Do you experience chest pain, lightheadedness, fatigue or heart palpitations/irregularity? Are there moments when you can’t catch your breath?

If so, you may have atrial fibrillation. It’s commonly known as AF or AFib. AFib occurs when the atria, or upper chambers of the heart, lose their normal rhythm and beat chaotically.

When AFib occurs, blood doesn’t flow through the atria in a coordinated fashion. Inefficient flow can cause the blood to pool inside the atria, which increases the risk of blood clots.

Fast heart rates, which can result from erratic atrial activity, can also cause these symptoms. If uncontrolled, the heart’s pumping function can weaken over time.

Paroxysmal AFib are episodes of AFib that occur occasionally and usually stop spontaneously. Episodes can last a few seconds, hours or a few days before stopping and returning to normal sinus rhythm, which is the heart’s normal rhythm.

Some people may have single episodes of AFib. However, the condition may progress to the point that it’s constant, which is referred to as chronic AFib.

There are three types of AFib:

  • paroxysmal
  • persistent
  • chronic, or permanent

Persistent AFib is defined by an episode that lasts longer than 7 days. It doesn’t stop without treatment. Normal rhythm may be achieved with medications or electric shock treatment.

Chronic, or permanent, AFib may be ongoing for many years. Usually the decision has been made to not restore sinus rhythm, whether with medication or with electric shock therapy.

It’s not uncommon for you to develop persistent or chronic AFib if you’ve had paroxysmal AFib.

Research has shown that 9 to 30 percent of all cases of paroxysmal AFib progress into more chronic cases after 1 year.

Factors that can influence your chance of developing chronic AFib include:

According to the Centers for Disease Control and Prevention (CDC), between 2.7 and 6.1 million people in the United States have some type of AFib. It’s the most common abnormal heart rhythm. There are also many more individuals who are at an increased risk for developing atrial fibrillation.

Studies have shown that around 40 percent of people with AFib have paroxysmal AFib. However, estimates vary widely because of the difficulty of diagnosing and classifying different types of AFib.

Age is an important risk factor for AFib. AFib occurs more often in older people. The older you are, the more likely you are to have it. However, younger people are more likely to have paroxysmal AFib than other types of AFib.

You’re also at greater risk for the condition if you have:

You’re also at an increased risk if you’re an elite or endurance athlete.

AFib can be caused by irritation of the heart from heart disease or high blood pressure. Medications and other factors can also lead to AFib. These factors include:

  • binge drinking, or consuming 4 to 5 drinks within 2 hours
  • stimulant medications and drugs, such as methylphenidate, pseudoephedrine, or cocaine
  • nicotine
  • caffeine
  • low potassium levels, which can lead to an electrolyte imbalance
  • low magnesium levels
  • a significant illness or surgery
  • viral infections
  • heart or heart valve defects
  • congestive heart failure or cardiomyopathy
  • hyperthyroidism (overactive thyroid)
  • inflammation
  • family history of AFib
  • obesity
  • illicit drug use, like cocaine

Symptoms of AFib can include:

  • lightheadedness
  • weakness
  • pounding heart, palpitations, or irregular heartbeat
  • chest pain
  • shortness of breath
  • fatigue

Many individuals with AFib don’t even know it. You may not have any symptoms at all. However, AFib is an arrhythmia that can have complications, and complications can occur in anyone with AFib.

Complications

Stroke and systemic embolism are the most serious and the most common complications of AFib. If you have AFib, you’re 4 to 5 times more likely to have a stroke than people without it. This is because blood pooling inside the heart can coagulate and form clots.

There are also other unknown factors associated with AFib that increase risk of stroke that can occur in individuals with AFib, even when they’re not in AFib. The risk of stroke and systemic embolism is somewhat independent of the burden — amount — of AFib you’re having.

Those clots can travel to your brain and cause a stroke. They can also lodge in your gut, limbs, and kidneys, blocking blood flow and starving the tissue, causing systemic embolism.

If your AFib persists over a long period without treatment, the heart may no longer effectively push blood and oxygen throughout the body and start to weaken, which could result in congestive heart failure.

Treatment for AFib involves the following options:

  • resetting the heart’s rhythm from AFib back to a normal sinus rhythm versus controlling the heart rate and leaving the person in atrial fibrillation
  • preventing blood clots

If you have paroxysmal AFib, your doctor may recommend restoration of the normal heart rhythm. To do this, your doctor may try to reset the normal rhythm with medications or electric shock, also known as cardioversion.

Your doctor may suggest an antiarrhythmic medication, such as amiodarone (Cordarone) or propafenone (Rythmol), even when normal rhythm has returned. They also may prescribe beta-blockers or calcium channel blockers to control your heart rate.

Another treatment option for AFib is AFib ablation. A heart rhythm specialist called an electrophysiologist performs an ablation.

For this procedure, the doctor inserts an instrument into your groin that goes through the femoral vein and up into the areas of the heart where AFib originates, which is the left atrium.

Then, they ablate to try to electrically isolate the source of the abnormal rhythm. In certain people, this intervention can treat AFib permanently or “cure” it, but in others, it can recur.

Not everyone with AFib is treated with blood thinners. The decision to treat is based on underlying risk factors determined by the CHA2DS-Vasc scoring system.

If you have ongoing AFib, your doctor most likely will prescribe blood-thinning medications such as non-vitamin K direct oral anticoagulants (DOACs) or warfarin (Coumadin) to prevent blood clots.

DOACs are now recommended for most people over warfarin unless you have:

Examples of NOACs include:

  • dabigatran (Pradaxa)
  • rivaroxaban (Xarelto)
  • apixaban (Eliquis)
  • edoxaban (Savaysa)

For those who cannot tolerate blood thinners or are at very high risk of bleeding, your doctor may recommend implanting a device called a “Watchman.” This device can isolate the pocket in the heart where most of the blood clots originate, which is called the left atrial appendage.

Staying healthy is key to living a normal, active life with AFib. Common risk factors for developing AFib are underlying conditions, such as:

  • high blood pressure
  • thyroid disease
  • diabetes
  • obesity

To prevent additional paroxysmal AFib episodes, avoid:

  • excessive alcohol consumption
  • stimulants such as caffeine and nicotine

Lastly, always remember to talk to your doctor and schedule regular checkups.

Q:

Why does atrial fibrillation sometimes occur in seemingly healthy young people?

A:

Atrial fibrillation can occur in those who are healthy and young probably due to underlying genetic predisposition, although the risk for atrial fibrillation increases with age. Sometimes an unknown abnormality to the heart, coupled with undiagnosed hypertension, hyperthyroidism, or lifestyle factors such as alcohol consumption and tobacco use can lead to the development of atrial fibrillation. Other times, there’s no known cause to be found.

Judith Marcin, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.