Atrial fibrillation is an irregular heart rhythm that can cause symptoms such as palpitations, shortness of breath, chest pain, fatigue, reduced exercise capacity, and dizziness. It is often first detected by a healthcare professional listening to the heart and confirmed with an electrocardiogram. Treatment options include medications, electrical cardioversion, and blood thinners to reduce the risk of stroke. Reversible risk factors such as obesity and high blood pressure should be addressed to prevent atrial fibrillation.
Atrial fibrillation is an irregular heart rhythm associated with disorganized electrical activity in the heart’s two upper chambers. Abnormal electrical impulses cause the atria to beat very quickly and in an uncoordinated way. This is called fibrillation. Paroxysmal atrial fibrillation indicates that the arrhythmia occurs at variable intervals, rather than consistently or constantly. The result of rapid, irregular beats is ineffective filling of the ventricles, the heart’s two lower chambers that pump blood around the body.
Atrial fibrillation is the most common cardiac arrhythmia. The underlying cause is often unknown, but the risk increases with age. As many as 4% of people over the age of 65 suffer from atrial fibrillation. Other risk factors include coronary heart disease, uncontrolled high blood pressure and obesity.
Some non-cardiac conditions can also cause this condition. This includes hyperthyroidism and potassium, calcium, or magnesium imbalances. In these cases, atrial fibrillation usually reverses when the underlying condition is treated.
Many of the symptoms associated with atrial fibrillation are due to the fast heart rate. A normal resting heart rate is 60-100 beats per minute. During an episode of paroxysmal atrial fibrillation, the heart can beat up to 175 times per minute. Some patients actually feel the rapid irregular beats of the heart. These are called palpitations.
Ineffective filling of the ventricles also leads to many symptoms of atrial fibrillation. Patients often experience shortness of breath and chest pain. Fatigue, reduced exercise capacity, and dizziness are also common. When atrial fibrillation is severe, confusion and fainting can occur.
Atrial fibrillation is often first detected by a healthcare professional listening to the heart. The diagnosis is then confirmed with an electrocardiogram (ECG), which detects the electrical activity of the heart. Occasionally an echocardiogram of the heart may be needed. This is a test that visualizes the heart as it beats.
For paroxysmal atrial fibrillation, episodes occur intermittently and may last only a few seconds or minutes. To confirm this diagnosis, patients can wear a portable, continuous ECG for one to two days. This is called a Holter monitor. A similar device, called an event monitor, takes ECG readings only when the patient has symptoms and presses a button. An event monitor can be worn for several months.
Due to the intermittent nature of this condition, many patients with this condition require no treatment. This is especially true if they are experiencing no symptoms. Patients are advised to minimize stress whenever possible. Over half of patients with paroxysmal atrial fibrillation list stress as the number one trigger for fibrillation episodes.
There are other steps patients can take to prevent episodes. Caffeine, alcohol, and nicotine should all be avoided, as all have been shown to be triggers. Over-the-counter cold medications such as pseudoephedrine can also precipitate episodes and should be avoided. Smoking cessation is also encouraged, as it contributes significantly to the development of heart disease. High blood pressure should be checked for the same reason.
If symptoms begin to occur more frequently, patients with paroxysmal atrial fibrillation can take medications that slow the heart rate to less than 80 beats per minute. This includes beta blockers, calcium channel blockers and digoxin. Rate control allows the ventricles more time to completely fill with blood. Note that this strategy manages symptoms but does not correct the underlying arrhythmia.
When symptoms are not managed effectively with rate control alone, patients can take medications that correct the underlying rhythm problem. Examples include sotalol, amiodarone and ibutilide. Long-term therapy has the potential to cause many side effects, so patients are screened carefully before starting antiarrhythmic drugs.
There are also non-drug treatment options for atrial fibrillation. The most commonly used is electrical cardioversion. This is a procedure that attempts to convert the abnormal rhythm into a normal one with a controlled electric current passed through the heart.
Atrial fibrillation itself is not a life-threatening condition, but there are two potentially life-threatening complications: stroke and heart failure. The risk of stroke arises from pooling of blood in the atria during fibrillation. This can cause a blood clot to form and, in some cases, break free and travel to the brain. Persistent or permanent atrial fibrillation requires treatment with blood thinners to reduce this risk.
Ineffective filling of the ventricles means that the heart is not pumping enough oxygenated blood to the body’s tissues. This is heart failure, and once it occurs, it often cannot be reversed. Educating patients about reversible risk factors, such as obesity and high blood pressure, will help prevent atrial fibrillation before it occurs.
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