Will Your Atrial Fibrillation Get Worse?

Sometimes AFib goes away on its own. But for many people, it's a long-term problem. Both AFib that's caused by something wrong with a heart valve (valvular AFib) and AFib caused by something else, like diabetes or smoking (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 though, because we don't have a good way to measure progression.

What Happens

AFib can get worse in almost anyone. That's because the disease makes changes -- electrical, structural, and mechanical -- to your heart muscle so that it's easier to get and stay out of synch.

For 10%-20% of people who are newly diagnosed, paroxysmal AFib (when you have episodes that last less than a week) has become a persistent form of AFib (that lasts longer than 7 days) a year later.

Some people get worse faster in the first year after they're diagnosed. Others have a steady decline over the years.

How quickly your AFib progresses may depend on how well you follow your doctor's instructions and how it's being treated. People whose treatment includes rhythm control (not just rate control) and who get their rhythm back to normal sooner when they have an episode seem to do better.

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What Makes It Worse

The same things that lead to AFib can also make it progress. This includes having other types of heart-related problems -- high blood pressure, atherosclerosis (hardened arteries), heart failure, or pericarditis, for example -- as well as:

  • Having diabetes
  • Age, especially 75 and older
  • Being male
  • An overactive thyroid, called hyperthyroidism
  • Drinking alcohol

People with these issues tend to get worse faster:

  • Are older
  • Have a faster heart rate
  • Have an enlarged left atria (a chamber of the heart)
  • Have a weakened left ventricle (another chamber of the heart) that can't pump blood effectively, also called systolic heart failure or dilated cardiomyopathy

If you have sleep apnea, are obese, or have had a stroke, your AFib is more likely to progress. Your genes and ethnic background may also contribute.

Researchers think chronic kidney disease, inflammation, and the thickening and scarring of your heart's tissue (a condition called fibrosis) may play a role, too.

Slowing the Progress of Nonvalvular AFib

Nonvalvular AFib is more common, and your doctor may have more ways to control and manage it.

When you have paroxysmal AFib, you might not need medical treatment right away. But you'll probably have to make changes so it doesn't get worse.

Your doctor may ask you to stop smoking, lose weight if you have extra pounds, exercise, and eat a heart-healthy diet. Be careful to avoid triggers like monosodium glutamate (MSG is naturally found in some foods and added to boost flavor in others), alcohol, caffeine, and over-the-counter cold medicines. If you don't follow through with these recommendations, paroxysmal AFib can quickly turn into persistent AFib.

Persistent AFib doesn't go away on its own, so you'll need some type of treatment: medication, cardioversion, or ablation. Which one or combination is best depends on things like on your age, how long you've had AFib, and your overall health.

Catheter ablation is usually what doctors suggest after medicines and cardioversion don't work. It uses high-energy radio waves or intense cold or heat to make scars on the part of your heart causing your abnormal heart rhythm.

Research suggests that ablation can slow the progress from persistent AFib to long-standing persistent AFib, which lasts a year or more without stopping and is much harder to treat. But the procedure isn't perfect. You might need to have it again because AFib can come back. There's also a danger of damage to your heart or blood clots.

Ablation and other treatments can usually return your heartbeat to normal. But at some point it may get so difficult that you and your doctor decide to stop trying. This is known as permanent AFib.

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Slowing the Progress of Valvular AFib

Rhythm control medicines and catheter ablation can also help control valvular AFib.

If you're healthy enough and are already having open-heart surgery for another problem, like getting your valve repaired, your doctor may suggest the maze procedure. Like catheter ablation, it uses radio waves or intense cold to make a pattern of scars that interrupts the misfiring signal.

Maze surgery works to stop AFib for most people who have it, though you may need to keep taking rhythm control medicine. But it can also slow your heart rate so much that you'll need a permanent pacemaker.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on October 25, 2018

Sources

SOURCES:

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Penn Medicine: "Do Heart Valve Issues Cause AFib?"

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JACC: Clinical Electrophysiology: "A Systematic Review on the Progression of Paroxysmal to Persistent Atrial Fibrillation: Shedding New Light on the Effects of Catheter Ablation."

Heart: "Heart rate is associated with progression of atrial fibrillation, independent of rhythm."

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Cleveland Clinic: "Heart Surgery for Atrial Fibrillation (MAZE)."

StopAfib.org: "What to Expect After a Maze Procedure."

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