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What is atrial fibrillation?
Atrial fibrillation (AFib) is a common type of heart arrhythmia. (Arrhythmia means an abnormal heart rhythm). It's caused by the electrical signals in the heart’s left upper chamber (left atrium) misfiring. The heartbeat becomes irregular and sometimes speeds up.
Atrial Flutter (AFL) is a similar condition, but the abnormal electrical signal originates from the right upper chamber (right atrium).
You can have one of the conditions or both simultaneously. They are usually diagnosed by an electrocardiogram (an EKG), which tracks the electrical activity of the heart.
Atrial fibrillation symptoms
Common symptoms of AFib and AFL include a sudden rapid or irregular heartbeat. Some people never notice any symptoms and only learn that they have AFib or AFL while getting an EKG for another medical issue.
Fast or irregular heart beating sensation. Sometimes can feel like the heart is fluttering or skipping beats.
- Palpitations (heart-pounding sensation)
- Difficulty breathing or catching your breath
- Chest discomfort or pressure, typically in the middle or left side of the chest
Symptoms I listen for when diagnosing AFib: Heart skipping or fluttering sensation, heart-pounding sensation, trouble breathing or catching one’s breath, lightheadedness or feeling like you are about to pass out, fatigue or tiredness, or chest pressure that come on suddenly and usually last anywhere from seconds to several minutes." —Dr. Anubodh Varshney
Risk factors for AFib and AFL
- Older than age 60
- Sleep apnea
- Diabetes mellitus
- High blood pressure
- Coronary artery disease or prior heart attack,
- Structural heart disease (e.g., valve problems)
- Thyroid disease
- Chronic lung disease (e.g., emphysema)
- Heavy alcohol use
- A sudden condition like a pulmonary embolism, surgery, infection,
- Certain medications (e.g., some chemotherapies or inhalers for asthma)
If you think you are having AFib or AFL, get immediate medical attention.
If you have severe symptoms or feel like you are about to pass out, call 911.
If you have mild symptoms that are not interfering with your daily life, either go to urgent care or call your primary doctor.
Afib and AFL need to be treated. Otherwise, it can lead to complications like stroke or blood clots, low blood pressure, or congestive heart failure.
What is the best treatment for atrial fibrillation?
Your doctor will want to reduce your risk of stroke with blood thinners. They may try to get the electrical rhythm back to normal. Or decide to leave the heart in atrial fibrillation/flutter but control the heart rate.
They will also address any other condition you may have (like lung disease or an infection) that increases your risk for developing AFib.
Recently, there has been interest in monitoring for atrial fibrillation with consumer health devices, such as smartwatches and smartphones. These technologies are promising. However, much more research needs to be done. —Dr. Varshney
Some medications that are prescribed for AFib.
- Blood thinners (like apixaban, rivaroxaban, dabigatran, edoxaban, warfarin) help with stroke prevention. Especially for those with higher risk factors for stroke. These medications thin the blood and make clots less likely to form. But while they decrease the risk of strokes, they increase the risk of excess bleeding.
- Beta blockers (e.g. metoprolol), calcium channel blockers (e.g. diltiazem), and digoxin help keep the heart rate down.
- Antiarrhythmic drugs (e.g., flecainide, propafenone, dofetilide) maintain a normal heart rhythm to stop atrial fibrillation/flutter. Medications may need to be taken daily. Or sometimes only during a flare-up.
- Amiodarone is another type of antiarrhythmic medication. It has side effects including causing thyroid, liver, and lung abnormalities. Taking long-term will require regular monitoring by your doctor.
You don’t necessarily have to get the heart back to a normal rhythm. Studies suggest that for most patients, the goal of AFib treatment should focus on preventing symptoms, such as palpitations or trouble breathing, and lowering stroke risk with blood thinners. Still, sometimes, undergoing procedures or using medications to keep the heart in a normal rhythm is needed. This is a decision that should be discussed with your cardiologist. —Dr. Varshney
If medication is not helping, doctors may suggest catheter ablation. The procedure is generally considered minimally invasive (small and few incisions). It does not always require an overnight hospital stay.
A cardiac electrophysiologist threads a catheter (a long, thin tube) into the heart through blood vessels in the leg. The heart tissue that has misfiring electrical currents is either burned or frozen.
Make changes to improve your heart health.
- Maintain an active and healthy lifestyle that includes at least 150 minutes per week of a moderate-intensity aerobic exercise.
- Avoid smoking, e-cigarette use, and secondhand smoke.
- Avoid excess alcohol (more than 1 drink per day for women and more than 2 drinks per day for men).
- Eat heart-healthy meals. Mostly fruits, vegetables, whole grains, low-fat dairy, skinless poultry and fish, and nuts/legumes. Limit saturated fat, trans fat, sodium, red meat, sweets, sugary drinks.
- Treat any other illnesses, like hypertension, high cholesterol, diabetes, chronic obstructive pulmonary disease, or sleep apnea.
Continue to have your heart monitored by a primary care physician and a cardiologist. They will want to see how your medication is working, including checking for side effects like bleeding.
If you had an ablation, they will check for AFib or AFL and other complications. Sometimes, you will be asked to wear a patch monitor or similar device for one day to multiple days to check for abnormal heart rhythms.
Questions your doctor may ask to determine atrial fibrillation
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do you have a cough?
- Do you notice your heart beating hard, rapidly, or irregularly (also called palpitations)?
- Where is your chest pain exactly?
- Are you sick enough to consider going to the emergency room right now?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Varshney is a board-certified Internist and current Cardiovascular Medicine Fellow at Brigham and Women's Hospital / Harvard Medical School. He earned his undergraduate degree in Biomedical Engineering from Washington University in St. Louis (2010) and graduated first in his class from the University of Texas Southwestern Medical School (2014). He then completed an internal medicine residency at Brigham and Women's Hospital / Harvard Medical School. Following this, he worked as a hospitalist at Brigham and Women's Hospital for 1 year while completing multiple projects spanning translational, clinical, and implementation research. He then began Cardiovascular Medicine Fellowship at Brigham and Women's Hospital in 2018.
Dr. Varshney is interested in the evidence-based design, development, evaluation, and implementation of technologies to improve outcomes for patients with cardiovascular disease. He has a particular interest in remote monitoring and mechanical circulatory support devices and is pursuing multiple academic endeavors in these areas. He plans to complete additional clinical training in the care of patients with advanced heart failure, cardiac transplantation, or need for mechanical circulatory support after completing Cardiovascular Medicine Fellowship. He has published multiple articles in the peer-reviewed medical literature and has written for other outlets including U.S. News & World Report and Doximity.
- Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2013;127(18):1916. UpToDate Link
- Division for heart disease and stroke prevention. Centers for Disease Control and Prevention. Updated August 22, 2017. CDC Link
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- Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: A randomized clinical trial. JAMA. 2013;310(9):2050-2060. UpToDate Link
- January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071. UpToDate Link
- What is the AFib-stroke connection? American Stroke Association. American Stroke Association Link
- Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, et al. Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med. 2012;172(13):997. UpToDate Link