What Is Atrial Fibrillation?
Atrial fibrillation, also called AF or AFib, is a quivery, fluttery heartbeat. You might also hear the doctor call it arrhythmia. It means your heart’s normal rhythm is out of whack. Because your blood isn't moving well, you're more likely to have heart failure. That's when your heart can't keep up with your body’s needs. Blood can also pool inside your heart and form clots. If a clot gets stuck in your brain, you can have a stroke.
What happens in AFib? Normally, the top part of your heart (the atria) squeezes first, then the bottom part (the ventricles). The problem starts in the upper part of your heart. The timing of these contractions is what moves the blood. When you have AFib, the electrical signals that control this process go haywire. This causes the atria to act independently, instead of working together.
AFib vs. atrial flutter
Both are problems with your heart's beating. When you have atrial flutter, your heart beats too fast but still mostly in a regular rhythm. When you have AFib, your heart's rhythm is irregular.
Types of Atrial Fibrillation
AFib doesn’t so much have types as it has durations. Doctors classify it by how long it lasts, or what causes it. Yours could change over time. Your treatment will depend on your specific condition.
This is an episode of atrial fibrillation that lasts less than a week. You might feel it happening for a few minutes or several days. You may not need treatment for this type of AFib, but you should see a doctor.
You could hear it nicknamed “holiday heart syndrome.” This refers to AFib that follows a bout of heavy drinking. If your heart isn’t used to all this different activity, it may go into AFib. It also happens sometimes when you’re under extreme stress.
Persistent atrial fibrillation
Persistent AFib usually starts as short-term AFib (paroxysmal AFib). Usually, this lasts longer than a week. You’re more likely to get persistent AFib if you’re:
It could stop on its own, or you may need medicine or treatment to stop it. Doctors can use medicine to treat this type of AFib. If that doesn’t work, they might use a low-voltage current to reset your heart’s rhythm to normal. It’s called electrical cardioversion. Doctors usually do this procedure in a hospital while you’re sedated, so you won’t feel anything. You can go home after it’s done, but someone else will have to drive you.
Long-standing persistent atrial fibrillation
This means your AFib has lasted more than a year and doesn’t go away. Medicine and treatment such as electrical cardioversion may not stop the AFib. Doctors can use another kind of treatment, such as ablation (which burns certain areas of your heart’s electrical system) to restore your normal heart rhythm.
Permanent (chronic) atrial fibrillation
Valvular atrial fibrillation
This type affects people who have an artificial heart valve or valve disease such as valvular stenosis (when one of your heart valves stiffens) or regurgitation (when a valve isn’t closing properly, which lets some blood flow the wrong way). Your chance of getting valvular AFib rises if you have mitral valve disease or artificial heart valves.
Nonvalvular atrial fibrillation
You're more likely to get nonvalvular AFib if you:
- Are older
- Have had high blood pressure for many years
- Have heart disease
- Drink large amounts of alcohol
- Have a family member with AFib
- Have sleep apnea
Both valvular and nonvalvular AFib can cause blood to pool in your heart, which raises your risk of complications such as blood clots and strokes. Medicines and other treatments can lower your chances of having these complications.
Whether AFib is valvular or nonvalvular determines the type of medicine your doctor will prescribe to help lower your odds of having a stroke.
Acute onset atrial fibrillation
This rapid, chaotic heartbeat comes on quickly and goes away quickly. It usually resolves by itself in 24 to 48 hours. Causes include age, cardiovascular disease, alcohol abuse, diabetes, and lung disease.
Postoperative atrial fibrillation
Doctors have many ways to treat AFib, no matter which type you have. If you have symptoms, see your doctor to discuss what will be best for you.
Atrial Fibrillation Risk Factors
More than 2 million Americans have AFib. It's more common in people 60 and older. Traditionally, researchers thought that your risk of AFib is higher if you're white. But recent studies suggest that the numbers may reflect the way doctors detect AFib rather than the actual risk. Similarly, doctors have always believed that the AFib risk is higher for people assigned male at birth. New research suggests that the real difference-maker is body size. In one study, women who were taller than average had a greater risk of AFib.
Other heart problems that can make it more likely include:
- Heart disease due to high blood pressure
- Heart valve disease
- Heart muscle disease (cardiomyopathy)
- Heart defect from birth (congenital heart defect)
- Heart failure
- Past heart surgery
- Coronary artery disease
At least 1 in 10 people with AFib have no other heart problems but do have other medical conditions that raise their AFib risk:
- Long-term lung disease (such as COPD)
- Overactive thyroid gland
- Sleep apnea
- A blood clot in your lung, called a pulmonary embolism
- Chronic kidney disease
- Metabolic syndrome
Medicines (including digitalis and theophylline) can raise the chance of having AFib.
Sometimes, it's linked to:
Causes of Atrial Fibrillation
The most common cause of AFib is a problem with your heart's structure. It can happen as a result of:
- Previous heart surgery
- Heart attack
- A problem with your heart's natural pacemaker
- An issue you were born with (congenital heart defect)
- Heart valve disease
What can trigger atrial fibrillation?
You can make lifestyle choices to avoid setting off AFib. These include:
- Don't smoke or use tobacco
- Get plenty of sleep
- Exercise 30 minutes a day, unless your doctor advises you not to
- Manage your stress
- Limit how much caffeine and alcohol you drink
- Avoid illegal drugs that can make your heart beat faster, such as cocaine and amphetamines
- Stay away from intense exercise
- Drink plenty of water
- Avoid large meals
Atrial Fibrillation Symptoms
When your heart is in AFib, you might feel:
- Like your heart is racing or fluttering in your chest (palpitations)
- Fatigued or weak
- Dizzy or lightheaded
- Chest pain or pressure
- Short of breath
If you have these symptoms, call your doctor and make an appointment as soon as possible. If they last more than 24 hours, go to the hospital.
Sometimes, it doesn't cause any symptoms. If you're at risk, talk to your doctor about your chances of having AFib, and get regular checkups.
Atrial Fibrillation Diagnosis
The main thing your doctor wants to see is the electrical activity in your heart. They will probably do some tests to see what’s going on. Tests for atrial fibrillation include:
- Blood tests to check your thyroid, liver, and kidneys .
- Electrocardiogram(EKG) to record how fast your heart is beating and the timing of electrical signals that pass through it. A nurse or technician will place about 12 small, sticky sensors on your chest. Wires connect them to a machine that takes the measurements.
- Chest X-ray to make sure lung disease isn’t the cause of your problems.
- Echocardiogram, which uses sound waves to make a video of your heart working.
- CT scans, special X-rays that make a 3D picture of your heart.
- MRI, which uses magnets and radio waves to create snapshots and videos of your heart.
- Exercise stress test to see how your heart works when you’re active. You might walk on a treadmill or ride a stationary bike while wearing sensors connected to an EKG machine.
The doctor might use some special gadgets to learn more about your heartbeat. These include:
Your doctor may want you to wear this gadget for a few days while you go about your regular activities. It's like a mobile EKG that records data from your heart 24/7. It helps your doctor spot signs of an arrhythmia. If your AFib symptoms come and go, you may need a different kind of monitor for a longer time.
This is similar to a Holter monitor, but it doesn't record constantly. You wear it for about 30 days. You might push a button when you feel AFib symptoms, or it might detect a problem with your heartbeat and record it automatically.
Implantable loop recorder
This device records your heartbeat constantly for up to 3 years. It can tell how often you have AFib symptoms. It can also be used to see whether someone at risk of heart problems has AFib. It's sometimes called a cardiac event recorder.
Atrial Fibrillation Treatment
Depending on how severe your symptoms are, your doctor may recommend medications, surgery, or even a pacemaker to keep your heart in a normal rhythm.
Medications are typically the first things doctors try to treat atrial fibrillation. Various drugs can help control your heart's rhythm, slow your heart down, and help prevent blood clots that might lead to a stroke.
Your doctor can give you drugs that will:
- Slow your heart rate and ease the strength of contractions (beta-blockers and calcium channel blockers).
- Bring your heart's rhythm back to normal (sodium and potassium channel blockers).
- Prevent blood clots (“blood thinners,” or anticoagulants and antiplatelets). These include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin (Jantoven).
- Control your heartbeat when you are resting but not during activity (digoxin), often used with another drug.
- Manage your heart's rate and rhythm (antiarrhythmics), though these are used rarely because of side effects.
If medications don’t work, your doctor will probably try one of these to reset your heart’s rhythm:
Cardioversion. If you have electrical cardioversion, they'll stick special pads to your chest to send an electric shock to your heart. You won't feel it because you'll be asleep under general anesthesia. If you have drug cardioversion, you'll receive medicine through your vein or by mouth to reset your heart rhythm. This is also called chemical or pharmacologic conversion.
Ablation. They'll make a cut in one of your blood vessels and run a small tube through it and into your heart. Your doctor will then use a laser, radio waves, or extreme cold to burn off the tissue on the surface of your heart that's causing the problem. This creates scar tissue that doesn't pass the off-beat signals. Some hospitals offer robotic-assisted surgery that uses smaller cuts and allows for greater precision. Your doctor will put a video camera or tiny robot into your chest. It’ll guide the creation of scar tissue that may help keep your heartbeat at the right pace.
Maze procedure. If you're having open heart surgery for another reason, your doctor might do this. It’s similar to ablation. Your doctor will create a maze of scar tissue on the part of the heart that relays the electrical signals that control your heartbeat. The scar tissue created by a maze procedure stops the wonky signals that lead to an irregular heartbeat and helps get your heart back on track. Your doctor might consider maze surgery if:
- AFib medications don't control your symptoms, or they cause serious side effects.
- You have AFib and are having heart surgery for other reasons. For instance, the surgery may be to treat valve disease or blocked coronary arteries.
Mini maze. Most people with AFib don’t need open-heart surgery. That’s where this minimally invasive option comes in. You might hear it called Cox-Maze IV. This is also similar to ablation, but the doctor will make three or four small cuts in your side and put tubes, surgical tools, and a tiny camera into them.
Convergent procedure. This pairs catheter ablation with a mini maze. One doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.
Left atrial appendage closure. This seals off a spot in the top left chamber of your heart. The left atrial appendage, or LAA, is a little sac. Blood can pool there and form clots, which can lead to stroke. If the LAA is closed, clots can't escape.
Pacemaker for Atrial Fibrillation
This device helps prevent your heart from beating too slowly. If you take medicine to lower your heart rate, you may need one as a backup. You'll have minor surgery to put it under your skin. It runs on batteries and sends little electrical bursts to your heart when it beats too slowly.
Managing Atrial Fibrillation
You can protect your heart by the choices you make daily. This will make living with AFib easier.
Quit smoking.Smoking can double your risk of AFib.
Stop drinking. Alcohol can raise your odds of AFib. The extent of the risk depends on how much you drink. Drinking can also affect the way your blood thinners work.
Exercise. It’s good for you and your heart. It helps keep your muscles strong, your blood moving, and your weight in check. It even helps you sleep. People with AFib who exercise tend to have fewer episodes of arrhythmia, are less likely to be hospitalized, and have a higher quality of life. Talk to your doctor about the best activities for you, so you don't overdo it.
Check labels. Over-the-counter products such as cold medications could have ingredients that can speed up your heart rate.
Lower your stress. Stress can make the condition worse by speeding up your heart rate. Strong emotions such as anger, fear, and anxiety could have the same effect. It's important to take care of yourself. Find something that gets your mind off your worries and puts you in a good mood. Yoga, music, and time management strategies might ease some tension.
Diet for atrial fibrillation
Focus on eating healthy foods. These include:
- Fruits and vegetables
- Whole grains
- Dairy products that are low in fat
- Lean meat
- Nuts, seeds, and beans
You may also need to avoid or limit certain things. They can include:
- Leafy green vegetables, which can interfere with warfarin
- Foods that have a lot of salt
- Processed foods that have a lot of added sugar, saturated fat, or trans fat
- Grapefruit and grapefruit juice can make some heart drugs less effective. Check with your doctor.
Natural treatment for atrial fibrillation
There's no substitute for a healthy diet. But if your doctor agrees, you might take certain vitamins and supplements to control AFib. They might include:
- Coenzyme Q10
- Wenxin Keli, although scientists believe more research is needed on this Chinese herb
You may have read or heard that fish oil supplements are good for heart health. But new research suggests that taking more than 1 gram a day actually increases your risk of AFib.
Complications of Atrial Fibrillation
AFib can cause serious health problems. Your doctor has treatments to put your heart back into a normal rhythm and prevent complications.
Untreated AFib and valve disease each increase your risk for blood clots and stroke. Having the two conditions together raises your risk even more.
The odds of having an ischemic stroke -- the type caused by a blockage in blood flow to the brain -- are five times higher in people with nonvalvular AFib. That risk is 17 times higher in people with mitral valve stenosis.
AFib medicines bring your heart back into a normal rhythm, prevent blood clots from forming, and lower the odds of stroke. A measure called your CHADS2 score can help your doctor figure out how likely you are to have a stroke -- and decide if you need to take something to help prevent one. The CHADS2 score is basically a series of questions, with each letter in the name representing something that may raise your stroke risk.
High blood pressure can also lead to strokes. So, it’s even more important to keep your blood pressure in a healthy range with a nutritious diet, exercise, and medicine if you need it.
AFib makes the ventricles beat faster to push blood out of the heart. Beating too fast for a long time can make the heart muscle too weak to pump enough blood to your body. This is called cardiomyopathy.
AFib prevents your heart from pushing out blood as well as it should. After a while, the effort of pumping could make your heart so weak that it can't send out as much blood as your body needs. This is called heart failure.
Blood can get backed up in the veins of your lungs and cause fluid to build up there. That causes symptoms such as fatigue and shortness of breath.
Heart failure can also lead to AFib. Your heart's rhythm is controlled by electrical signals. For those signals to work well, they need healthy heart tissue.
But heart failure can actually stretch your atria and cause tissue in your heart to thicken and scar. Those changes throw off the electrical signals, and that messes up the heart's rhythm and can cause AFib.
To lower your chances of heart failure, manage these four key things:
- Keep your blood pressure in a normal range.
- Stay at a healthy weight with diet and exercise.
- Don't smoke.
- Control your blood sugar if you have diabetes.
Your body needs a steady supply of oxygen-rich blood to work properly. When your heart can't pump enough, you'll feel tired. If fluid builds up in your lungs because of heart failure, that can add to your exhaustion.
To manage fatigue, balance your activities with periods of rest. Try to get more sleep at night. And exercise as often as you can. A combination of aerobic exercises like walking and biking, plus strength training can give you more energy.
Sleep apnea could be another reason you feel extra tired. This condition, which keeps you from breathing properly when you sleep, can happen along with AFib. Your doctor can test you while you sleep to find out if you have it. One treatment for sleep apnea uses a machine called CPAP, which delivers mild air pressure through a face mask to keep your airways open while you sleep.
In studies, people with AFib did worse on memory and learning tests than those without the condition. Dementia is also more common in people with AFib.
One possible reason for the link is that AFib raises your odds of getting a stroke, which can damage the brain. AFib might also affect memory by keeping the brain from getting enough blood.
High blood pressure
If you have AFib, there's a pretty good chance you have high blood pressure too. The two conditions often go together.
When everything's going right, your heart chugs along with a steady rhythm you can keep time to. It pumps blood through your body with just the right touch, and all your cells get the oxygen they need.
But high blood pressure throws a wrench into the works. It means your blood's flowing with more force than normal, so it's pushing hard on your artery walls. If that goes on for too long, the added stress causes damage that can lead to all kinds of problems.
Atrial Fibrillation Prevention
You may not be able to change some of your risk factors for AFib, such as family history or other medical conditions. But you can take other steps to prevent it. They include:
- Eat a healthy diet with lots of vegetables and fruit, low-fat protein, and whole grains.
- Limit how much alcohol you drink.
- Don't use tobacco.
- Get aerobic exercise.
Atrial Fibrillation Outlook
Sometimes, AFib goes away on its own. But for many people, it's a long-term problem. Both valvular and nonvalvular AFib are progressive, meaning that over time, symptoms happen more often and last longer.
You might start out with occasional, mild AFib that, years later, doesn't ever seem to go away. And in terms of your health, how fast that happens—what doctors call “the rate of progression”—might be more important than how long your AFib episodes last.
Studies on AFib progress and what to do about it are challenging for researchers because they don't have a good way to measure progression.
The biggest risk factor for AFib is your age. Lifestyle changes can lower your risk of getting AFib and help you manage it if you have it. If you have AFib, you have many treatment options. They include different kinds of medicines and procedures. AFib can lead to serious health complications, including stroke.
Atrial Fibrillation FAQs
What can trigger atrial fibrillation?
Many things can set off AFib, including:
- Poor sleep
- Alcohol, especially binge drinking
Is atrial fibrillation a serious condition?
AFib itself isn't life-threatening. But it can lead to serious problems such as stroke.
What are the warning signs of AFib?
You may not have any symptoms at all. But common signs include:
- Trouble catching your breath
- Feeling lightheaded
- A racing heartbeat or feeling that your heart is fluttering