Valvular atrial fibrillation: Everything to know

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Valvular A-fib involves an abnormal heart rhythm caused by a heart valve disorder or artificial heart valve. In valvular A-fib, the heart valve disorder or artificial heart valve causes the top chamber of the heart, called the atrium, to beat erratically.

Doctors classify A-fib by the cause, including valvular and nonvalvular atrial fibrillation. Nonvalvular A-fib occurs in the absence of a mechanical heart valve or moderate to severe mitral stenosis.

The American Heart Association’s (AHA) guidelines clarified that valvular A-fib refers to people with an artificial heart valve or moderate to severe mitral valve stenosis. The guidelines also recommend eliminating the term “nonvalvular.” Instead, the AHA recommends specifying the instances when someone should not take certain types of anticoagulant medications.

Learn more about A-fib.

Not everyone with valvular A-fib experiences symptoms. Some people may find out they have the condition incidentally.

When symptoms of valvular A-fib develop, they are similar to nonvalvular A-fib and include:

• heart palpations
• a racing heart
• chest pain
• shortness of breath
• fatigue
• lightheadedness
• weakness

The causes of valvular A-fib include:

Mitral stenosis

Mitral stenosis causes constricting or a narrowing of the valve. The mitral valve controls the flow of blood from the left atrium to the left ventricle. This narrowing prevents normal blood flow to the left ventricle and can lead to an irregular heartbeat. Rheumatic fever is the most frequent cause of mitral valve stenosis. Mitral valve stenosis occurs due to rheumatic fever in about 80% of people with the condition.

Artificial heart valve

Another cause of valvular A-fib is an artificial or mechanical heart valve. Doctors use an artificial heart valve to replace a diseased valve. The valves used may include:

• an animal valve
• tissue from a human donor
• a mechanical heart valve

Doctors diagnose valvular A-fib through a combination of a physical exam, medical history, and tests. Tests recommended may include:

• Electrocardiogram: This records the heart’s rhythm and can detect abnormal electrical activity.
• Echocardiogram: An echo looks at the valves and helps determine the heart’s pumping action. It may also identify blood clots in the chambers of the heart.
• Blood tests: Blood work measures the levels of thyroid hormones and other substances, which may help identify the cause of A-fib.
• Cardiac MRI scan: This test creates pictures of the structures of the heart. It may help a doctor determine the cause of A-fib.

Treatment for valvular A-fib often includes medication. Medications, called anticoagulants, can reduce the risk of stroke by about 70%.

A class of medications known as vitamin K antagonists, such as warfarin, remains the standard treatment option for people with valvular A-fib.

However, researchers also continue to study the use of another category of medications known as direct oral anticoagulants (DOACs).

People with valvular A-fib do not usually take DOACs due to an increased risk of developing a brain bleed. However, some limited research suggests DOACs may be an option for people with valvular A-fib in the future.

For instance, this 2021 study involving 56,336 people with valvular A-fib concluded that new users of DOACs with valvular A-fib had a lower risk of a systemic embolism or ischemic stroke than new users of warfarin. However, the study did not include a long-term follow-up.

Another 2022 meta-analysis examined the effect of DOACs versus vitamin K antagonists in treating A-fib in people with bioprosthetic heart valves. The study indicates that people taking DOACs had a decreased risk of major bleeding, including brain bleeding, compared with people taking vitamin K antagonists.

Currently, it appears additional research needs completion before doctors make a definite change in their recommendations for treatment.

Treatment may also include lifestyle changes to reduce a person’s risk of stroke.

Lifestyle changes may include:

• stopping smoking
• getting regular exercise
• managing stress
• maintaining a moderate weight

Some people may require additional treatment. One treatment option is catheter ablation, a procedure to destroy the tissue causing the fibrillation. Another option is electrical cardioversion, a procedure that uses low-energy shocks to restore a normal heart rhythm.

The outlook for valvular A-fib varies depending on whether a person receives proper treatment. A-fib is the leading cause of stroke. Anyone with A-fib has an increased risk of experiencing a stroke.

According to this 2019 risk stratification, people with valvular A-fib have a high risk of developing a blood clot that occurs outside their left atrium. However, proper treatment and lifestyle changes can reduce the risk of stroke.

The following are some questions people frequently ask about valvular atrial fibrillation.

What is the most likely cause of valvular atrial fibrillation?

Mitral valve stenosis is the most common cause of valvular atrial fibrillation. Mitral stenosis leads to the narrowing of the valve, which controls the flow of blood from the left atrium to the left ventricle.

What are nonvalvular A-fib and valvular A-fib?

Nonvalvular A-fib occurs for other reasons besides moderate to severe mitral stenosis or an artificial heart valve. Causes may include:

• high blood pressure
• sleep apnea
• coronary artery disease

Is Eliquis a treatment option for valvular atrial fibrillation?

Eliquis belongs to a classification of medications called direct oral anticoagulant drugs. Research continues on the use of this class of drug for treating valvular atrial fibrillation. But the current recommendations exclude people with valvular A-fib from taking Eliquis due to potential risks.

Valvular atrial fibrillation is an abnormal heart rhythm that occurs due to moderate to severe mitral stenosis or an artificial heart valve.

Valvular A-fib increases a person’s risk of stroke. Treatment, including anticoagulant medications, such as warfarin, can reduce the risk of having a stroke.

A person who experiences symptoms, such as changes in their heart rate, shortness of breath, and chest pain, should speak with a healthcare professional.