Like the chaos of a hailstorm on a tin roof comes the electrical storm of atrial fibrillation (AF). During AF, the atria are quivering (fibrillating) and firing hundreds of impulses at the same time. It’s as if the electrical circuits have gone haywire. If this rhythm problem is not diagnosed or isn’t managed properly, it can lead to strokes, heart failure, and death.
AF is the most common heart rhythm abnormality diagnosed in the U.S. and is a major health, social, and economic problem affecting between 2.7- 6.1 million Americans. It’s becoming increasingly common as the population ages.
Our Hearts and Atrial Fibrillation
The Washington Post, describing atrial fibrillation, said, “Our hearts have four chambers. The two upper ones are the right and left atriums, and the lower two are the ventricles. The heart’s electrical activity (via tissues that create electrical impulses) starts in the right atrium and spreads quickly to the left, allowing the atriums to squeeze blood forward into the ventricles. Then, the electrical activity spreads to the ventricles, allowing them to contract and push blood to the rest of the body.”
Normally, the heart beats with a regular rhythm or a steady beat. During AF, the electrical activity causes the atria to quiver, and the ventricles don’t get regular signals to contract and pump blood throughout the body.
How it Feels to Have Atrial Fibrillation
Some people don’t feel anything. For these people AF might be discovered during a medical check-up or for 1 in 5, the first sign of AF is that they have a stroke.
For others, AF can make them feel anxious, lightheaded, weak, or extremely tired. They may also feel like their heart is racing or they are having palpitations and they will complain of shortness of breath.
People often see their healthcare provider because they have symptoms of fatigue, shortness of breath at rest or activity, decreased exercise capacity, or chest pain.
What increases the chance of having AF?
AF is associated with hypertension (high blood pressure) and congenital heart disease. A study published in the International Journal of Heart & Vasculature found that 1 in 10 patients hospitalized with COVID-19 had newly developed AF.
AF may also occur with chronic alcohol ingestion or binge drinking, increased caffeine intake, and increased sympathetic activity. Occasionally, it’s familial and has a genetic link.
How to Gain Control
AF treatment generally involves three goals:
- anticoagulation (blood thinners) to prevent thromboembolism (clots)
- rate control to manage the ventricular rate
- rhythm conversion to restore normal sinus rhythm
The main goal of treatment, whether controlling the rate or the rhythm, is to increase cardiac output and reduce symptoms, as well as reducing the frequency and duration of AF episodes.
Sometimes if the treatment does not result in a normal rhythm, your doctor may recommend an ablation. Ablation is a surgical procedure that uses radio frequency to burn or freeze small sections of your heart muscle. The scars from the ablation help interrupt or block the electrical signals that cause the heart to beat irregularly, helping the heart return to a normal rhythm.
Much more remains to be learned about the causes of AF, and the ideal treatment approach remains elusive. However, evidence-based guidelines are available and your healthcare provider can provide strategies for reducing complications and improving function and quality of life.