Atrial Fibrillation (AFib): An Overview

Arrhythmia is an abnormal or irregular heart rhythm. So, having an arrhythmia could mean several things; your heartbeat might be too fast, slow, or irregular. And of all arrhythmia types, atrial fibrillation (also called afib) is the most common. It occurs in about one percent of the population worldwide and in at least 3 to 6 million US adults. 

This condition is the leading cause of stroke and increases a person’s risk of a blood clot by five times. If you have atrial fibrillation, you may or may not show symptoms. Because of this, testing for afib can be life-saving and allow you to get necessary treatment.

This article looks at atrial fibrillation including its symptoms, types, causes, diagnosis, and treatment.

Atrial fibrillation is a heart rhythm disorder that causes an irregular or abnormal heartbeat. This condition occurs when abnormal electrical activity causes the heart's upper chambers, called the atria, to contract irregularly and often too fast. 

In a healthy heartbeat, electrical signals allow the atria to contract at a coordinated pace that syncs with the heart’s lower chambers. This way, blood flows from the upper chambers to the lower chambers efficiently and in a steady rhythm.

However, in afib, the abnormal electrical activity causes the atria to quiver or contract abnormally. In this case, blood doesn’t flow well out of the upper chambers to the heart's lower chambers. This can reduce how efficiently the heart pumps blood by 10%. The blood that remains in the atria can then form a clot. And if the clot leaves the heart and enters into the bloodstream, it can cause a stroke.

The good news is that afib is not life-threatening on its own. But it is important to know that because it can cause stroke, heart failure, or other complications, it could lead to fatality if not treated.

Afib is grouped into five categories depending on how often and long a person experiences this condition. Here are the five types of afib:

• Paroxysmal: This afib lasts for only a week or less and goes away on its own or with treatment. But it can happen again.  
• Persistent: This afib occurs for longer than a week and doesn’t go away independently.
• Long-standing persistent: Here, afib occurs for longer than a year.
• Permanent: This afib never goes away even with treatment, ultimately becoming the person’s normalized heart rhythm. Treatment used here is to help prevent blood clots.
• Nonvalvular: This afib isn’t due to a problem with a heart valve, but rather due to other conditions like high blood pressure.

Atrial fibrillation is the most common heart rhythm disorder, affecting one percent of the world’s population and seven percent of people older than 70. This condition occurs in about 3 to 6 million Americans. This prevalence in American adults is expected to rise to between 6 to 16 million by 2050. 

In 2010, about 9 million people had afib in Europe, estimated to increase to 14 million by 2060. 

This condition is more likely to occur as a person ages. By the age of 80, the risk of developing atrial fibrillation rises to 22%. And it's more common in men and white people than in women and black people. 

Afib might come with symptoms or have no symptoms at all. People who show no symptoms won’t know they have it all unless they take a test that finds an irregular heart rhythm. Those who do have symptoms may experience:

• Irregular or pounding heartbeat
• Mild chest pain, tightness, or discomfort
• A racing heart
• Lightheadedness
• Mild shortness of breath 
• Fatigue

People with afib may also show more severe symptoms like:

• Sharp chest pain
• Difficulty breathing
• Fainting, or lightheadedness due to lack of blood blow to brain
• Intense exhaustion

A doctor will likely decide how severe your symptoms are based on how much and how often they interfere with your day-to-day living.

It's been found that afib has many causes. Most often, it occurs in older people and those with underlying chronic conditions like heart diseases, diabetes, obesity, or other chronic conditions. 

Here are some common heart conditions that increase a person’s risk of developing afib:

• High blood pressure or hypertension (hypertensive heart disease)
• Heart failure
• Heart valve disease
• Heart attack
• Heart surgery complications
• Infection or inflammation of the heart
• Heart muscle disease

Other health conditions and habits that can contribute to afib include:

• Alcohol and binge drinking 
• Hyperthyroidism
• Medications that affect the heart 
• Chronic kidney diseases
• Chronic lung diseases
• Obesity
• Diabetes
• Sleep apnea
• Lung embolism or blood clots in the lungs
• Recreational drug use
• Smoking
• Psychological stress

Some folks can develop afib seemingly without any cause at all. This type of afib is called idiopathic afib. Thankfully, those below 65 with idiopathic afib have less of a risk of blood clots and stroke than in other types.

Afib may also be genetic. So, if afib runs in your family, you may be more prone to developing it compared to those with no family history of afib. And in this case, we again recommend talking to your doctor about testing, just to be on the safe side.

Atrial flutter is another type of arrhythmia. Although atrial flutter might look like afib, it’s not quite as common.

Atrial flutter occurs when electrical activity in the atria causes the atria to contract at a regular but extremely rapid rate. 

It is possible for a person to have an atrial flutter or atrial fibrillation, or both. Both conditions can raise a person’s risk of blood clots. But the risk is is lower for someone with atrial flutter compared to those with atrial fibrillation. 

Because symptom severity varies case-by-base, the symptoms themselves could impact your life greatly, or hardly at all. Note that if you find that your symptoms are disabling or interfere with how active you are, treatment can help manage these symptoms, improve your functioning and well-being, and lower your risk of stroke, heart failure, and other complications. 

Untreated atrial fibrillation can raise the risk of stroke by five times compared to those with a healthy heart rhythm. Other certain groups of people with afib are also at a higher risk of stroke. These groups include:

• Older people
• People with heart valve problems
• People with hypertension
• People with diabetes
• People with a history of blood clots

Seek immediate medical help if you start feeling:

• Chest pain 
• Racing or pounding heartbeat
• Shortness of breath
• Excess sweating 
• Extreme dizziness.

Atrial fibrillation can also cause a person to develop other health problems like heart failure, chronic kidney disease, dementia, and cancer. 

Speak with a doctor if you have new symptoms or if your symptoms affect your day-to-day living.

The length of time atrial fibrillation hangs around also varies greatly. It may last for weeks, months, or years depending on the type and other factors. Some afib episodes may also be reoccurring.

If you have permanent afib, it will stay forever, even with treatment. But don't be discouraged! Your doctor will help by recommending a treatment plan that will manage your symptoms and reduce your risk of health complications.

Detecting atrial fibrillation early helps lower your risk of health complications and premature death due to afib. It also allows you to lead a healthier, more active life.

Your doctor will likely look into your health history to see if you’ve had symptoms like shortness of breath, chest pain, fainting spells, or dizziness. 

Your doctor might also check if you have conditions that raise the risk of atrial fibrillation, like heart valve problems, hypertension, sleep apnea, obesity, heart disease, and diabetes. 

Your doctor should also note if you drink alcohol, smoke, use recreational drugs, or are under severe stress as these can all play a part.

If you’ve already had a history of atrial fibrillation in the past, your doctor might ask questions like:

• How long and frequently do you experience symptoms?
• What triggers your afib?
• What treatment has successfully made afib go away?
• What medications for regulating heart rhythm were you on?
• Do you have any heart diseases?

Your doctor will also conduct a thorough physical exam. They may check you for an irregular pulse that could suggest atrial fibrillation.

You’ll also be asked to take an electrocardiogram (ECG) test. This test checks your heart’s electrical activity and rhythm. However, an ECG may not detect atrial fibrillation that comes and goes, even when you show typical afib symptoms. 

In some cases, your doctor might recommend continuous monitoring of your heart rhythm with devices like the Holter monitor, an event monitor, or implantable loop recorder. You should also talk to your doctor about Cardiogram and ask them if this data would suffice. (You can easily share minute-to-minute heart rate data with your doctor with Cardiogram Premium). Some other wearables or fitness trackers have sensors that detect irregular heart rhythm, but relying on clinically validated products, like Cardiogram, is advisable. 

Echocardiography can also help with detecting atrial fibrillation. Echocardiography is a scan of your heart that can show your doctor if you have any physical heart defects or at risk of stroke.

You might also have some blood tests or other lab work done to check for underlying causes of atrial fibrillation like hyperthyroidism and infection.

Treatment for atrial fibrillation varies for each person. Depending on an individual's particular needs, treatment may help:

• Regulate heart rate and rhythm
• Stop blood clots from forming, lowering your risk of stroke

You could also receive any of these treatments:

Blood thinners or anticoagulants

These medications prevent blood clots and can reduce the risk of stroke by ​​50 to 70%. You might receive blood thinners if you're at higher risk of blood clots or stroke. Medications that your doctor might prescribe are:

• Apixaban 
• Dabigatran
• Edoxaban
• Rivaroxaban
• Warfarin 

Rate control medication

These are medications that regulate heart rate and support normal heart function. Some of these medications include:

• Beta-blockers like Atenolol and Bisoprolol
• Calcium channel blockers like Diltiazem and Verapamil
• Digoxin
• Amiodarone

Rhythm control medication

These medications, also known as antiarrhythmics, regulate heart rhythm and help restore normal heart rhythm. Medications a doctor might prescribe for rhythm control include:

• Sodium channel blockers like Flecainide and Propafenone
• Potassium channel blockers like Amifampridine and Ampyra 

Your treatment option may also involve surgery or other procedures:

• Cardioversion: This procedure resets the heart rhythm electrically or with medications.
• Ablation: This procedure destroys heart tissue causing atrial fibrillation.
• Maze procedure: This surgery creates scars or cuts in a maze pattern within the heart tissue to block electrical signals that cause atrial fibrillation. 
• Left atrial appendage closure: This procedure closes the opening of the left atrial appendage so that blood clots cannot pass through it, reducing stroke risk.

If atrial fibrillation results from an underlying health condition, your treatment plan will also include managing that condition.

Also, be sure to inform your doctor about any supplements or medications you’re currently on so they can best and most safely create your treatment plan.

You can prevent atrial fibrillation by preventing or managing some risk factors that cause or contribute to it. Some of these risk factors include:

• Smoking
• Alcohol intake
• Sleep apnea
• Physical inactivity 
• Stress

More specific way that you can reduce your chances of atrial fibrillation include:

• Avoid smoking, drinking alcohol, or using recreational drugs.
• Take your sleep health seriously. Try to get adequate sleep (at least 7 hours) regularly. If you’re having trouble sleeping, start a good sleep-hygiene habit in your Cardiogram app.
• Engage in physically activity every day. The American Heart Association recommends 150 minutes of moderate-intensity cardio activity, 75 minutes of vigorous cardio activity, or both weekly.
• Aim for a well-balanced diet. You can speak with a nutritionist or dietitian about creating a personalized diet program for you.
• Manage your stress levels by taking time daily to do activities that help you relax and wind down. Consult a therapist if managing your stress levels with self-care activities sounds too difficult or doesn't seem to work.

The Cardiogram app acts as a clinically-validated heart health monitor. Unlike most apps, it collects your minute-to-minute heart rate data and offers it in a way that's easy to analyze. Because afib can be so difficult to detect, having this detailed heart rate data available for your doctor with Cardiogram Premium can help them to diagnose afib, as well as to create a more tailored treatment plan. It can also be a much more cost-effective testing method. Talk to your doctor about using Cardiogram!