Atrial fibrillation, or A-fib, is a common arrhythmia, affecting over two million Americans with about 160,000 new cases diagnosed each year. With A-fib, the electrical signal that coordinates the muscle contractions of the upper chambers of the heart – the atria – becomes fast and disorganized, causing the atria to beat in a rapid, chaotic pattern rather than in a regular rhythm.

The muscle of the atria can’t contract properly, so it doesn’t effectively pump blood into the lower chambers of the heart – the ventricles – which are responsible for pumping blood/oxygen to the lungs and body.

The likelihood of developing A-fib increases with age, especially over age 60. A-fib can happen occasionally or it may be a permanent condition. Though not life-threatening, A-fib can lead to other rhythm disturbances, chronic fatigue or heart failure, and A-fib puts you at a five-times-higher risk of stroke than the general population.

Types of A-Fib

There are different types of atrial fibrillation, characterized by their duration and response to treatment.

  • Paroxysmal A-Fib - If A Fib occurs periodically and ends spontaneously, it is known as paroxysmal A Fib. Symptoms of paroxysmal A Fib can range from mild to severe, with episodes occurring a few times a year or daily. Their duration is usually unpredictable, sometimes lasting just seconds or continuing for hours or longer.
  • Persistent or Chronic A-Fib - With persistent A Fib, the irregular heart rhythm will not return to normal on it’s own but will respond to treatment.
  • Permanent A-Fib - This condition occurs when the irregular heart rhythm can’t be corrected with treatment and continues indefinitely.

What Causes A-Fib?

  • high blood pressure
  • heart failure
  • coronary artery disease
  • heart valve disease
  • healing process following heart surgery
  • changes in the heart muscle, or cardiomyopathy
  • chronic lung disease
  • pulmonary embolism
  • congenital heart disease
  • hyperthyroidism
  • pericariditis
  • viral infection

In about ten percent of A-fib cases, no other heart disease is present. In these cases, A-fib may be related to excessive alcohol or caffeine use, stress, certain drugs, electrolyte or metabolic imbalances, or genetics. In some cases, no cause can be found.

Signs/Symptoms of A-fib

  • irregular, fast heartbeat
  • palpitations or rapid thumping within the chest
  • dizziness
  • shortness of breath
  • sweating
  • chest pain or pressure
  • fatigue
  • fainting

How is A-fib Diagnosed?

In addition to gathering your medical history and performing a thorough physical exam, some common diagnostic tests for a-fib include:

  • Electrocardiogram [EKG] – a simple, painless test that records the heart’s electrical activity.
  • Echocardiogram [Echo] – an external test of the heart that uses high-frequency sound waves to produce a visual image of the heart’s structure and movement.
  • Holter monitor – a small portable recorder attached to the patient’s chest with electrode patches for 24-48 hours to record heart activity.
  • event monitor – a similar recorder for patients who experience infrequent A-fib episodes, an event monitor can be worn for about a month, with the patient recording heart activity only during A-fib, then transmitting the device’s information over a phone line to the doctor’s office for evaluation.
  • cardiac stress test – a test that measure’s the heart’s ability to respond to external stress, such as strenuous physical exercise.
  • Transesophageal echocardiogram [TEE] – an internal Echo, during which an ultrasound transducer positioned on an endoscope is guided down the patient’s throat and into the esophagus, providing a view of the heart’s chambers and valves.
  • Electrophysiology study [EP study] – a test to record the heart’s electric activity in order to determine the exact cause of arrhythmia and the best solution for it.

How is A-fib Treated?

Treatment for a-fib depends upon the details of your particular condition, and might include:

  • lifestyle changes – for a healthier heart, which can decrease the likelihood of arrhythmias.
  • antiarrhythmic medications – help return the heart to its regular rhythm or maintain a normal heartbeat
  • rate-control medications – help slow the heart rate during A-fib.
  • anticoagulants – drugs to prevent blood clots from forming in order to lower the risk of stroke.
  • pacemaker – a silver-dollar-sized electronic device is inserted into your chest that delivers small electrical impulses to the heart muscle through wires called leads, in order to keep your heart beating normally.
  • cardioversion – the delivery of an electric shock to the chest through electrodes or paddles, to restore a regular heart rhythm.
  • cardiac ablation – sometimes, the heart’s electrical flow becomes blocked or travels the same pathways over and over again, creating a “short circuit” and upsetting the heart’s regular rhythm. Cardiac ablation simply creates a scar in the tissue to break the short circuit and restore a normal heartbeat.
  • cardiac surgery – more commonly used to treat other heart disorders that may be increasing the likelihood of arrhythmias.

Health Risks

Atrial fibrillation is in itself not generally life threatening. Left untreated, however, it can lead to more serious health problems such as heart failure or heart muscle disease.

People with A-Fib are also at a three to five times greater risk of stroke. This is because A Fib reduces the efficiency of blood flow through the heart’s upper chambers, creating the potential for blood to pool and clot within the heart. If a blood clot is then released into the blood stream, it can obstruct circulation to the brain and cause a stroke. The American Heart Association estimates that approximately 105,000 strokes occur each year in individuals with A Fib, making it responsible for approximately 15 percent of total cases and a leading cause of stroke.

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