maintaining a healthy weight
- limiting alcohol consumption
- managing stress and anxiety
- controlling blood pressure
- avoiding excess caffeine
People who want to start to make positive changes in their lifestyle may consider talking to a doctor or dietitian. Often, they can help create a general health plan help a person reach their goals safely.