Atrial Fibrillation

Atrial fibrillation, or AFib, is a condition marked by an irregular heart rhythm, known as arrhythmia. Normally, the heart beats in an orderly sequence that starts in the upper chamber (atrium) and progresses to the lower chamber (ventricle). In AFib, however, the electrical signals in the atrium become disorganized, leading to an irregular heartbeat. This can result in the heart beating too fast or too slow, causing blood to pool in the atrium and potentially form clots. While some individuals with AFib may not experience immediate symptoms, others may need urgent medical care due to complications like stroke, blood clots traveling to other parts of the body, heart failure, or additional types of arrhythmias.

Causes

Atrial fibrillation (AFib) can be attributed to various factors, including heart and vascular conditions. Here are common causes and risks associated with AFib:

• Heart-Related Conditions:

• High blood pressure (responsible for up to 20% of AFib cases)

• Heart failure

• Heart attack

• Heart valve disease

• Congenital heart defects (present at birth)

• Non-Heart-Related Risk Factors:

• Advanced age

• Family history of AFib

• Thyroid disorders

• Lung disease

• Obstructive sleep apnea

• Diabetes mellitus

• Body Mass Index (BMI) of 30 or more

• Chronic kidney disease

• Infections or viral illnesses

• Certain medications

• Lifestyle and Behavioral Risks:

• Alcohol consumption

• Smoking or vaping

• Excessive caffeine intake

• Use of illegal drugs like cocaine and amphetamines

Understanding these factors is crucial for the prevention and management of AFib.

Symptoms

Atrial fibrillation (AFib) can present with various symptoms, although some people might not experience any. Common symptoms include:

• Palpitations: A sensation of a racing or fluttering heartbeat

• Shortness of Breath: Difficulty breathing

• Chest Pain: Discomfort or pain in the chest

• Dizziness or Lightheadedness: Feeling faint or dizzy

• Fatigue: Unusual tiredness or exhaustion

• Exercise Intolerance: Difficulty in maintaining physical activity

Symptoms vary depending on the type of AFib:

• Paroxysmal AFib: Episodes come and go, lasting less than 24 hours to a week, and treatment depends on episode duration and frequency.

• Persistent AFib: Lasts longer than seven days, often needing medical intervention.

• Long-Standing Persistent AFib: Persists over 12 months, typically requiring treatment to manage heart rate or restore normal rhythm.

• Permanent AFib: A continuous form where medication or procedures do not resolve the condition.

Diagnosis

If you show symptoms of atrial fibrillation, consult your primary care provider. They may recommend tests to evaluate your heart's condition. A common test is an electrocardiogram (EKG), measuring your heart’s electrical activity, though it may not detect intermittent AFib. For a better assessment, a Holter monitor or an event monitor can continuously track your heart rhythm over days or weeks, respectively. An echocardiogram, or "echo," uses ultrasound to produce live heart images, revealing its function as it beats. Additionally, a stress test may be conducted to evaluate blood flow to your heart muscle, either through physical exercise or medications mimicking exercise effects.

Treatments

When medications alone don't manage atrial fibrillation (AFib), specialized procedures might be required to correct the heartbeat. These are categorized as nonsurgical and surgical:

• Nonsurgical Options: Typically the first approach involves minimally invasive methods like electrical cardioversion to return your heart to normal rhythm. Catheter ablation uses radiofrequency energy to target areas causing AFib. A permanent pacemaker may be placed near the heart to help maintain regular heart rate. The left atrial appendage (LAA) occlusion procedure involves an implant to prevent clot formation, especially in patients unsuitable for blood thinners.

• Surgical Options: Considered if nonsurgical methods fail or other heart surgeries are necessary. The maze procedure removes parts of the electrical system causing AFib, often performed during surgeries for other heart issues. Another approach is removing the left atrial appendage to preclude AFib-related blood clots.

Medications

Medications for atrial fibrillation (AFib) are prescribed based on your health status, AFib duration, symptoms, and other conditions. The main medication types include:

• Rhythm Control Medications: Help restore or maintain a regular heart rhythm. Common options include:

• Amiodarone

• Dofetilide

• Flecainide

• Propafenone

• Sotalol

• Rate Control Medications: Slow down the heartbeat during AFib episodes, including:

• Beta blockers like metoprolol, Carvedilol, and Atenolol

• Calcium channel blockers such as diltiazem and Verapamil

• Digoxin, though less frequently used today

• Anticoagulants (Blood Thinners): Reduce the risk of clots and stroke, featuring:

• Warfarin

• Apixaban (Eliquis)

• Rivaroxaban (Xarelto)

• Dabigatran (Pradaxa)

• Edoxaban (Savaysa)

These medications control heart rhythm and rate, alleviate symptoms, and prevent complications like strokes. Collaborate with your healthcare provider to find the best treatment plan.