What is Atrial Fibrillation (AFib)?

Atrial fibrillation (AFib) is a common heart rhythm disorder where the heart beats irregularly and often too fast. It occurs when the upper chambers of the heart (atria) beat out of sync with the lower chambers (ventricles), leading to poor blood circulation.

AFib can be occasional (paroxysmal), persistent, or permanent, and if left untreated, it increases the risk of stroke, heart failure, and other heart-related complications.

What Are the Symptoms of Atrial Fibrillation?

AFib symptoms vary based on severity and duration. Some people may not notice any symptoms, while others experience significant discomfort.

Common Symptoms of AFib

• Irregular or Rapid Heartbeat (Palpitations) → Feels like the heart is racing, fluttering, or skipping beats.
• Shortness of Breath → Especially noticeable during physical activity or while lying down.
• Fatigue or Weakness → A general lack of energy or feeling drained.
• Dizziness or Lightheadedness → A result of decreased blood flow to the brain.
• Chest Pain or Discomfort → Occurs in some cases, especially if heart disease is present.
• Fainting (Syncope) → In rare cases, due to inadequate blood flow to the brain.

Some people may have silent AFib, meaning they have no noticeable symptoms but are still at risk for complications like stroke.

What Causes Atrial Fibrillation?

AFib is caused by disruptions in the heart’s electrical signals, leading to an uncoordinated heartbeat. Several conditions can trigger or increase the risk of AFib, including:

Heart-Related Causes

• High Blood Pressure (Hypertension) → Puts strain on the heart.
• Coronary Artery Disease (CAD) → Narrowed arteries reduce blood supply.
• Heart Valve Disorders → Especially mitral valve disease.
• Congenital Heart Defects → Present from birth.
• Heart Attack or Previous Heart Surgery → Can damage heart tissue.
• Heart Failure → Weakens the heart’s ability to pump effectively.

Other Health Conditions

• Sleep Apnea → Repeated interruptions in breathing can stress the heart.
• Overactive Thyroid (Hyperthyroidism) → Can accelerate heart rate.
• Diabetes → Increases the risk of heart disease and AFib.
• Obesity → Can lead to high blood pressure and structural heart changes.
• Lung Diseases (COPD, Pneumonia, etc.) → Affect oxygen levels and heart function.

Lifestyle & External Triggers

• Excessive Alcohol Consumption → Especially binge drinking.
• Stimulants (Caffeine, Nicotine, Drugs) → Can disrupt heart rhythm.
• Extreme Stress or Anxiety → Affects the autonomic nervous system.
• Heavy Exercise Without Proper Conditioning → Can strain the heart.
• Certain Medications → Some decongestants, asthma medications, and stimulants may contribute.

Types of Atrial Fibrillation

AFib can be classified into different types based on its duration and recurrence:

1. Paroxysmal AFib (Intermittent)

• Comes and goes suddenly, lasting for minutes to hours, sometimes days.
• May stop on its own or require treatment.
• Some people experience episodes occasionally, while others have frequent attacks.

2. Persistent AFib

• Lasts more than a week and does not stop on its own.
• Requires medical treatment (medications or cardioversion) to restore normal rhythm.

3. Long-Standing Persistent AFib

• Lasts more than 12 months and continues despite treatment attempts.

4. Permanent AFib

• Ongoing AFib that cannot be corrected with treatments like medications or procedures.
• Requires long-term heart rate control and stroke prevention strategies.

How is Atrial Fibrillation Diagnosed?

To diagnose AFib, doctors perform heart tests to analyze electrical activity and rule out underlying conditions.

1. Physical Examination & Medical History

• Pulse Check → Irregular or fast heartbeats may indicate AFib.
• Listening to the Heart → Detects abnormal rhythm.
• Checking for Symptoms → Identifies palpitations, dizziness, and fatigue.

2. Diagnostic Tests

• Electrocardiogram (ECG or EKG) → The primary test to detect AFib. Records electrical signals from the heart.
• Holter Monitor (24-Hour ECG) → Portable ECG worn for 24+ hours to capture irregular episodes.
• Echocardiogram (Heart Ultrasound) → Evaluates heart structure and function.
• Stress Test (Exercise ECG) → Assesses heart response to physical activity.
• Blood Tests → Checks for thyroid issues, infections, or electrolyte imbalances.
• Chest X-Ray → Identifies lung conditions contributing to AFib.

How is Atrial Fibrillation Treated?

Treatment for AFib depends on symptom severity, underlying causes, and stroke risk. The main goals are:

1. Restoring a normal heart rhythm (cardioversion).
2. Controlling the heart rate.
3. Preventing blood clots to reduce stroke risk.

1. Medications

• Rate Control Medications → Slow down the heart rate. Examples: Beta-blockers (metoprolol), calcium channel blockers (diltiazem).
• Rhythm Control Medications (Antiarrhythmics) → Help restore and maintain normal rhythm. Examples: Amiodarone, flecainide.
• Blood Thinners (Anticoagulants) → Prevent stroke by reducing clot formation. Examples: Warfarin, Apixaban, Rivaroxaban.

2. Cardioversion (Electric Shock Therapy)

• A controlled electric shock to the heart resets it to a normal rhythm.
• Used for persistent AFib when medications are not effective.

3. Catheter Ablation (Minimally Invasive Procedure)

• Destroys abnormal heart tissue causing AFib using radiofrequency or cryotherapy.
• Recommended if medications and cardioversion fail.

4. Pacemaker (For Slow Heart Rate Cases)

• A small device implanted in the chest to regulate heart rhythm.

5. Surgery (For Severe Cases)

• Maze Procedure → Creates scar tissue in the atria to block faulty electrical signals.
• Done during open-heart surgery in patients with other heart conditions.

Stroke Risk & Blood Clot Prevention

AFib increases the risk of stroke due to blood clots forming in the heart. To prevent this:

• Anticoagulants (Blood Thinners) are prescribed for high-risk patients.
• Aspirin is sometimes used for mild cases.
• Left Atrial Appendage Closure (Watchman Device) → A device implanted to reduce clot formation.

Complications of Atrial Fibrillation

If untreated, AFib can lead to:

• Stroke → Blood clots travel to the brain, causing life-threatening damage.
• Heart Failure → Weakens the heart over time.
• Chronic Fatigue → Due to poor blood circulation.

Lifestyle Changes to Manage AFib

• Limit Caffeine & Alcohol → Avoid triggers that worsen AFib.
• Quit Smoking → Improves heart health.
• Exercise Regularly → Moderate activities help control weight and blood pressure.
• Manage Stress → Yoga, meditation, and relaxation techniques reduce episodes.
• Eat a Heart-Healthy Diet → Low in salt, fat, and processed foods.
• Monitor Blood Pressure & Cholesterol → Keeps heart function stable