Atrial fibrillation is an abnormal heart rhythm, also known as an arrhythmia. Blood flow from the top chambers of the heart to the bottom chambers varies from beat to beat, and the heart cannot pump blood to the rest of the body efficiently.
The Centers for Disease Control and Prevention (CDC) estimate that between 2.7 and 6.1 million people currently have A-fib.
Age is a key risk factor for developing the disorder. According to the CDC, 9 percent of people over the age of 65 years have A-fib in the U.S., but only two percent under 65 years have it.
The heartbeat usually starts from one spot in the right atrium, the upper-right chamber of the heart. However, people with A-fib have a heartbeat that triggers from multiple spots, which means both atria and the ventricles, or lower chambers, beat at their own pace.
The arrhythmia may or may not produce symptoms. Recognizing and treating A-fib early in its development can greatly improve the chances of avoiding complications.
A-fib may not cause any symptoms at all, and, when there are symptoms, they may only occur intermittently.
Often the heart rate is higher than usual with A-fib, but this depends on how many signals get from the atria to the ventricle.
Common symptoms include:
- palpitations, or the feeling of an irregular heartbeat
- breathlessness, particularly when lying flat
- chest pain or pressure
- low blood pressure
- dizziness, light-headedness, and fainting
Keep a close eye on the symptoms and when they occur or change in severity. Make a note of them for your doctor. This will help them make the diagnosis and decide on the best treatment.
A-fib can cause potentially life-threatening health issues.
Blood can pool in the atria if the heart is not beating regularly. Blood clots can form in the pools.
A segment of a clot, called an embolus, might break off and travel to different parts of the body through the bloodstream and cause blockages.
An embolus can restrict blood flow to the kidneys, intestine, spleen, brain, or lungs. A blood clot can be fatal.
A stroke occurs when an embolus blocks an artery in the brain and reduces or stops blood flow to part of the brain.
The symptoms of a stroke vary depending on the part of the brain in which it occurs. They can include weakness on one side of the body, confusion, and vision problems, as well as speech and movement difficulties.
Stroke is a key cause of disability in the U.S. and the fifth most common cause of death, according to the CDC.
A-fib can lead to heart failure, especially when the heart rate is high. When the heart rate is irregular, the amount of blood flowing from the atria to the ventricles varies for each heartbeat.
The ventricles may therefore not fill up before a heartbeat. The heart fails to pump enough blood to the body, and the amount of blood waiting to circulate the body instead builds up in the lungs and other areas.
A-fib can also worsen the symptoms of any underlying heart failure.
A study in the Journal of the American Heart Association showed people with A-fib have a higher long-term risk of cognitive difficulties and dementia that have no link to reduced blood flow in the brain.
Certain factors increase the risk of developing A-fib.
Age: The older a person is, the higher the risk of A-fib becomes.
Hypertension: Long-term high blood pressure can add strain to the heart and increase the risk of A-fib
Pulmonary embolism: A blood clot in the lung increases the risk of A-fib.
Heart disease: People with the following conditions have a higher risk of A-fib:
Excessive alcohol consumption: Men who have more than two drink a day and women who have more than one drink daily are at increased risk of A-fib .
Family members with A-fib: A family history of the disease increases the risk of getting it.
Sleep apnea: People with this condition, especially when it is severe, have a higher risk of developing A-fib.
Surgery: A-fib commonly occurs directly after receiving heart surgery.
Controlling the factors that increase the risk of A-fib may help prevent it.
Manage the diet: A heart-healthy diet can help prevent A-fib and other heart diseases. The DASH diet, which the American Heart Association (AHA) promotes, has shown protective effects on heart health.
Abstaining from harmful substances: Tobacco, alcohol, and some illicit drugs, like cocaine, can damage the heart. With or without a diagnosis of A-fib, eliminating tobacco and mood-altering substances and moderating alcohol is vital for protecting the heart. This is also important in a person who already has A-fib.
Stress management: Stress can increase blood pressure and heart rate, which makes the heart work harder. Managing stress levels can help to prevent the progression and development of A-fib. Breathing exercises, mindfulness, meditation, and yoga can all help reduce stress.
Exercise: A physically active lifestyle has profound effects on cardiac health and can help strengthen the heart, reducing the risk of A-fib and other heart conditions.
The treatment of A-fib aims to improve symptoms and reduce the risk of complications. For some people, converting the heart back to a normal rhythm is the best option.
For others, the doctor deems it better to leave the irregular rhythm in place and prescribe medication to control a high heart rate and prevent the formation of blood clots.
In addition to recommending a healthy lifestyle, a doctor will determine the most appropriate treatment depending on symptoms, other conditions they have, and overall health.
For A-fib, medications are used to control the heart rate, prevent clots from forming. Sometimes medications or a procedure is used to try to restore a regular rhythm.
When a doctor thinks the best option is to let someone stay in A-fib, they may prescribe anticoagulant medications, or blood-thinners. These medications make it harder for blood to clot.
However, stopping bleeding becomes more difficult in a person who takes these medications. The doctor will weigh the risk of developing a clot against the risk of falling and causing a bleed in the brain.
These medications include:
- direct-acting oral anticoagulants (DOACs), including rivaroxaban, apixaban, and edoxaban
Elderly people with an increased risk of falling often use aspirin but also have a high risk of forming a clot. Aspirin reduces clotting factor but not to the same extent as other medications, so any bleeding is easier to manage.
People taking warfarin or other anti-clotting agents should advise any medical professional treating them of their current medications, especially if they will be having a procedure or surgery or have been in an accident.
While taking anticoagulants, make sure the doctor knows about any planned or existing pregnancy or any signs of bleeding, such as:
- very large bruises
- nausea and light-headedness
- vomiting blood
- coughing up blood
- unusually heavy menstrual flow
- gums that bleed regularly
- bloody or black stool
- blood in the urine
- sudden back pain that is very severe
Take blood thinners exactly as the doctor advises for the best chance of preventing a clotting-related complication and avoiding excessive thinning of the blood.
Managing heart rate
If the heart rate is high, bringing it down is important to avoid heart failure and reduce the symptoms of A-fib.
Several medications can help by slowing conduction of the signals that tell the heart to beat.
- beta-blockers, such as propranolol, timolol, and atenolol
- calcium-channel blockers, such as diltiazem and verapamil
Normalizing heart rhythm
Instead of putting a person on blood thinners and heart rate-controlling medicine, doctors may try to return the heart rhythm to normal using medication.
This is called chemical or pharmacologic cardioversion.
Medications called sodium channel blockers, such as flecainide and quinidine, and potassium channel blockers, such as amiodarone and sotalol, are examples of medications that help to convert A-fib to regular heart rhythm.
When a person does not tolerate A-fib medication needed for someone who has an irregular heart rhythm or doesn’t respond to pharmacologic cardioversion, surgical and non-surgical procedures can be used to control the heart rate or try to convert to a regular rhythm to help prevent complications from A-fib.
Options for converting A-fib to a regular rhythm include:
Electrical cardioversion: The surgeon delivers an electric shock to the heart, which briefly resets the abnormal rhythm to a regular beat. Before carrying out cardioversion, they will often perform an echocardiogram by inserting a scope down the throat to produce an image of the heart to make sure no clots are present in the heart.
If they find a clot, a doctor will prescribe anticoagulant medication for several weeks to dissolve it. Cardioversion will then be possible.
Catheter ablation: This destroys the tissue that is causing the irregular rhythm, returning the heart to a regular rhythm. The surgeon may need to repeat this procedure if the A-fib returns.
The surgeon sometimes destroys the area in which the signals travel between the atria and ventricles. This stops the A-fib, but the heart can no longer send a signal to orchestrate a beat. In these instances, the surgeon will then fit a pacemaker.
Surgical ablation: The heart tissue that is causing the irregular rhythm can also be removed in an open-heart surgery called a maze procedure. A surgeon will often carry out this procedure alongside a heart repair.
Pacemaker placement: This device instructs the heart to beat regularly. A surgeon will sometimes place a pacemaker in a person with intermittent A-fib that only occurs intermittently.
When a doctor feels that another condition is responsible for the A-fib, such as hyperthyroidism or sleep apnea, they will treat the underlying condition alongside the arrhythmia.
A-fib is a disorder that causes an irregular heart rhythm.
It occurs more often after the age of 65 years and may or may not cause symptoms. The condition can lead to a stroke when blood pools in the heart and forms a clot that travels to the brain.
Lifestyle adjustments that can help to prevent A-fib include a heart-healthy diet, limiting alcohol intake, not smoking, and getting regular exercise.
There are two treatment options. A doctor might allow an irregular rhythm to continue but control the heart rate and prescribe an anticoagulant to help prevent a stroke. Alternatively, the doctor might try to convert the irregular rhythm back to a regular one with medication or a procedure.
If A-fib does not show symptoms, how can I take steps to stop it before it causes complications?
The first step is recognizing you have it. Without symptoms, you won’t know you have A-fib unless your doctor finds it while listening to your heart during an examination or while testing for a different health issue.
Increase the odds of finding A-fib by regularly visiting your doctor for ongoing or preventative care.
Once you have A-fib, unless it stops spontaneously on its own, the only way to avoid complications is through appropriate treatment.Nancy Moyer, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.