Let's Talk About Atrial Fibrillation
When your heart’s rhythm gets erratic, blood can clot in its upper chambers, the atria—increasing your risk for stroke. Here’s how to prevent that from happening.by Matt McMillen Health Writer
Most of the time, your heart beats like a champ, delivering oxygen-rich blood to your every nook and cranny. But, sometimes, irregular rhythms occur. Called arrhythmias, most are infrequent and harmless, like when your heart skips a beat during times of high stress. Others, though, can be life-threatening. Of these, atrial fibrillation is the most common. While “Afib” is incurable, the good news is that it can be managed with treatments—so never ignore your symptoms. The sooner you see your doctor, the better chance you’ll have to avoid dangerous complications from this condition. Have we got your attention? Good. Keep reading, and we’ll tell you everything we know.
Our Pro Panel
We went to some of the nation’s top experts in atrial fibrillation to bring you the most up-to-date information possible.
Daniel Cantillon, M.D.
Laurence M. Epstein, M.D.
System Director of Electrophysiology
Andrew Freeman, M.D.
Director of Cardiovascular Prevention and Wellness
National Jewish Health
This is very individual, and the answer will depend on many factors. Health conditions such as diabetes and high blood pressure make you more prone to stroke, for example. Your doctor will establish your particular risk and develop a prevention strategy.
No! Remember you could be having an episode of afib and have no symptoms at all. Also, stroke risk is higher in people with atrial fibrillation even when their hearts are beating normally.
If you have any symptoms, such as a racing heart, shortness of breath, or unexplained fatigue, let your doctor know. Your heart’s activity should be evaluated. Be sure you understand all the possible symptoms you may experience so that you recognize them when they occur.
Exercise can be a trigger, especially if you overdo it. Then again, low- to moderate-intensity exercise is good for your overall heart health. Discuss your situation with your doctor, who can help you develop a safe fitness program.
What Is Atrial Fibrillation, Anyway?
Bu-bump … Ba-bump … Ba-da-ba-bump. An arrhythmia is an abnormal heart rhythm. There are many kinds. Some arrhythmias you barely notice. Others are bothersome, if benign. But a few, like atrial fibrillation, can trigger dangerous symptoms that get progressively worse without treatment, putting your health—and sometimes, even your life—at risk.
Why? Because “Afib,” as this condition is often called, interferes with your heart’s ability to pump blood efficiently and effectively to the rest of your body, including your brain. With this disorder, the heart’s electrical activity can get super erratic. Instead of promoting healthy blood flow, your heart’s pump allows blood to pool and stagnate within the heart’s chambers.
The Centers for Disease Control and Prevention (CDC) estimate that anywhere from 3 million to 6 million Americans have atrial fibrillation. While it can occur at any age, it’s most common in adults over 65. It's also more common in men than women, although women with Afib are more likely to have a stroke or early death.
To clearly explain why such a chaotic rhythm occurs, it’s important to first understand how the heart functions when it’s working properly.
In brief, the heart has four chambers:
On top are the right atrium and left atrium (together, called the atria).
On the bottom are the left and right ventricles.
Those chambers work in tandem, employing a system of valves that open and close as your heart beats in order to bring blood in and pump blood out. Remember, the heart is a muscle, and when it’s healthy, it’s quite strong. As a pump, it provides sufficient pressure so that your entire blood supply, rich with oxygen and nutrients, cycles through your body every 60 seconds.
Your heart also has its own pacemaker that controls your heartbeats. It sends out electrical signals, which travel along a variety of pathways to your heart’s four chambers and elsewhere, telling the upper and lower chambers to beat on a fixed schedule. This allows blood to flow normally into, through, and out of your heart.
Sometimes, those signals go awry. In those cases, your heart can start to beat too fast, too slowly, or in an erratic fashion. This causes your heart to function less efficiently and less effectively.
With Afib, rather than contracting in the rhythmic way that it should, the atria quiver, or fibrillate. The resulting haywire electrical signals that occur can reach the left and right ventricles and upset their rhythm, too.
Is Atrial Fibrillation Dangerous?
Left untreated, this erratic quivering can lead to serious—even life-threatening—health risks, including:
Stroke: When your atria aren’t functioning properly, some of the blood that should be passing through them instead pools in the left atrium. That pooled blood can clot, and if one of those clots breaks away into your bloodstream, it can travel to your brain and cause a stroke. In fact, atrial fibrillation is the leading preventable cause of stroke.
Heart failure: Over time, your rapid and irregular heartbeat can weaken your heart and heighten your risk of heart failure, which makes it progressively more difficult for your heart to pump an adequate amount of blood to the rest of your body.
What Causes Atrial Fibrillation in the First Place?
Sometimes, Afib develops even when your heart is perfectly healthy in the structural sense—the Cleveland Clinic estimates that this happens in one out of 10 cases—but most people who are diagnosed with it already have some form of heart disease or other health problem, including:
High Blood Pressure, a.k.a. Hypertension
When you have chronic high blood pressure, your heart must work harder to pump blood to the rest of your body. Over time, this extra strain causes your heart to enlarge and stiffen. This makes it more difficult for the heart’s electrical system to function properly. Atrial fibrillation may result.
Coronary Artery Disease (CAD)
The narrowing and stiffening of the arteries that results from plaque building up in the blood vessels—called CAD—often leads to a heart attack, which damages heart tissue. That damage, in turn, can interfere with the heart’s electrical system and cause atrial fibrillation.
Congestive Heart Failure
When your heart is failing, your atria can thicken and scar over time, which makes it harder to conduct electricity. That can lead Afib.
No, this is not your 50-watt light bulb type of current, but rather an electrical stimulus that travels down through the heart’s conduction pathways to help your ventricles pump out blood. With this current goes rogue (stress, diabetes, sleep apnea, hypertension, or other health problems are common culprits), contractions can begin in the wrong area of the heart, or the current doesn’t flow in an organized, top-to-bottom way, causing the heart to quiver, or fibrillate.
Heart Valve Disorders
Like high blood pressure, heart valve disorders can cause parts of your heart to enlarge, increasing your risk of atrial fibrillation. Valve problems can be present at birth, or be caused by infection, aging, or injury.
When you have an overactive thyroid, or hyperthyroidism (a.k.a. Graves’ disease), you’re at higher risk of atrial fibrillation. Why? Your thyroid gland produces hormones involved with setting your heart’s pace. When too many of those hormones get produced, fast and irregular heartbeats can result.
What Are the Risk Factors for Atrial Fibrillation?
We know that certain health problems, like hypertension and CAD, can lead to Afib. But what are the risk factors that might give you a greater chance for developing this unsafe heart rhythm? They include:
The reasons for the connection remain unclear, but it’s thought that diabetes, which also increases the risk of heart disease, may affect the way your heart’s electrical system works.
Your heart has to work harder when you carry more weight. This can lead to its enlargement, making your ticker more prone to atrial fibrillation. Obesity also can cause inflammation in the heart, which in turn may cause scarring that affects the way the heart conducts electricity.
The interrupted breathing caused by sleep apnea ups your odds of developing both high blood pressure and diabetes. It also may directly affect your heart, in part by leading to enlarged upper chambers which may contribute to atrial fibrillation.
The older you get, the weaker your heart muscle becomes, raising the odds of system malfunction. Also, aging raises the likelihood of developing conditions that put you at risk of atrial fibrillation, such as heart disease and diabetes.
If you have a close relative, such as a parent or sibling, with atrial fibrillation, your own risk is about 40% higher than normal.
Some people are sensitive to stimulants, which increase your heart rate and blood pressure and can trigger an Afib episode. These include what you’d expect (caffeinated beverages like coffee and energy drinks, as well as illicit drugs like cocaine), and also what might surprise you (certain over-the-counter cold medications, semi-legal drugs like marijuana, and even alcohol).
Speaking of alcohol, binge drinking can cause what’s known as holiday heart syndrome, in which excessive booze can trigger an episode of atrial fibrillation. It’s not clear why alcohol has this effect, but in general the bigger the bender, the higher the risk.
What Are the Symptoms of Atrial Fibrillation?
The first thing you should know is that you can have atrial fibrillation and experience no symptoms at all. In other words, your heart may be beating chaotically, but you don’t always feel it. What you may feel: Fatigue, weakness, and shortness of breath—the result of your heart not being able to keep pace with your body’s demands for the oxygen that your blood delivers.
Still, such symptoms are pretty vague, and can be written off as signs of getting older, of slowing down with age. (Once properly diagnosed and treated, people are often amazed at how much stamina they recover.) Other symptoms of atrial fibrillation may include:
This happens when the heart does not get enough oxygen during an episode of atrial fibrillation.
This is a sensation of feeling like your heart is beating erratically or too rapidly, which usually occurs when your heart rate tops 120 beats per minute. It can be quite unpleasant. For some people, such symptoms can be debilitating, causing extreme fatigue and even leading to blacking out. Head straight to the emergency room if you experience any of the following:
Uncomfortable chest pain
And/or severe shortness of breath
What Are the Stages of Atrial Fibrillation?
Afib usually starts with abrupt but short and infrequent episodes. They last about 5 to 10 minutes before the heart returns to its normal rhythm. But this condition generally worsens over time. Episodes become more frequent, and the heart becomes less likely to return to a normal rhythm on its own. Some people do not get diagnosed with atrial fibrillation until they’ve already had a stroke.
Atrial fibrillation has four types, or stages:
1. Paroxysmal: Early on in this first stage, episodes might last just a few minutes. But over time, they become more frequent and last longer, eventually lasting hours or days. Usually, they stop on their own.
2. Persistent: In the second stage, an episode of atrial fibrillation needs medical intervention in order to stop it and return your heart to normal.
3. Long-Term Persistent: You’ve entered this stage once you’ve had persistent atrial fibrillation for more than a year.
4. Permanent: In this stage, your heart’s rhythm can’t be restored to normal; it remains in atrial fibrillation. Medications can help moderate your heart rate and also reduce your risk of blood clots and stroke.
Because symptoms of Afib are not always noticeable, many people with this condition can cruise right through the paroxysmal stage and not even know it until they’re diagnosed at a later stage that requires medical intervention. Others, like those with overactive thyroid disorders (such as Graves’ disease) may actually begin in the persistent stage.
What’s important to know is that Afib varies from person to person, and that doesn’t just refer to how the condition begins and advances—but also to the frequency and severity of episodes, too. You might have an Afib event only once a year, for example, while someone else could go into and out of atrial fibrillation several times a day. Both of you could require medical intervention to right your rhythm—or either of your rhythms may right themselves, depending on the stage you’re in. Like we said, how Afib plays out is as individual as those who have this condition.
How Do Doctors Diagnose Atrial Fibrillation?
As with most medical matters, the earlier you get diagnosed, the better. You may not progress to the second stage of the disease if it’s caught and treated right away, and you likely will have longer intervals between episodes. As noted above, though, atrial fibrillation is tough to catch early because symptoms are minimal. Once you get to the doctor, diagnosis is pretty straightforward. Here’s what your visit will likely entail:
Your doctor will review your symptoms and your health history, including any previous episodes of fainting, dizziness, or shortness of breath. You’ll also be asked about your family’s heart health.
Your doctor also will run blood tests to see if you have an overactive thyroid, which can trigger atrial fibrillation.
This painless test provides a view of your heart’s electrical activity. If you are in an episode of Afib, your doctor will spot it right away.
Portable ECG Devices
If you’re Afib episodes are infrequent, and if you’re not having one at the time of your appointment, your doctor will provide you with a portable ECG device that you will wear for a few days to a few weeks. One type, called a Holter monitor, continuously records your heart’s electrical activity over a few days. Those recordings are then analyzed for abnormalities that indicate atrial fibrillation. Event recorders, on the other hand, must be activated by the person who wears it when symptoms begin to occur. They can be worn for about a month.
This is a test that uses sound waves to produce a picture of your heart. It can reveal problems with your heart’s structure, such as heart valve disorders, as well as the presence of blood clots.
This is an exercise test you take while you’re hooked up to a heart monitor. You’ll be asked to walk on a treadmill, gradually increasing your pace and the incline until it feels like you’re walking up a small hill. This makes your heart work harder. Your doctor will monitor your blood pressure, heart rate, and any discomfort you feel to identify any possible signs of Afib.
What Is the Best Treatment for Atrial Fibrillation?
The most critical goal of treatment: reducing your risk of stroke due to Afib, which can be fatal. Your doctor also will want to regulate your heart rate and rhythm so that your heart beats normally. Treatments include:
Antiarrhythmic Medications for Atrial Fibrillation
These drugs are used to restore and/or maintain your heart’s normal rhythm. You may need to stay in the hospital when starting these meds so that you can be monitored to be sure that they are both safe and effective for you. Several medications exist, so if one does not work or stops working, you have options. They include:
Rate Control Medications for Atrial Fibrillation
These drugs are prescribed to slow a too-fast heart rate:
Beta blockers such as Lopressor and Toprol XL (metoprolol) and Brevibloc (esmolol)
Calcium channel blockers such as Calan, Verelan, and Verelan PM (verapamil) and Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilacor XR, and Tiazac, (diltiazem)
Digoxin, such as brands Digox or Lanoxin, though less effective than the above, may be prescribed if you have heart failure.
Anticoagulant Medications for Atrial Fibrillation
Prescription medications such as Coumadin (warfarin), Eliquis (apixaban), Plavix (clopidogrel), Xarelto (rivaroxaban), and heparin, as well as over-the-counter aspirin, can prevent clotting and reduce your risk of a stroke.
Procedures for Atrial Fibrillation
Sometimes, medication doesn’t quite do the trick, or your doctor thinks you’re a good candidate for surgery to stop you’re Afib episodes altogether. These invasive procedures include:
A jolt of electricity stops your heart’s electrical activity briefly to reset your heart’s rhythm and halt an Afib episode. Your doctor will sedate you so that you don’t feel any discomfort during the procedure. You may need to take an anticoagulant for a few weeks before and after the procedure to reduce the risk of dislodging a blood clot already in your heart, which would allow it to travel to your brain and cause a stroke.
Your doctor inserts a long, thin tube, called a catheter, into a vein near your groin and threads it to your heart. Once there it delivers radiofrequency energy, heat, or extreme cold to kill tissue and create scarring that seals your heart’s rogue electrical pathways so your rhythm can return to normal.
AV Node Ablation
In this procedure, a catheter is used to destroy the part of the heart that enables electricity to pass from your heart’s upper to lower chambers. This will slow your heartbeat, but you will need an artificial pacemaker permanently implanted to activate your heart’s lower chambers, or ventricles.
Can Lifestyle Changes Help With Atrial Fibrillation?
Caring for your heart also will help relieve your Afib. In fact, the treatments listed above will be more successful when you address any lifestyle factors that put your heart health at risk.
Manage Other Health Conditions
First and foremost? Stay on top of other health problems that might be causing atrial fibrillation. This includes diabetes, sleep apnea, and hypertension. Talk to your doctor about the right approach to treat all underlying health concerns to best protect your heart.
All those extra pounds, while difficult to shed, can strain your heart and trigger Afib—and potentially a stroke, too. We know it’s difficult, but do everything you can to lose weight. Try interactive apps like Noom or WeightWatchers to help you do it.
Get Quality Sleep
Your heart health relies on consistent, quality zzz’s, so hit the sack each night for 7 to 9 hours. If you have sleep apnea, ask your doc about the CPAP (Continuous Positive Airway Pressure) machine, which keeps healthy airflow going all night long. With consistent use, it has been shown to help prevent dangerous arrhythmias and protect your heart from hypertension and heart failure.
Regular exercise conditions and strengthens your heart, which in turn can help with your heart rhythm. If you’re concerned about triggering an Afib episode with too-intensive cardio, speak to your doctor about taking a stress test, or simply go for power walks instead.
Emotional duress and high bouts of stress have been shown to be big Afib triggers. Make a point of decompressing every day with mindful meditation, deep breathing techniques, yoga, a walk with a friend, or other activities you enjoy—gardening, oil painting, cooking with your kids!—that help you to unwind and let go of the worries of the day.
Limit or Quit Caffeine and Alcohol
Arrhythmias can be set off in some people by even small amounts of stimulants like caffeine. If you have afib, try decaf brew in the morning, or limit your daily intake to just a single cup of coffee or black tea. Alcohol can act as a stimulant, too—and booze, even in small amounts, has been shown to be a common trigger for atrial fibrillation in some people. Talk to your doctor about the right amount for you.
What’s Life Like for People With Atrial Fibrillation?
Episodes of atrial fibrillation can sap you of your energy and make you less able to be active. But treatment likely will restore your stamina, as it gets your heart pumping blood normally once more. Make sure that you stick to the medication schedule your doctor gives you.
And if you have a romantic partner, you most likely can—and should!—enjoy a regular sex life. In fact, most doctors think sexual activity is good for the heart. If you’re fit enough to climb a few flights of stairs, you’re likely fine in the bedroom, too. Talk to your doctor (no blushing!) about what’s best for you. Episodes of atrial fibrillation can occur randomly, but they can also be triggered, so you’ll want to pay attention to what’s going on when one starts—whether that’s stress or alcohol or even moderate exercise.
Above all, be aware of the symptoms of stroke, which come on suddenly. Call 911 immediately if you suspect you’re having one. Here’s what to watch for:
Numbness or weakness on one side of your body
Trouble forming words and slurred speech
Drooping on one side of your face
To help remember these symptoms, think of the acronym FAST, which stands for:
Time to call 911
With the possibility of stroke ever-looming, many people with atrial fibrillation report feeling anxious or even depressed. The American Heart Association offers an Afib digital community to connect people with this condition—you are not alone. Sometimes sharing common fears and concerns with others who understand them is enough to make you feel better about life—which is waiting for you to go out and experience to the fullest, Afib or not.
Atrial Fibrillation (1). National Heart, Lung and Blood Institute (NHLBI). (n.d.). “Atrial Fibrillation.” nhlbi.nih.gov/health-topics/atrial-fibrillation
Atrial Fibrillation (2). Cleveland Clinic. (2019). “Atrial Fibrillation (Afib).” my.clevelandclinic.org/health/diseases/16765-atrial-fibrillation-afib
Atrial Fibrillation (3). Mayo Clinic. (2019). “Atrial Fibrillation.” mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
Atrial Fibrillation: Diagnosis. Merck Manuals. (2019). “Atrial Fibrillation.” merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-disorders/atrial-fibrillation
Atrial Fibrillation: Treatment (1). Merck Manuals. (2019). “Atrial Fibrillation.” merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-disorders/atrial-fibrillation
Atrial Fibrillation: Treatment (2). Cedars-Sinai. (n.d.). “Atrial Fibrillation.” cedars-sinai.org/health-library/diseases-and-conditions/a/atrial-fibrillation.html