Atrial fibrillation (AFib) is a type of heart arrhythmia that causes the top chambers of your heart, the atria, to quiver and beat irregularly. AFib used to be described as chronic or acute, with chronic AFib lasting longer than one week.
After new guidelines were released in 2014, chronic AFib is now called long-standing, persistent AFib. Long-standing, persistent AFib lasts longer than 12 months.
Other types of AFib are:
- paroxysmal: AFib that is intermittent and lasts less than one week
- persistent: AFib that is continuous for more than one week but no more than 12 months
- permanent: AFib that is continuous and isn’t treated
Symptoms of long-standing, persistent AFib
AFib may not cause symptoms. If you do experience symptoms, they may include:
- fluttering in your chest
- heart palpitations
- shortness of breath
- chest pain
AFib symptoms can mimic those of a heart attack. If you’re having any of these symptoms for the first time, seek emergency medical attention. You should also get emergency help if you’ve been diagnosed with AFib, but your symptoms seem unusual or severe.
Who’s at risk for long-standing, persistent AFib
Anyone can develop AFib at any time. You’re at risk of developing AFib if you:
- are over 60
- have high blood pressure
- have heart disease or structural heart problems
- have sick sinus syndrome
- have had heart surgery
- are a binge drinker
- have a family history of AFib
- have sleep apnea
- have chronic health conditions, such as hyperthyroidism, diabetes, or lung disease
To assess your risk of developing AFib, take this online AFib risk assessment. Discuss the results with your doctor.
Diagnosing long-standing, persistent AFib
Because AFib doesn’t always cause symptoms, it can be difficult to diagnose. You may have AFib for a long time and not know it until you see your doctor for a routine checkup or another condition.
If your doctor suspects that you have AFib, they’ll review your symptoms and medical history. A test known as an electrocardiogram will be done to evaluate your heart’s electrical activity. This test should pick up long-standing, persistent AFib. It won’t, however, show paroxysmal AFib unless you’re experiencing it at the time of the test.
Other tests that may be ordered are:
- an event monitor, such as a Holter monitor, that records your heart’s electrical activity for a period of time
- a stress test to evaluate how your heart functions during exercise
- an echocardiogram to view the structure of your heart and how well it’s pumping
- a chest X-ray to look for fluid in your heart or lungs
- a transesophageal echocardiogram to get a closer look at your heart via your esophagus
- blood tests to check for hyperthyroidism or other conditions that may trigger AFib
Long-standing, persistent AFib treatment
Long-standing, persistent AFib is almost always aggressively treated to reduce the risk of blood clots. Other treatment goals are to restore normal heart rate and rhythm and treat any underlying conditions that may cause AFib.
The first line of treatment is often medication to slow the heart rate such as beta blockers, calcium channel blockers, or digitalis. A medication to bring heart rhythm back to normal may also be used. These are known as antiarrhythmics and can include:
Antiarrhythmics can cause severe side effects. They are often started while you’re in the hospital so you can be monitored.
Blood thinners are usually prescribed to reduce the risk of a blood clot. These include:
If long-standing, persistent AFib can’t be managed with medications, more invasive treatments may be tried:
- electrocardioversion: to shock your heart back into normal rhythm
- catheter ablation: to destroy abnormal heart tissue that’s causing faulty electrical signals
Outlook for long-standing, persistent AFib
There is no cure for AFib, but it can often be managed with medications and lifestyle changes. In general, AFib is considered a progressive condition. The longer it lasts, the more difficult it may be to get under control.
It’s important to get regular medical care for AFib. According to the American Heart Association, you’re five times more likely to have a stroke if you have AFib. Thirty-five percent of people with AFib who don’t take steps to manage their condition have a stroke at some point.
Research suggests managing risk factors for AFib may help increase the chance of long-term success after catheter ablation.
How to prevent AFib
Some cases of AFib can’t be prevented. If you have a condition linked to AFib such as sleep apnea or hyperthyroidism, treating it may prevent further episodes. Avoiding common AFib triggers such as stress, caffeine, and excessive alcohol may also prevent the condition.
A heart-healthy lifestyle helps reduce your risk of heart problems overall. If you’re not taking care of your heart already, take these steps:
- Avoid foods high in saturated fats or trans fats.
- Eat plenty of fruits, vegetables, and whole grains.
- Add healthy fats to your diet, such as omega-3s, olive oil, and avocados.
- Avoid excessive alcohol consumption, such as binge drinking.
- Stop smoking.
- Avoid caffeine.
- Stay active and exercise regularly.
- Manage stress.
- Control your blood sugar.
- Control your blood pressure.
- Maintain a healthy weight.
If you want to change your lifestyle but don’t know where to begin, ask your doctor for help. They can refer to you a nutritionist or psychotherapist. They can also help you quit smoking and develop a safe exercise program.