AFib is short for "atrial fibrillation." AFib is an abnormal heart rhythm (arrhythmia). It’s when disordered or rapid electrical signals cause the upper chambers (the atria) of the heart to contract too quickly and chaotically (fibrillate). The normal, ordered contraction of the muscle fibers of the atria typically allow for the coordinated and complete emptying of blood from the heart’s upper chambers into its lower ones. However, in the presence of fibrillation, flow becomes irregular and chaotic, and that can cause blood to pool in the atria without being pumped into the lower chambers of the heart (the ventricles). To maximize the efficiency of the heart and to avoid various diseases, the upper and lower chambers of the heart should work as a team. That doesn’t happen during AFib.
AFib can also affect blood flow to the rest of the body. AFib may happen only occasionally in some people. For others, it’s a long-term problem. Sometimes, emergency medical assistance is necessary.
Paroxysmal atrial fibrillation is when AFib begins without warning and stops just as suddenly. Most of the time, this type of AFib clears up on its own within 24 hours, but it can take up to a week. When AFib lasts longer than a week, it’s called persistent atrial fibrillation. AFib that continues despite treatment is called permanent atrial fibrillation. When it’s inherited, it’s called familial atrial fibrillation.
A 2013 study published in Circulation revealed that 33.5 million people around the world have AFib. That’s about 0.5 percent of the world’s population. In 2005, AFib affected about three million Americans, according to the Cleveland Clinic. That figure is projected to rise to eight million by the year 2050.
Causes and Risk Factors
One of the reasons AFib is on the rise is that the chances of developing AFib increase with age, and our population is growing older. A study published in JAMA Internal Medicine showed that the prevalence of AFib is 2.3 percent in people over 40 years old and 5.9 percent in those older than 65. About 70 percent of people with AFib are between the ages of 65 and 85. Men have a higher incidence of AFib than women in each age group. Women tend to be about five years older when symptoms start. In people over age 75, there are more women than men in the general population, so the ratio of women to men with AFib is about equal for this age group.
Caucasians are more likely to develop AFib than non-Caucasians. You are more likely to develop AFib if you have:
- high blood pressure
- coronary heart disease, heart defects, or heart failure
- rheumatic heart disease or pericarditis
- diabetes or metabolic syndrome
- lung disease or kidney disease
- sleep apnea
- family history of AFib
Behaviors can also increase risk for AFib. These include caffeine and alcohol abuse. A high stress level can also be a factor in AFib. The cause of AFib can’t always be determined.
You don’t always feel symptoms of AFib. Some people experience heart palpitations, and shortness of breath. It may also cause dizziness and fainting. General weakness and fatigue are common.
If you have chest pain, pressure in your chest, or difficulty breathing, seek medical attention immediately.
Whether you have symptoms or not, AFib puts you at greater risk of stroke. According to the American Heart Association, if you have AFib, you’re five times more likely to have a stroke than someone who doesn’t. If your heart beats too fast, it may even lead to heart failure. AFib can cause blood to clot in your heart. Blood clots can travel in the bloodstream, eventually causing a blockage (ischemia). A study published in Gender Medicine showed that women with AFib are at greater risk of stroke and of dying than men with AFib.
Tests and Diagnosis
If you have symptoms of AFib, see your doctor. Diagnostic testing may include an electrocardiogram (EKG or ECG) to check your heart’s electrical activity. Another test that may help is the Holter monitor, a portable ECG that can monitor your heart rhythms for several days. An echocardiogram is another noninvasive test that can produce images of your heart, so your doctor can look for abnormalities.
Your doctor may also order blood tests to look for underlying conditions that may be causing your symptoms, such a thyroid problems. A chest X-ray can give your doctor a better look at your heart and lungs to see if there’s any obvious cause for your symptoms.
One of the main goals of treatment is to prevent blood clots from forming. The most common medications are warfarin (Coumadin) and aspirin.
Other medications can help to normalize your heart rate. These include beta blockers (metoprolol, atenolol), chalcium channel blockers (diltiazem, verapamil), and digitalis (digoxin).
If those medications aren’t successful, other drugs can help maintain normal heart rhythm. These medications require careful dosing and monitoring:
- amiodarone (Cordarone, Pacerone)
- dofetilide (Tikosyn)
- flecainide (Tambocor)
- ibutilide (Corvert)
- propafenone (Rythmol)
- sotalol (Betapace, Sorine)
- disopyramide (Norpace)
- procainamide (Procan, Procapan, Pronestyl)
Normal heart rhythm can also be restored using low-energy shocks in a procedure called electrical cardioversion. If that doesn’t work, your doctor may try something called catheter ablation, a procedure that uses radio wave energy to get rid of abnormal tissue that interferes with your heart’s electrical signals.
Atrioventricular node ablation is another choice. In this procedure, radio wave frequencies are used to destroy a portion of tissue. In doing so, the atria can no longer send electrical impulses. A pacemaker keeps the ventricles beating normally.
Maze surgery is an option generally reserved for people who already need some type of heart surgery. Small cuts are made in the atria so that chaotic electrical signals can’t get through.
As part of your treatment, you’ll be advised to maintain a heart-healthy diet. Regular exercise is an important part of heart health, so ask your doctor how much exercise is good for you. See your doctor regularly for follow-up care. Don’t smoke.
AFib is an expensive condition. According to the American Heart Association, treatment for AFib costs about $26 billion dollars a year in the United States. Broken down, that’s $6 billion for care specifically aimed at treating AFib, $9.9 billion to treat other cardiovascular disease and risk factors, and $10.1 billion to treat related non-cardiovascular health problems.
When compared to other patients, those with AFib are admitted to the hospital at double the rate. AFib patients are three times more likely to be hospitalized more than once. The admission rate for cardiovascular problems is four times greater for people who have AFib than for those who don’t. One retrospective study calculated 2007 in-hospital pharmaceutical costs related to AFib at $3,278 to $3,610 per patient. After hospitalization, continuing care and pharmaceutical costs continue to mount.
In addition to direct health costs, AFib places a substantial burden on the work force. Studies show that workers with AFib miss more days of work than those without AFib: 2.44 vs. 1.85 adjusted mean days. In Europe, people with AFib average nine to 26 days of lost work per year.
You can’t prevent AFib entirely, but there are things you can do to keep your heart healthy. Strive to keep your blood pressure, cholesterol levels, triglyceride levels, and weight within the normal range. Take the following measures:
- Maintain a diet low in cholesterol, saturated fat, and trans fat. Eat plenty of vegetables, fruits, and whole grains.
- Get some exercise every day.
- Don’t smoke.
- Drink alcohol in moderation.
- Avoid caffeine if it triggers your AFib.
- Take all your medications according to label directions. Ask your doctor before taking over-the-counter medications or supplements.
- Schedule regular visits with your doctor.
- Report chest pain, breathing difficulties, or other symptoms to your doctor promptly.
- Monitor and treat other health conditions.