Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation is a condition characterized by the irregular quivering or fibrillation of the heart’s upper
chambers, known as the atria. To fully understand this phenomenon, it’s essential to first understand the mechanics of a normal heartbeat.

In a healthy heart, this signaling process usually goes smoothly. The resting heart rate is typically 60 to 100 beats a minute.

Types of atrial fibrillation

The type of AF you may have depends on the duration of the AF and its underlying reason:

• Paroxysmal or occasional fibrillation: symptoms last for a few minutes to hours, for 7 days or less and returns to a normal rhythm on its own, or with intervention; people may have a few episodes a year or their symptoms may occur every day. Paroxysmal fibrillation may become more frequent and longer lasting and can lead to permanent or chronic AF.
• Persistent AF: when the condition lasts for longer than 7 days and requires treatment to return to a normal sinus rhythm.
• Longstanding AF: when the condition lasts for longer than 12 months. Medicine or a procedure is needed to correct the irregular heartbeat.
• Permanent or chronic AF: when the condition lasts indefinitely and the irregular rhythm can’t be reset. Medicines are used to control the heart rate and prevent blood clots.
• Nonvalvular AF: not caused by a heart valve issue.

Symptoms

• The most common symptom of AF is a quivering or irregular heartbeat. Additional symptoms include:
• extreme fatigue
• heart palpitations
• fluttering or “thumping” (like a fish flopping) in the chest
• dizziness
• fainting
• shortness of breath/ anxiety
• weakness
• sweating
• chest pain (angina) – this is a medical emergency. Get medical help immediately.

Some people with AF may not have any symptoms and therefore only detectable upon a physical exam.

AF can lead to serious medical complications, so it’s important to know what the symptoms are of the most common complications.

Causes

Damage to your heart’s tissue and electrical system cause atrial fibrillation, and this is mostly caused when there are problems with the heart’s structure.

Heart diseases and health problems that can cause AF:

• a congenital heart defect – a heart problem you’re born with
• a problem with the heart’s natural pacemaker, called sick sinus syndrome
• obstructive sleep apnea – a sleep disorder
• heart attack
• heart valve disease
• high blood pressure
• lung diseases, including pneumonia
• coronary artery disease – narrowed or blocked arteries
• thyroid disease such as an overactive thyroid
• infections from viruses
• complications following heart surgery

Lifestyle habits that may trigger an AF episode include:

• drinking too much alcohol
• caffeine
• illegal drug use
• smoking or using tobacco
• medication that contains stimulants
• anxiety

For some people, there’s no identifiable cause to a triggered heartbeat.

Risk factors

You are at higher risk of developing AF if you have one or more of the following:

• longstanding and uncontrolled high blood pressure
• underlying heart disease – including valve problems, hypertrophic cardiomyopathy, acute coronary syndrome, Wolff-Parkinson-White syndrome, and a history of heart attack (Heart Failure)
• heart surgery – it’s a common complication post-surgery
• age – the risk increases as you get older
• family history of AF
• other chronic conditions – this includes hyperthyroidism, asthma, diabetes (Diabetes), and other chronic medical problems.
• binge drinking (five drinks in two hours for men, or four drinks for women)
• rapid heart rate (supraventricular tachycardia) as seen in athletes
• sleep apnea
• anxiety (Generalised Anxiety Disorder – GAD)
• some medications and supplements

Diagnosis

Your health care provider will start off with a physical exam, and check your heart rhythm, pulse, blood pressure, thyroid, swelling in your feet or legs, and listening to your lungs. They may also use:

• An electrocardiogram (ECG), which measures and records your heart’s electrical signals.
• An echocardiogram (echo), which can reveal problems with blood flow and heart muscle contractions.
• An ambulatory arrhythmia monitor that monitors and records your heart rate 24 hours a day.
• An electrophysiologic study to determine the heart’s electrical map; a thin catheter is inserted from a blood vessel in your leg up to your heart.
• Blood tests, to check levels of potassium and thyroid hormone, for instance, which will help decide on the best medications for treatment.

Treatment

Treatment for AF consists of maintaining your heart rate, restoring normal heart rhythm, and the prevention of blood clots. Treatment options include medication and surgical procedures, depending on your symptoms, the severity of AF, and your general health.

Medication

• Blood thinners or anticoagulant medications reduce the risk of blood clots and stroke; these include apixaban, dabigatran, rivaroxaban, and warfarin.
• Rate control medications slow the heart rate and include beta blockers (such as bisoprolol or atenolol), calcium channel blockers (such as digoxin, metoprolol, verapamil) or diltiazem.
• Rhythm control medications (anti-arrhythmics) help your heart beat in a normal sinus rhythm; they include procainamide, disopyramide, flecainide acetate, propafenone, sotalol, dofetilide, or amiodarone.

If AF is anxiety-related, the first recourse will be SSRIs and SNRIs.

Surgical procedures

• Electrical cardioversion is a procedure in which a patient receives an electrical shock on the outside of the chest using either paddles or patches. These low-energy shocks are used to “reset” the heart to a normal rhythm. This treatment may only be temporary.
• Catheter ablation is a procedure that uses small burns or freezes to cause some scarring on the inside of the heart to help break up the electrical signals that cause irregular heartbeats. This helps the heart maintain a normal heart rhythm. Using a catheter, radiofrequency waves, extreme heat or extreme cold are used on the heart tissue causing AF.
• A maze procedure is when a “maze” of scar tissue is cut to prevent electrical signals from passing through.
• A permanent pacemaker may be inserted if you have a slow heart rate, however this is only used if you have AF and another type of arrhythmia.
• Left atrial appendage closure is a procedure that reduces your risk of blood clots and stroke.

Living and managing

Although a stroke or blood clot is not always preventable, there are ways to reduce the risk:

• Get regular exercise. Try to add about 150 minutes of cardio per week.
• Eat a heart-healthy diet low in salt, saturated fats, trans fats, and cholesterol. Check out our award-winning, heart-healthy recipe book series Cooking from the Heart.
• Manage your high blood pressure.
• Avoid excessive amounts of alcohol and caffeine.
• Quit smoking.
• Control your cholesterol. Click for more on cholesterol control here.
• Maintain a healthy weight.
• Get enough sleep.
• Manage your stress by adopting stress management techniques such as exercise, journaling, breathing exercises, grounding, or meditation.