Atrial Fibrillation (AFib)
What is Atrial Fibrillation?
Atrial fibrillation (AFib) occurs when the upper chambers of the heart, called the atria, beat in an irregular and disorganized manner. This causes the atria to quiver or fibrillate rather than contract normally. As a result, the electrical signals that coordinate the heart's pumping action are disrupted.
In AFib, the atria beat very rapidly—sometimes over 300 beats per minute. However, the ventricles below may only beat around 100-175 times per minute as they try to compensate. This irregular transmission of signals from the atria to the ventricles is what causes the arrhythmia.
The erratic electrical impulses lead to an irregular heartbeat that can disrupt normal blood flow through the heart. Blood may pool and form clots in the fibrillating atria. If a clot breaks free and travels to the brain, it can cause a stroke. Therefore stroke prevention is a major focus of AFib treatment.
Causes & Symptoms of Atrial Fibrillation
Atrial fibrillation (AFib) has a variety of potential underlying causes and can manifest with an array of symptoms, ranging from subtle to severe. Recognizing the causes and symptoms of this irregular heart rhythm disturbance is key to obtaining timely diagnosis and treatment.
The exact cause of AFib is not always known. Some people with AFib may not experience any noticeable symptoms, a condition referred to as "silent AFib." However, even in the absence of symptoms, AFib can still increase the risk of serious complications like stroke. If you suspect you have AFib or are experiencing any of the symptoms, it is crucial to seek medical evaluation for accurate diagnosis and appropriate management.
Causes of Atrial Fibrillation
The risk of AFib increases with age, particularly in individuals over 60.
- Heart conditions
Underlying heart issues like high blood pressure, coronary artery disease, heart valve disorders, and heart failure can contribute to AFib.
- Lifestyle factors
Unhealthy habits such as excessive alcohol consumption, smoking, obesity, and leading a sedentary lifestyle can elevate the risk.
- Other medical conditions
Thyroid disorders, sleep apnea, and chronic lung diseases can influence AFib development.
Family history can play a role in predisposing individuals to AFib.
- Heart surgery
Some cardiac surgeries or procedures can trigger AFib.
Symptoms of Atrial Fibrillation.
- Irregular heartbeat (palpitations)
Many people with AFib experience a fluttering or rapid heartbeat that may feel like the heart is "racing" or "skipping a beat."
AFib can lead to reduced blood flow, causing feelings of tiredness and weakness.
- Shortness of breath
The irregular heartbeat can affect the heart's ability to pump blood efficiently, resulting in breathlessness, especially during physical activity.
- Dizziness or lightheadedness
Inadequate blood flow to the brain can lead to feelings of dizziness or faintness.
- Chest discomfort
Some individuals may experience chest pain, discomfort, or pressure during episodes of AFib.
- Fainting (syncope)
In some cases, AFib can lead to fainting, particularly if the heart rate becomes extremely rapid.
AFib episodes can induce anxiety or a sense of impending doom in some individuals.
Testing & Diagnosis for Atrial Fibrillation
A diagnosis of atrial fibrillation (AFib) is confirmed when irregular heartbeats are detected in ECG recordings. Additionally, tests may help determine the type and underlying cause of AFib, whether paroxysmal (intermittent), persistent, or permanent. Your medical history, symptoms, and test results collectively inform the diagnosis and guide the treatment plan. Timely diagnosis is crucial to prevent complications like stroke and manage the condition effectively. Here is an overview of the testing and diagnostic methods commonly used to diagnose atrial fibrillation:
- Electrocardiogram (EKG)
This painless test records the electrical activity of the heart. It is a primary tool for diagnosing AFib by detecting irregularities in heart rhythm.
- Holter monitor
This portable device continuously records your heart's activity over 24 to 48 hours. It is helpful for capturing intermittent AFib episodes.
- Event recorder
Similar to a Holter monitor, an event recorder is worn for a longer duration, often up to 30 days. You activate the device when you feel symptoms, allowing it to capture heart rhythm data during those moments.
This ultrasound test produces detailed images of the heart's structure and function. It helps identify structural abnormalities that might contribute to AFib.
- Stress test
Exercise stress tests evaluate heart function during physical activity, helping to detect AFib episodes that may not occur at rest.
- Blood tests
Blood tests can identify underlying conditions that might trigger AFib, such as thyroid disorders or infections.
- Electrophysiology study (EPS)
This invasive procedure involves threading catheters into the heart to study its electrical signals and identify abnormal pathways.
- Implantable loop recorder
A small device implanted under the skin can continuously monitor heart rhythms, capturing episodes of AFib over an extended period.
Atrial Fibrillation Treatments
The treatment approach for atrial fibrillation (AFib) aims to control heart rhythm, prevent blood clots, and alleviate symptoms. Treatment depends on factors like the type of AFib, its underlying causes, your overall health, and preferences.
With proper diagnosis and treatment, many patients can manage AFib effectively and prevent serious consequences. Staying aware of your heart health is key. Talk to your doctor if you have any concerns about rhythm disturbances or stroke risk factors. Here are some common treatments used to manage AFib:
- Rate control
Medications are used to slow down the heart rate, improving its rhythm and allowing the heart chambers to fill properly. Drugs like beta-blockers, calcium channel blockers, and digoxin are commonly used for rate control.
- Rhythm control
Medications called antiarrhythmics can help restore and maintain a normal heart rhythm. They can be used to convert episodes of AFib back to normal sinus rhythm. Cardioversion is a procedure in which a controlled electrical shock is delivered to the heart, resetting its rhythm to normal. It can be performed as an external (external cardioversion) or internal (transesophageal echocardiography-guided cardioversion) procedure.
- Anticoagulants and antiplatelets
Anticoagulant medications like warfarin, novel oral anticoagulants (NOACs), and antiplatelet medications (aspirin) are prescribed to reduce the risk of blood clot formation and stroke. Blood thinners help to prevent blood clots from forming in the heart, which can lead to stroke.
- Catheter ablation
In this minimally invasive procedure, catheters are threaded into the heart to destroy or isolate the abnormal electrical pathways causing AFib. PVI targets the pulmonary veins, which are often a source of AFib triggers.
- Surgical procedures
Maze procedure and AV node ablation are two surgical procedures that can be used to treat AFib.
- Lifestyle changes
Adopting a heart-healthy diet and maintaining a regular exercise routine can help manage AFib and its risk factors. Stress reduction techniques like meditation, yoga, and deep breathing can also help manage AFib triggers.
- Managing underlying conditions
Treating underlying conditions like high blood pressure, sleep apnea, and thyroid disorders can help control AFib.
- Stroke prevention
For individuals at high risk of stroke, anticoagulant medications are crucial to prevent blood clot formation.
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