Atrial Fibrillation (AFib)

Have you or your loved one been diagnosed with atrial fibrillation (AFib)? You should know that you are not alone — many people worldwide have AFib, the most common heart rhythm disorder.

Introduction

Have you or your loved one been diagnosed with atrial fibrillation (AFib)? You should know that you are not alone — many people worldwide have AFib, the most common heart rhythm disorder. 

This diagnosis comes with many questions and terms that may be hard to understand. After reading the information below, we hope that you will feel more comfortable:

  • Taking an active role in your treatment decisions
  • Having open and honest conversations with your doctor about your concerns

Before Your Visit


UpBeat's AFib Question Builder can help you prepare for your upcoming appointment(s) by generating a list of the important AFib questions you may have for your heart care team.

The Basics

What is Atrial Fibrillation?

Atrial Fibrillation, AFib for short, is a problem with how your heart beats. With AFib, your heart may beat too fast, switch back and forth from fast to slow, or skip beats. We call this type of heartbeat “irregular.” AFib may start suddenly and then stop on its own, or it may become a long-lasting problem. With AFib, your heart can’t pump blood out to your body in a normal way. AFib is an illness that can become worse if it’s not treated.

 


Heart Rhythm TV "EP Explained:" What is AFib? [English]


Heart Rhythm TV "EP Explained:" What is AFib? [Spanish]


Heart Rhythm TV "EP Explained:" What is AFib? [Portuguese]


What are the types of AFib?

The type of AFib you are diagnosed with could change over time. It depends on how often AFib occurs and how it responds to treatment:

  • Paroxysmal AFib: This type of AFib occurs occasionally and then stops within 7 days. An episode may last seconds, minutes, hours, or days before the heart returns to its normal rhythm. People with this type of AFib usually have more symptoms than others. As the heart goes in and out of AFib, the pulse rate may change from slow to fast and back again in short periods of time. 
  • Persistent AFib: This type of AFib is continuous and lasts for more than 7 days. This type of AFib does NOT stop by itself. If no treatment is given, the heart will stay out of rhythm. Various treatments may help return the heart to its normal rhythm. People with persistent AFib who become paroxysmal with treatment may still be treated as patients with persistent AFib for the best outcomes. 
  • Long-standing persistent AFib: This type of AFib is has continuous symptoms that last 12 months or longer.
  • Sometimes, a patient with AFib may make the decision with their provider to stop attempts to restore or maintain normal rhythm. When this decision is made, the patient is said to have Permanent AFib. Unlike the other types of AFib, this type describes a treatment decision and not the AFib itself.

Download the "What is AFib?" patient information sheet.

Symptoms & Signs

The signs and symptoms of AFib are different from person to person. Some people with AFib feel no symptoms at all. They might not even know they have AFib or that there is a problem. Others can tell as soon as it happens. AFib symptoms can be bothersome and frightening.

Signs and symptoms include:

  • Feeling overtired or having little to no energy
  • Having a faster-than-normal heartbeat or a heartbeat that switches between fast and slow (irregular)
  • Having shortness of breath
  • Feeling like your heart is racing or pounding
  • Finding everyday exercises or activities harder than usual
  • Having chest pain, pressure, tightness, or discomfort
  • Feeling dizzy or lightheaded, or fainting

It’s important to see a doctor early if you have symptoms of AFib. Make an appointment if you notice something different or bothersome with your heartbeat

Diagnosis

If your doctor thinks you may have AFib, the first thing they’ll do is ask you questions about your symptoms and listen for an irregular heartbeat through a stethoscope. They may also do tests to be sure of the diagnosis. The tests will help them figure out the reason for your irregular heartbeat and the best way to treat it.

A few tests can be done to check for an irregular heartbeat. An ECG or EKG for short, is a simple, painless test that is the most helpful in diagnosing AFib.

It can measure how fast your heart beats and the type of heartbeat you have. It can also measure the timing of the signals passing through your heart.

An ECG can be done in a doctor’s office. During this test, special stickers, called electrodes, are temporarily attached to your chest, arms, and legs. The electrodes pick up signals from your heart. The ECG test gives your doctor a picture of your heart’s activity.

Sometimes, the ECG done in the doctor’s office does not catch your AFib, and a test that lasts longer is needed. In this case, your doctor will ask you to wear a special monitor or a mobile device to keep track of your heart over a longer period of time.

There are several other tests that can be done to check for a fast or irregular heartbeat. Your doctor may order these tests if you are having signs or symptoms of a heart problem.

An ECG is a snapshot of your hear's electrical activity. Stickers (electrodes) are attached to your chest, arms, and legs. These electrodes measure the rate and rhythm of your heart.

A Holter monitor is a portable ECG. It can be worn for several days. Stickers (electrodes) are placed on your chest and are then connected to a small recording machine that is usually worn around the waist. It records the electrical activity of your heart for your doctor to review later.

A mobile cardiac monitor is worn for up to 30 days. It records your heart's beat when it is in normal and abnormal rhythm. The results are automatically sent to your doctor. Your doctor uses this information to evaluate your symptoms to determine what is causing the abnormal rhythm.

An event monitor is a portable ECG that is used for patients who have an irregular heart rhythm every once in a while. You will carry the monitor with you at all times and attach it to your chest when you feel symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.

An echocardiogram uses sound waves to produce images of your heart. This test allows your doctor to see how your heart muscle is moving and pumping blood.

A TTE is a standard non-invasive (no incisions or cuts) echocardiogram that gives your doctor a picture of your beating heart. An imaging device, called a transducer, gives off and reads sound waves. The imaging device records the sound waves bouncing off the walls and valves (echoes) in your heart. A computer then creates a video of your heart. This video can show the size of your heart, how well your heart is working, if the heart valves are working, and if there are blood clots in your heart.

A TEE is often done when the doctor needs to get a good picture of the back of your heart. To get a clear picture, a probe is placed down the esophagus (the tube that connects your mouth to your stomach). The esophagus passes right behind the heart. Once the probe is in place, it works the same way as a TTE described above.

Cardiac CT uses an X-ray machine and a computer to take clear, detailed pictures of the heart. During a cardiac CT, an X-ray machine will take pictures of your heart and chest. A computer will put the pictures together to make a three-dimensional (3D) picture of your heart and chest.

A cardiac MRI uses radio waves, magnets, and a computer to create pictures of your heart. Cardiac MRI creates detailed pictures of your heart as it is beating. The MRI will create snapshots as well as videos. Doctors use cardiac MRI to see the beating heart, the parts of the heart, and how the heart is working.

Treatment

Once you are diagnosed with AFib, you and your doctor will make a treatment plan that is right for you. Your treatment plan may include being referred to a heart specialist, which might be a general cardiologist or a cardiologist who treats heart rhythm problems (electrophysiologist). Your doctor may treat your AFib diagnosis in different ways, such as with:

  • Medication (e.g., blood thinners)
  • Procedural/Interventional (e.g., ablation, pacemaker, cardioversion, etc.)
  • Lifestyle Modifications (e.g., diet, exercise, alcohol and smoking limitations, etc.)

Every patient is different, but there are four main strategies for managing AFib. You may hear your doctor call these the Four Pillars of AFib Care. Depending on your needs, your doctors may recommend one or more of these strategies:

Managing or preventing your heart from beating too fast

Lowering your heart rate is an important part of treating AFib, and there are many options to achieve this goal: 

Medications: Your doctors may prescribe rate-control medications called beta-blockers or calcium channel blockers to slow the heart rate when in AFib.

Pacemakers: A pacemaker is a small device implanted under the skin near the collarbone that monitors the heart's rhythm and sends a controlled electrical pulse to the heart muscle if it identifies a slow rate.
 

Returning to and Maintaining a Normal Heart Rhythm

People living with AFib may have an irregular heartbeat that feels like a fluttering in their chest or a strong pulsation in their chest or throat, called palpitations.

Medications: Your doctors may recommend special medications called antiarrhythmics to maintain a normal rhythm.

Catheter Ablation: The physician inserts a catheter into a blood vessel at the groin and gently guides it to the heart, where an electrical map is made to determine the electrical properties of the tissue. Energy is applied to the appropriate area to create a “scar” so that abnormal signals can no longer fire.

Electrical Cardioversion: A non-medicinal rhythm control option is electrical cardioversion, during which an electrical shock is administered to the chest (while the patient is under mild anesthesia) using paddles or patches. The goal of the shock is to “reset” the heart to a normal rhythm.

Download "Your Guide to Care with Rhythm Control: What is Rhythm Control?" patient information sheet.

Download "Your Guide to Care with Rhythm Control: Why is Rhythm Control important?" patient information sheet.

Focusing on Lifestyle Choices and Modifications

Living a “heart healthy” lifestyle can ease AFib symptoms and benefit your overall health:

  • Eating a healthy diet and maintaining a healthy weight
  • Exercising moderately and regularly (Please note: Extreme exercise in certain circumstances may increase your risk of AFib. Talk to your doctor before you start a new exercise routine.)
  • Avoiding or limiting the use of tobacco, recreational drugs, caffeine, and alcohol
  • Managing your diabetes
  • Controlling your blood pressure and cholesterol
  • Treating sleep apnea (if present)
  • Avoiding unnecessary stress
  • Having regular physical exams

Download the "What To Do To Reduce AFib and Prevent Stroke: 5 Health Tips Treatment Plan" patient information sheet.

Download the "A Closer Look At Sleep Apnea and AFib" patient information sheet.

Download the "Navigating Your AFib Treatment Strategies" patient information sheet.

AF Treatment Strategies (Pillars of AF Care)


AF Catheter Ablation

Lifestyle Changes

Lifestyle Modifications for AF Patient

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Risk Factors

Your risk of developing AFib increases if you have:

  • Advanced age (60+)
  • High blood pressure
  • Obesity
  • European ancestry
  • Diabetes
  • Heart failure
  • Ischemic heart disease
  • Hyperthyroidism
  • Chronic kidney disease
  • Moderate to heavy alcohol use
  • Cigarette/nicotine use
  • Enlargement of the chambers on the
  • left side of the heart

Sometimes, people get AFib for unknown reasons. Even people with healthy lifestyles who have no other medical problems can get AFib.

Complications

This type of irregular heartbeat gives you a 5x higher risk of stroke. During AFib, the atria contract chaotically, and because they are not pumping blood properly, blood pools and gets stuck inside the heart. Blood clots may form, which could get pumped to the brain and interrupt the brain’s
blood flow, resulting in an ischemic stroke 

CHA2DS2-VASc

Individual stroke risk depends on various factors, including age, medical conditions, and others. Your provider may measure your individual risk of stroke using the CHA2DS2-VASc risk criteria. Points are assigned for each major stroke risk factor. By adding the points, your provider can determine your stroke risk. Higher total points (up to the maximum score of nine) mean a higher risk of stroke. The stroke risk calculator does not apply to patients with mitral stenosis, mechanical heart valves, or hypertrophic cardiomyopathy.

Last updated on March 19, 2024

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