Atrial fibrillation, also known as AFib or AF, is an irregular heartbeat (arrhythmia) that can lead to various heart-related complications such as blood clots, stroke, and heart failure.
AFib is a serious condition that can occur without any signs or symptoms but can result in life-threatening complications if left untreated.
The normal contraction of the muscle fibers of the upper chambers of the heart (the atria) typically allow for the coordinated and complete emptying of blood from the heart’s upper chambers into its lower ones (the ventricles).
In AFib, however, disordered or rapid electrical signals cause the atria to contract too quickly and chaotically (fibrillate).
Blood that’s not completely pumped out of the atria can remain and may pool there. 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 may occur in brief episodes, or it may be a permanent condition. Sometimes, emergency medical assistance is necessary. Here’s what you need to know:
AFib is the most common arrhythmia diagnosed in clinical practice.
Worldwide, the estimated number of individuals with AFib in 2010 was 33.5 million, according to a 2013 study. That’s about 0.5 percent of the world’s population.
According to the Centers for Disease Control and Prevention (CDC), approximately 2 percent of people younger than 65 years old have AFib, while about 9 percent of people ages 65 and older have it.
According to a 2013 review, people who don’t identify as white have a lower prevalence and incidence of having AFib.
Causes and risk factors
There are four main types of AFib.
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 lasts for more than a year without going away is long-standing persistent atrial fibrillation.
AFib that continues despite treatment is called permanent atrial fibrillation.
Abnormalities or damage to the heart’s structure are the most common cause of atrial fibrillation. You’re 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
- a family history of AFib
AFib is also associated with increased mortality in individuals with other cardiovascular conditions and procedures, including heart failure and stroke.
Behaviors can also increase risk for AFib. These include caffeine consumption and the misuse of alcohol. High stress levels or mental health conditions can also be a factor in AFib.
The chances of developing AFib increase with age. About 70 percent of people with AFib are between the ages of 65 and 85. The prevalence of AFib is higher in men. However, since women live longer than men, the overall number of men and women with AFib is about equal.
Even though people of European ancestry have atrial fibrillation at higher rates, research has found that many of its complications — including stroke, heart disease, and heart failure — are more common among African Americans.
You don’t always feel symptoms of AFib, but some common symptoms include heart palpitations and shortness of breath.
Other symptoms can include:
- irregular heartbeat
- lightheadedness or dizziness
- faintness or confusion
- extreme fatigue
- chest discomfort or pain
If you have chest pain, pressure in your chest, or difficulty breathing, seek medical attention immediately.
There’s increasing awareness that atrial fibrillation is frequently unrecognized but it is a serious condition.
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 5 times more likely to have a stroke than someone who doesn’t have it.
If your heart beats too fast, it may even lead to heart failure. AFib can cause blood to clot in your heart. These clots can travel in the bloodstream, eventually causing a blockage.
Research has shown that women with AFib are at greater risk of stroke and of dying than men with AFib.
Tests and diagnosis
Screening may be part of your regular care if you’re 65 years or older, or if you have other risk factors. 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 as 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.
AFib is treated with lifestyle changes, medicines, procedures, and surgery to help prevent blood clots, slow the heartbeat, or restore the heart’s normal rhythm.
If you have atrial fibrillation, your doctor will also look for any disease that may be causing it and assess your risk of developing dangerous blood clots.
Treatment for AFib can include:
- medications to control the heart’s rhythm and rate
- blood-thinning medication to prevent blood clots from forming and reduce stroke risk
- healthy lifestyle changes to manage risk factors
Other medications can also help to normalize your heart rate. These include beta blockers (metoprolol, atenolol), calcium 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 ablation, which works by scarring or destroying tissue in your heart to disrupt faulty electrical signals causing the arrhythmia.
Atrioventricular node ablation is another choice. In this procedure, radiowave 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. You should also avoid smoking.
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.
Data suggests that overweight and obese individuals with symptomatic AFib who opted for weight loss and aggressive risk factor management had fewer hospitalizations, cardioversions, and ablation procedures than their counterparts who declined enrollment.
Other lifestyle changes you can make include:
- maintaining a diet low in cholesterol, saturated fats, and trans fats
- eating plenty of vegetables, fruits, and whole grains
- getting daily exercise
- quitting smoking
- drinking alcohol in moderation
- avoiding caffeine if it triggers your AFib
- taking all of your medications according to the label or your doctor’s instructions
- asking your doctor before adding any over-the-counter medications or supplements to your regimen
- scheduling regular visits with your doctor
- reporting chest pain, breathing difficulties, or other symptoms to your doctor promptly
- monitoring and treating other health conditions
AFib is an expensive condition. The total cost for AFib in the United States came in at around $26 billion dollars per year.
Broken down, this was $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 noncardiovascular health problems.
According to the CDC, more than 750,000 hospitalizations occur each year because of AFib. The condition also contributes to nearly 130,000 deaths each year.
The CDC reports that the death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.
A recent study of Medicare patients between 1998 to 2014 found that people with atrial fibrillation were much more likely to be hospitalized (37.5 percent vs. 17.5 percent) and much more likely to die during hospitalization (2.1 percent vs. 0.1 percent) than were similar people without AFib.