By Mark P. Abrams, MD, Cardiac Electrophysiology, CareMount Medical
June 29, 2021
In medicine, AFib is not an exaggeration of the truth. Rather, it is an abbreviation for atrial fibrillation, the most common type of arrhythmia – or abnormal heart rhythm. AFib results from disorganization of the heart’s electricity that can cause an irregular heartbeat.
Electrical signals sent between the chambers of the heart, through its conduction system, tell each part when and how to beat. Normally, the top chambers of the heart – or atria – beat first, initiated by an impulse that starts in a small area of the right atrium. Then, the bottom chambers – or ventricles, pump blood out to the body. Think of the heart’s conduction system as an electrical highway that allows the signals to efficiently go where they need to, and stay organized. AFib results when abnormal areas of the atria all try to beat at once. This overloads the electrical highway and results in an irregular, disorganized, and often fast heartbeat. When this happens, the ventricles do the best they can to keep up, but instead, they pump irregularly and often very fast, preventing blood from being pumped as well as it should. This leads to a higher risk of blood clots, stroke, heart failure, other cardiac complications, and even death.
Symptoms of AFib include palpitations, fluttering or thumping in the chest, heart racing, and dizziness or passing out if the pumping function of the heart is affected. Since the irregular rhythm makes it hard for blood to flow effectively, the slow flow can make the heart prone to form blood clots. When these blood clots occasionally break off, they can be pumped out of the heart and clog a blood vessel meant to supply oxygen to various parts of the body. If this occurs in the brain, that part of the brain can die – causing a stroke. Importantly, AFib is not always symptomatic. In people without obvious symptoms, AFib is only detectable upon physical examination or with monitoring the heart rhythm. In fact, having a stroke is the presenting symptom for about 23% of people with AFib. It is only when these patients have a stroke that they first learn they ever had AFib.
Some risk-factors for AFib can be modified while others cannot. Non-modifiable risk factors include advanced age, being male, underlying heart problems, history of prior heart surgery, and genetics. Modifiable risk factors include lifestyle changes such as limiting alcohol intake, prevention/treatment of obstructive sleep apnea, and good control of chronic conditions like hypertension, diabetes, asthma, obesity, and thyroid problems.
The lifetime risk of AFib is estimated to be one-in-three for people who are white and of European descent, and one-in-five for African Americans. At least 2.7 million Americans are living with AFib – yet many people are not aware the condition has serious consequences such as an estimated four- to five-fold increased risk of ischemic stroke.
Key to avoiding the long term issues caused by AFib is to catch it early. Increasingly, research is showing the sooner we treat AFib and get people back to normal rhythm, the better the results will be. For this reason, and because treatments for AFib are more effective than ever before, proper diagnosis and a personalized treatment plan with a specialist are crucial. If your primary care doctor or cardiologist suspects you have AFib, he or she may refer you to a cardiac electrophysiologist – or EP – for further evaluation. An EP can decide what the right approach might be to properly diagnose and manage AFib.
AFib treatment options include:
Medications that control the heart’s rate to keep it from beating too fast, or other medicines that work to try to normalize the heart rhythm and keep it out of AFib.
Cardioversion, to reset the heart rhythm, and convert it out of AFib back to the normal rhythm. This can be done with pills or intravenous medications, but is more commonly done with a procedure that involves sedating the patient with anesthesia and shocking the heart back into rhythm.
Ablation, a minimally invasive, catheter-based procedure performed by a cardiac electrophysiologist. This involves mapping the electricity of the parts of the heart where AFib often originates and isolating those areas using special catheters and technology. This prevents the disorganized electricity from influencing the normal heartbeat, allowing the normal rhythm to take back over. There are no incisions and patients often go home the next day. Ablation is safer, more efficient, and more effective than ever using modern technology. It often enables the elimination of some medicines and results in great patient satisfaction.
Since atrial fibrillation is a chronic disease that may wax and wane over time, patients will often use a combination of these therapies in order to feel their best. Most will need to take anticoagulants – or blood thinners– in order to lower their risk of stroke from AFib in addition to continuing treatments that work to maintain good heart rhythm. Proper diagnosis and treatment of AFib can have a huge impact on quality of life. To learn more, to schedule an appointment or find a physician, just click here.