Atrial Fibrillation (AFib)

Atrial fibrillation (AFib) is the most common type of abnormal heart rhythm (arrhythmia). In AFib, the heart's upper chambers (atria) beat irregularly and often rapidly, out of coordination with the lower chambers (ventricles). This disrupts normal blood flow through the heart and increases the risk of blood clots, which can lead to stroke. AFib can be occasional (paroxysmal), persistent, or permanent. While some people with AFib don't experience symptoms, others may feel palpitations, weakness, fatigue, or shortness of breath. AFib itself isn't usually life-threatening, but it requires proper management to prevent complications, particularly stroke.

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Causes

Abnormal heart structure - Conditions like heart valve problems, congenital heart defects, or heart muscle disease (cardiomyopathy).
Coronary artery disease - Narrowed heart arteries due to plaque buildup.
High blood pressure - Longstanding hypertension is a common cause of AFib.
Previous heart attack - Damage to heart tissue can affect the electrical system.
Previous heart surgery - Scarring from surgery can disrupt normal electrical pathways.
Heart valve disease - Problems with the heart valves can lead to AFib.
Sick sinus syndrome - Dysfunction in the heart's natural pacemaker.
Sleep apnea - Interrupted breathing during sleep strains the heart.
Thyroid disease - Both overactive and underactive thyroid can trigger AFib.
Excessive alcohol consumption - "Holiday heart syndrome" or long-term heavy drinking.
Stimulant use - Caffeine, tobacco, certain medications, or illicit drugs.
Viral infections - Infections affecting the heart can trigger AFib.
Stress - Physical or emotional stress can precipitate episodes.
Family history - Genetic factors may increase susceptibility.
Aging - Risk increases with age, especially after 65.

Signs and Symptoms

Palpitations - Sensations of a racing, uncomfortable, irregular heartbeat or flopping in the chest.
Weakness or fatigue - Due to inefficient heart function and reduced cardiac output.
Reduced ability to exercise - Getting tired more quickly than usual during physical activity.
Shortness of breath - Difficulty breathing, especially during physical activity or when lying down.
Lightheadedness or dizziness - From reduced blood flow to the brain.
Confusion - Particularly in older adults.
Chest pain or pressure - May occur, especially in those with underlying heart disease.
Fainting (syncope) - In severe cases.
Reduced stamina - General feeling of being unable to perform usual activities.
Many people with AFib have no symptoms - Called "silent AFib," which is still risky for stroke.

Diagnosis

Electrocardiogram (ECG)

Records your heart's electrical activity and can detect AFib if it's occurring during the test. Shows the characteristic irregular rhythm and absence of P waves typical of AFib.

Holter Monitor

A portable ECG device worn for 24-48 hours that continuously records your heart's activity as you go about your daily routine, useful for detecting intermittent AFib.

Event Monitor

Similar to a Holter monitor but worn for longer periods (up to 30 days), recording heart activity when activated during symptoms or automatically when detecting arrhythmias.

Implantable Cardiac Monitor

A small device implanted under the skin that continuously monitors heart rhythm for up to three years, useful for very infrequent episodes that are difficult to capture.

Echocardiogram

Uses sound waves to create images of your heart to check for structural problems, valve issues, blood clots, or other conditions that might cause or result from AFib.

Transesophageal Echocardiogram (TEE)

A special type of echocardiogram where the probe is passed down the esophagus to get clearer images of the heart, particularly useful for detecting blood clots in the left atrial appendage.

Blood Tests

Check for thyroid problems, other medical conditions, or signs of heart damage that might trigger or result from AFib.

Chest X-ray

Can show if your heart is enlarged, which might indicate heart damage or heart failure that could contribute to AFib.

Electrophysiology Study

An invasive procedure where catheters are inserted into the heart to map its electrical activity in detail, typically done when considering catheter ablation treatment.

Treatment Options

Heart Rate Control

Medications to slow the heart rate to a normal range, making the heart beat more efficiently even though the rhythm remains irregular. Common medications include beta-blockers (like metoprolol), calcium channel blockers (like diltiazem), and digoxin.

Heart Rhythm Control

Medications (antiarrhythmics) or procedures to restore and maintain normal sinus rhythm. Antiarrhythmic drugs include amiodarone, flecainide, propafenone, and sotalol, among others.

Stroke Prevention

Blood-thinning medications (anticoagulants) to prevent clots from forming and causing a stroke. Options include warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban. Your doctor will assess your stroke risk using tools like the CHA₂DS₂-VASc score to determine if you need anticoagulation.

Cardioversion

A procedure to reset the heart rhythm to normal using either electrical shock (electrical cardioversion) or medications (pharmacological cardioversion). Often used when symptoms are severe or as part of a rhythm control strategy.

Lifestyle Modifications

Changes to reduce AFib triggers and improve overall heart health, including limiting alcohol and caffeine, quitting smoking, managing stress, treating sleep apnea, and maintaining a healthy weight through diet and exercise.

Home Remedies

Trigger Avoidance

Identify and avoid personal triggers that may precipitate AFib episodes. Common triggers include alcohol, caffeine, stress, lack of sleep, and certain medications. Keep a journal to track potential triggers and symptoms.

Heart-Healthy Diet

Follow a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit sodium, saturated fats, and processed foods. Consider a Mediterranean-style diet, which has been associated with lower rates of AFib and its complications.

Regular Physical Activity

Engage in moderate exercise as recommended by your doctor. Start slowly and gradually increase intensity, watching for symptoms. Activities like walking, swimming, and cycling are often well-tolerated.

Stress Management

Practice stress-reduction techniques such as deep breathing, meditation, yoga, or tai chi. Chronic stress can trigger AFib episodes and make them more frequent or severe.

Sleep Hygiene

Establish good sleep habits to ensure adequate rest. If you have sleep apnea, use your CPAP machine as prescribed. Poor sleep and sleep apnea can trigger or worsen AFib.

Weight Management

Maintain a healthy weight or lose weight if overweight. Obesity increases the risk of AFib, and weight loss has been shown to reduce AFib burden in overweight individuals.

Medication Adherence

Take all prescribed medications exactly as directed, even when feeling well. This includes both AFib medications and those for other conditions that might affect your heart, like high blood pressure or thyroid disease.

Vagal Maneuvers

Techniques that stimulate the vagus nerve, such as coughing, bearing down as if having a bowel movement, or applying an ice pack to the face, may help terminate some episodes of AFib. Discuss with your doctor before trying these techniques.

Preventive Care

Take all medications exactly as prescribed, including blood thinners to prevent stroke.
Keep all follow-up appointments with your healthcare team.
Have regular monitoring of your INR if you take warfarin.
Maintain a heart-healthy lifestyle with regular physical activity and a balanced diet.
Manage other health conditions that can affect heart function, such as high blood pressure, sleep apnea, and thyroid disorders.
Limit or avoid alcohol and caffeine, which can trigger AFib episodes.
Quit smoking and avoid secondhand smoke.
Reduce stress through relaxation techniques and adequate rest.
Know the signs of stroke (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services).
Wear a medical alert bracelet indicating you have AFib and take anticoagulants, if applicable.
Consider cardiac rehabilitation programs to improve your heart health under supervision.
Get vaccinated against influenza and pneumonia to prevent infections that can strain your heart.
Discuss with your doctor before taking over-the-counter medications or supplements, as some can interact with AFib treatments or trigger episodes.

Surgical Options

Catheter Ablation

A procedure that uses energy (usually radiofrequency or cryotherapy) to create small scars in the heart tissue that is causing the abnormal electrical signals. This is typically done by isolating the pulmonary veins, where most AFib triggers originate. It's most effective for paroxysmal AFib and may require multiple procedures for complete success.

Maze Procedure

A surgical approach usually performed during open-heart surgery for another reason (like valve repair). The surgeon creates a pattern of scar tissue in the atria to block abnormal electrical pathways. This can be done with scalpel incisions, radiofrequency, cryotherapy, or other energy sources.

Left Atrial Appendage Closure

A procedure to seal off the left atrial appendage (LAA), where most stroke-causing blood clots form in AFib patients. Devices like the Watchman are implanted via catheter to close off this small pouch, potentially allowing some patients to stop taking blood thinners. This addresses the stroke risk without affecting the arrhythmia itself.

AV Node Ablation with Pacemaker

For patients with AFib that can't be controlled with other treatments, this procedure intentionally blocks the electrical connection between the atria and ventricles by ablating the AV node. A permanent pacemaker is then implanted to maintain a regular heart rate. This doesn't cure AFib but can control symptoms by regularizing the ventricular rate.

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