ATRIAL FIBRILLATION

Under normal circumstances, the human heart pumps to a strong and steady beat – in fact, more than 100,000 heartbeats each day!

But if you have atrial fibrillation, or AFib, the heart doesn’t always beat or keep pace the way it should. Many people with AFib say they can feel their heart racing, fluttering or skipping beats.

AFib is the most common heart rhythm disorder (arrhythmia). A major concern with AFib is that it also makes blood clots in the heart that can travel and cause strokes or block flow to other critical organs.

In fact, people with this condition are 5 times more likely to have a stroke than people without the condition. It can also lead to heart failure. But finding and treating AFib early on can help you avoid these problems.

Your heart’s electrical system tells your heart when to contract and pump blood to the rest of your body. With AFib, these electrical impulses don’t work the way they should, short-circuiting in a sense. As a result, the heart beats too quickly and irregularly.

AFib is sometimes called a quivering heart. That’s because the two upper parts of the heart (called the atria) quiver. When this happens, the normal communication between the upper and lower chambers of the heart is disrupted and becomes very disorganized.

Because of this, many people with AFib feel zapped of energy fairly quickly or notice being out of breath simply walking up one flight of stairs, particularly when their heart rate is very fast. That’s because you may not be getting enough oxygen; the heart isn’t able to squeeze enough nutrient-rich blood out to the body.

AFib types are defined by how often an irregular rhythm occurs:

  • Paroxysmal: Comes and goes and generally stops on its own.
  • Persistent: Lasts more than a week. If AFib lasts more than 12 months, it is called “long-standing persistent” and can be hard to restore to normal rhythm.
  • Permanent: The heart’s normal rhythm can’t be restored.

Some cases of AFib are due to a heart valve problem.

If you have AFib, you’re not alone. It’s the most common type of irregular heartbeat, affecting more than 3 million Americans. If untreated, it can lead to blood clots, stroke and heart failure.

Because your heartbeat is out of sync, your heart has a harder time pumping blood out of the body. When this happens, blood can collect in the chambers of the heart and form blood clots. If a blood clot travels through the bloodstream to the brain, it can cause a stroke. Strokes related to AFib tend to be more severe and deadly.

Some people with AFib don’t have any symptoms. Those who do may report:

  • Heart palpitation – a thumping or racing heart, fluttering or skipping beats
  • Feeling unusually tired or fatigued
  • Unexplained shortness of breath
  • Dizziness or fainting spells
  • Chest pain (angina)

Several factors make AFib more likely:

  • Older age, although it can happen at any age
  • Conditions that place added strain on the heart including high blood pressure, a previous heart attack, heart surgery, valve disease, heart failure
  • Other illnesses such as obesity, sleep apnea or hyperthyroidism
  • Family history
  • Drinking too much alcohol (routinely having 3 or more drinks a day or binge drinking)

Episodes of AFib are often triggered by certain activities. These may include:

  • Heavy alcohol use
  • Excessive stimulants such as amphetamines and tobacco
  • Periods of severe stress
    • the stress of the body fighting infection
    • the stress of recent surgery

Pay attention to what might make your symptoms of AFib worse. Be sure to share this information with your health care team.

If you suspect you have atrial fibrillation – or when you first find out you have it – your care team will ask about your symptoms, review your medical history and perform a physical exam. Based on this information, your care team may order other tests to help plan your treatment. These tests include:

  • Electrocardiogram (ECG): Small electrodes are attached to your arms and chest to record electrical signals from your heart. This is the main way AFib is diagnosed.
  • Heart ECG monitor: A heart ECG monitor (examples include a Holter or event monitor) allows for your heart’s electrical activity to be recorded over a longer period of time (hours to weeks). It can show whether you are going in and out of AFib or whether you have a persistent form of AFib.
  • Echocardiogram: A test that uses sound waves from a device called a transducer to image your heart. It can show whether you have a problem with the structure of your heart, such as a weakened heart muscle or heart valve disease. This test can be done non-invasively over your chest. Sometimes using a device that is passed through your throat under sedation is needed to rule out blood clots in the heart.
  • Blood tests: Your care team may order blood tests to check for thyroid or kidney problems.
  • Stress test: Your care team may order a stress test to look for possible blockages in the arteries supplying your heart.
The good news is that with the right treatment, you can live a long, healthy life with AFib. But you need to be in tune with your heart and body. If untreated, atrial fibrillation can lead to blood clots, stroke and other heart-related problems, including heart failure.

Your treatment will likely depend on:

  • Your age
  • Your symptoms and how often the episodes happen
  • Whether your heart rate is under control
  • Your risk for stroke
  • Other medical conditions, including if you have heart disease

Treatment of AFib focuses on lifestyle changes and either rate control or rhythm control. Therapies to prevent stroke are also important.

Lifestyle Changes

Lifestyle changes may include:

  • Eating a heart-healthy diet full of fresh fruits and vegetables, fiber-rich foods, lean meats and fish, and unsaturated fats like olive oil
  • Limiting alcohol
  • Exercising regularly – aim to get 30 minutes of physical activity most days
  • Managing stress levels
  • Not smoking
  • Taking your medication(s) as directed and managing other conditions
  • Treating sleep apnea

In addition to lifestyle changes, treatments often include medications, procedures, or both.

Medications

Medications are used to:

  • Prevent clots from forming or to break up an existing clot
  • Restore your heart’s rate or rhythm
Rate controlling medications Heart rhythm controlling medications
  • Used to slow the heart rate during AFib
  • May relieve symptoms caused by a fast heart rate
  • Examples include:
    • Beta-blockers
    • Calcium channel blockers
    • Digoxin (brand: Lanoxin)
  • Used to return the heart to its normal rhythm and keep AFib from returning
  • May relieve symptoms caused by an irregular heart rate
  • Examples include:
    • Flecainide
    • Propafenone
    • Dronedarone
    • Sotalol
    • Dofetilide
    • Amiodarone

Medications to prevent or treat blood clots and stroke include blood thinners, also called anticoagulants, for example:

  • Warfarin (brand name: Coumadin, Jantoven)
  • Dabigatran (brand: Pradaxa)
  • Rivaroxaban (brand: Xarelto)
  • Apixaban (brand: Eliquis)
  • Edoxaban (brand: Savaysa)

Talk with your care team about which blood thinner is right for you. Keep in mind that if you take a blood thinner, you must be very cautious about falls and other accidents that might cause bleeding. There are medicines or antidotes that can reverse the blood-thinning power of warfarin, but those don’t exist yet for the newer medications.

You might also have limits on what you can eat. For example, foods like spinach, kale and other vegetables are rich in vitamin K, which can disrupt the way warfarin works. That’s why you have to be careful to eat the same amount every day if you take warfarin. You also need to have your blood checked often when taking this medicine (called your INR/PT).

If you have major bleeding on a blood thinner, your care team may talk with you about a procedure that closes the left atrial appendage – a common location for clots in patients with atrial fibrillation.

Procedures

Your treatment may also involve medical procedures such as:

  • Cardioversion – low-voltage electrical shock is applied to the chest with paddles to restore a normal rhythm
  • Ablation – a tube is inserted into a vein in the leg and threaded to the heart to fix the faulty electrical signals
  • Surgical maze – small scar lines are made on the heart to create a “maze” that prevents or redirects the abnormal beats from controlling the heart. This is done through open-heart surgery.
  • Pacemaker – an implantable device that prevents your heart rate from beating too slowly. This is used if your medications are causing too slow of a heart rate, or if an ablation is done to prevent your heart rate from going fast.
Living with AFib can affect many different aspects of your life, including your stamina, relationships and emotional health. But taking an active role in your care can help you feel better and more in control.

Common AFib Triggers
Certain things can trigger atrial fibrillation and acute episodes in people who already have it. For example:

  • Infections
  • Heart failure
  • Drinking too much alcohol
  • Skipping doses of medications aimed to control AFib
  • Smoking or taking stimulants

If you’ve been told you have atrial fibrillation, it can be helpful to write down a list of questions to ask your heart doctor during your next visit. These questions can help make sure that you and your doctor talk about your major risk factors so that you can become or stay as healthy as possible. Some questions might include:

  • Are there any foods I should avoid because of atrial fibrillation?
  • What is causing my atrial fibrillation?
  • What type of atrial fibrillation do I have (e.g., paroxysmal, persistent, permanent)?
  • What kind of activities can I perform and what should I avoid?
  • What exercise program is best for me?
  • Is my atrial fibrillation hereditary?
  • Has my heart been weakened by the atrial fibrillation?
  • What medicines should I take to control my heart rate?
  • What medicines can I take to control my heart rhythm?
  • What is my risk of having a stroke?
  • What can I do to lower my chance of having a heart attack or a stroke?
  • If my heart returns to the normal rhythm, can I stop my blood thinners?
  • Are there things that might trigger episodes of AFib?
  • Should I have a procedure to restore a normal heartbeat?
  • Do I need blood thinners to avoid a stroke? What kind (e.g., aspirin, warfarin, dabigatran, rivaroxaban)?
  • Will I still feel symptoms even if I am taking medicines for atrial fibrillation?
  • If I take a medicine or have a procedure, what are the odds that it will work?
  • The shock treatment (cardioversion) returned my heart to the normal rhythm but the atrial fibrillation is back. Is there anything I can do?
  • My heartbeat is no longer fast but I still feel tired and short of breath. Is there a next step?

VISUAL AIDS

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Atrial Fibrillation explained

How does Warfarin work

The 50 year quest to replace Warfarin

How do novel oral anticoagulants (NOACs) work

In Dr Salahaddin Ubaid I had a medical genius who also contributed significantly to aiding me overcome all of the negative worries and emotions I was feeling. The care he provided to me, his attention to detail, his personal knowledge, expertise, experience and skills was outstanding.

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