Atrial fibrillation (also called AF or A-fib) is an irregular or abnormal heartbeat (arrhythmia). In A-fib, the upper chambers of the heart (the atria) beat irregularly because the electrical signals that control the heart are not functioning properly. As a result, blood is not moved out of the upper chambers as fast as it should be and blood clots may form. Blood clots increase the risk of stroke.
There are two types of atrial fibrillation:
- Paroxysmal (or intermittent) A-fib refers to episodes that last under 24 hours and go away on their own within seven days
- Persistent A-fib, which lasts more than seven days
Atrial fibrillation often begins as paroxysmal and then progresses to persistent.
The most common causes of A-fib include heart conditions such as:
- Heart disease due to chronic high blood pressure (hypertensive heart disease)
- Heart failure
- Heart valve disease, such as mitral regurgitation or mitral stenosis
- Heart attack
- Coronary artery disease
- Complications from heart surgery and occasionally complications resulting from other types of surgery
- Congenital heart defects
Other risk factors for developing A-fib include:
- Alcohol binge drinking
- Overactive thyroid gland (hyperthyroidism)
- Sleep apnea
- Certain medications, including drugs that stimulate the heart such as theophylline
- Use of stimulants such as caffeine or nicotine
- Chronic lung diseases such as emphysema
- Chronic kidney disease (CKD)
- Viral infections
- Advanced age
- Family history of A-fib
- Supraventricular tachycardia (SVT)
What Are Symptoms of Atrial Fibrillation?
Atrial fibrillation may not always cause symptoms.
Mild symptoms of atrial fibrillation may include:
- Irregular heartbeat (arrhythmia)
- Heart palpitations
- Feeling of the heart racing
- Sensation of tightness, pain, or discomfort in the chest
- Mild shortness of breath
- Mild fatigue, especially with exercise
Severe symptoms of atrial fibrillation may include:
How Is Atrial Fibrillation Diagnosed?
A Holter or event recorder (devices worn over a day or two that monitor heart activity using an ECG recording) may be used in some cases.
Tests that may be indicated to check for other problems include:
What Is the Treatment for Atrial Fibrillation?
The goal of treatment for atrial fibrillation is to control heart rhythm and rate and to stop blood clots from forming (anticoagulation) to prevent stroke.
Treatment to control heart rhythm includes:
- Electrical cardioversion (usually a first-line treatment in young patients who have symptoms)
- Antiarrhythmic medications
- Ablation (catheter based, surgical, or hybrid) using heat (radiofrequency ablation) or cold (cryoablation)
- Surgical procedures, including the “maze procedure”
Treatment to control heart rate includes:
- Placement of a permanent pacemaker (used when other rate and rhythm control alternatives have not been successful)
Anticoagulation treatments include:
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