Atrial fibrillation symptoms vary from person to person but commonly include heart palpitations or chest discomfort. Illustration by The Epoch Times, Shutterstock
Affecting approximately 10 million people in the United States, atrial fibrillation is the most common type of irregular heart rhythm.
By: Allison DeMajistre
Atrial fibrillation, often referred to as “A-fib,” is an electrical disorder in the heart’s upper chambers that causes an abnormal heart rhythm (arrhythmia) and disrupts the normal flow of blood between the upper and lower chambers. Left untreated, A-fib can lead to serious complications, including blood clots, stroke, and heart failure.
A-fib is the most common irregular heart rhythm, leading to 450,000 hospitalizations each year. Recent studies estimate that it affects approximately 10 million people in the United States—about 5 percent of the population—and that number is expected to exceed 12 million by 2030.
What Are the Symptoms of Atrial Fibrillation?
A-fib symptoms vary from person to person. Common symptoms include:
Heart palpitations (rapid, fluttering, or pounding heartbeat)
Low energy or fatigue
Shortness of breath
Trouble exercising or performing everyday activities
Lightheadedness or dizziness
Fainting
Low blood pressure
Fluid buildup in the legs, ankles, or feet
Blood clots
Chest discomfort, pain, or tightness
Some people recognize the occurrence of A-fib by experiencing noticeable heart palpitations, while others have no symptoms and only learn of the condition through a physical examination.
What Causes Atrial Fibrillation?
To understand what causes A-fib, it helps to understand the heart’s electrical system and how a normal heartbeat is triggered.
The heart has four chambers: two upper chambers, called the atria, and two lower chambers, called the ventricles. Electrical impulses travel along a pathway in the heart, signaling the atria and ventricles to work harmoniously to pump blood through the heart and into the body.
In a healthy heart, a heartbeat begins with an electrical impulse to a tiny bundle of tissue in the right atrium called the sinoatrial (SA) node. This electrical impulse causes both atria to contract and pump blood down to the ventricles. The electrical current continues to travel through another bundle of tissue called the atrioventricular (AV) node, triggering the ventricles to contract and then relax in a steady rhythm.
In A-fib, the electrical signals in the atria become disorganized, causing the upper chambers to quiver or fibrillate. These chaotic signals continue to flood the AV node as they try to reach the ventricles, resulting in a rapid and irregular heart rhythm.
Several factors can cause these electrical signals to become erratic, but the problem usually stems from damage to the heart tissue caused by structural problems.
Medical Conditions
Congenital heart defect: Structural abnormalities that affect the heart’s electrical system
Heart valve disease: Leaking (regurgitation) or stenotic (narrowed) heart valves that enlarge heart chambers and interfere with electrical impulses
Coronary artery disease: Restricted blood supply to the heart, leading to tissue damage and electrical instability
Sleep apnea: Disrupted breathing patterns during sleep that strain the heart muscle and affect electrical pathways
Sinus node dysfunction: Malfunctioning of the sinus node, a natural pacemaker, that causes the heart’s upper chamber or atria to twitch rather than contract normally
Health Problems
Heart attack
High blood pressure
Overactive thyroid (hyperthyroidism)
Lung infections, such as pneumonia
Viral infections
Lifestyle Factors
Using illegal drugs
Drinking excessive alcohol or caffeine
Smoking
Taking stimulant-containing cold and allergy medications
What Are the Types of Atrial Fibrillation?
A-fib is often a progressive disease. It may start with heart palpitations with an irregular rhythm and as the condition progresses, episodes become more frequent, last longer, and often become permanent. The length of the episodes determines the classification of A-fib.
Paroxysmal A-fib
Also known as intermittent A-fib, paroxysmal atrial fibrillation (PAF) occurs when an irregular rhythm resolves within seven days of onset. According to a 2001 study published in the National Library of Medicine, PAF is estimated to account for anywhere from 25 percent to 62 percent of A-fib cases.
The wide range exists because many episodes are asymptomatic, meaning people may not realize they are in A-fib. Over time, PAF often progresses to persistent or permanent A-fib.
Persistent A-fib
When A-fib lasts more than seven days, it is classified as persistent and is the most common type of A-fib.
Like PAF, persistent A-fib may be asymptomatic and often develops as a progression from PAF. However, unlike PAF, persistent A-fib doesn’t resolve on its own and needs treatment to return to a normal rhythm.
Long-Standing Persistent A-fib
A-fib lasting longer than 12 months is classified as long-standing persistent.
Medication, a procedure, or both are needed to correct the irregular rhythm.
Permanent A-fib
When A-fib persists despite medication or surgical intervention, it is classified as permanent.
At this stage, treatment focuses on controlling the heart rate and symptoms rather than attempting to correct the rhythm.
What Are the Stages of Atrial Fibrillation?
There are four stages of A-fib. Understanding these stages can help people take steps to slow or prevent progression.
Stage 1: At Risk for A-fib Risk factors such as lifestyle, weight, and diabetes may be controllable, while others, such as age or genetics, are not.
Stage 2: Pre-A-fib The heart shows early signs of electrical changes that could lead to A-fib. Treatment and closer monitoring begin to prevent progression.
Stage 3: Diagnosed A-fib A formal diagnosis is made. Treatment focuses on controlling heart rate and rhythm with medications, procedures, or both. Stroke risk increases, so blood thinners may be recommended.
Stage 4: Permanent A-fib A-fib persists despite treatment. Management focuses on symptom control and regular stroke risk assessment.
Who Is at Risk for Atrial Fibrillation?
Anyone can develop atrial fibrillation, but certain factors significantly increase the risk.
Age: A-fib becomes more common with age, affecting about 70 percent of people with irregular heart rhythms between 65 and 85.
Family history: Certain genetic mutations can increase the likelihood of developing A-fib.
Medical conditions: Heart, lung, and sleep disorders can contribute to irregular heart rhythms.
Race: A-fib is more common in white people of European descent.
Stress or panic disorders: Chronic stress or anxiety can trigger irregular heartbeats.
Unhealthy habits: Smoking, excessive alcohol consumption, and illegal drug use can strain the heart and increase A-fib risk.
Obesity: Excess weight puts added stress on the heart and may contribute to electrical disturbances.
Surgical procedures: Surgeries involving the heart, lungs, or esophagus can affect heart rhythm.
Chronic kidney disease: Reduced kidney function is linked to a higher risk of A-fib.
Heart valve disease: Leaking or narrowed heart valves can lead to irregular heart rhythms.
High blood pressure: Increased pressure forces the heart to work harder, which can contribute to A-fib.
Diabetes: High blood sugar levels can damage blood vessels and increase A-fib risk.
Hyperthyroidism: An overactive thyroid can overstimulate the heart, leading to irregular rhythms.
Sleep apnea: Interrupted breathing during sleep can strain the heart and affect its electrical system.
Chronic obstructive pulmonary disease (COPD): Lung disease can lead to reduced oxygen levels and increased heart strain.
How Is Atrial Fibrillation Diagnosed?
Doctors typically begin by reviewing a person’s medical history and performing a physical exam, which may reveal an irregular heartbeat.
Since A-fib can come and go depending on which type and stage a person has, catching the irregular rhythm during an evaluation can be challenging. Several tests may be required to confirm a diagnosis, depending on the type and stage of A-fib.
Basic Diagnostic Tests
Electrocardiogram (EKG): Records the heart’s electrical activity and can detect A-fib if it occurs during the test
Holter monitor: A portable EKG worn for days or weeks to catch irregular heart rhythms that occur intermittently.
Loop recorder: A small implanted device that continuously tracks heart rhythm over months or years
Imaging Tests:
Echocardiogram: An ultrasound of the heart that evaluates chamber size, pumping function, and possible blood clots
Chest X-ray: Helps detect an enlarged heart or fluid buildup in the lungs
Cardiac magnetic resonance imaging: Produces detailed images of the heart’s structure and function to assess abnormalities
Other Assessments:
Blood tests: Measures thyroid function and checks for other conditions that may contribute to A-fib
Sleep study: Identifies sleep apnea, a common trigger for A-fib
Exercise stress test: Evaluates how the heart responds to physical activity and detects abnormalities that may not appear at rest
What Are the Possible Complications of Atrial Fibrillation?
According to the American Heart Association, A-fib increases the risk of serious medical problems and life-threatening complications—even in people without symptoms.
Stroke
The erratic electrical signal in A-fib causes the heart’s upper chambers to quiver instead of contracting properly. This prevents blood from moving forward efficiently, causing it to pool inside the heart. When blood is not moving freely, it can form clots. If a clot travels through the bloodstream and blocks a small artery in the brain, it can cause a stroke.
Stroke is the most serious complication of A-fib. Also, strokes related to A-fib are twice as fatal and more debilitating than those unrelated to the condition.
Heart Failure
Heart failure occurs when the heart weakens and cannot pump enough blood to meet the body’s needs. In A-fib, the heart beats so quickly and irregularly that it can’t fill appropriately between beats, reducing the amount of blood pumped with each contraction. This can lead to blood backing up into the lungs, causing shortness of breath, swelling in the feet and ankles, and fluid-related weight gain.
Dementia
A 2018 study published in the Journal of the American Heart Association found that A-fib was linked to an increased risk of dementia and cognitive decline. A-fib can also cause recurrent silent strokes—small, undetected strokes that don’t have overt symptoms but contribute to gradual brain function deterioration.
What Are the Treatments for Atrial Fibrillation?
Treatment for A-fib depends on symptoms, how long the heart has been in an irregular rhythm, and underlying health conditions. Medications, procedures, or a combination of both may be implemented.
The primary treatment goals are to:
Medications are an essential part of A-fib treatment and may need to be taken for life.
Rate control medications: Slow the heart rate and prevent the heart muscle from weakening. Examples include: beta-blockers such as metoprolol and atenolol
Rhythm control medications: Also called anti-arrhythmic drugs, these help maintain a regular heart rhythm
Blood thinners: Also called anticoagulants, help prevent blood clots and reduce the risk of stroke
More Invasive Procedures
If medications do not effectively control A-fib, procedures may be necessary to restore a normal heart rate and rhythm.
Electrical cardioversion: A procedure that involves using a controlled electrical shock through a defibrillator to reset the heart’s rhythm. If A-fib is severe, cardioversion may be performed immediately. Otherwise, doctors usually wait three to four weeks after starting blood thinners to reduce the risk of stroke from potential clots. Blood thinners are continued for at least four weeks after the procedure.
Catheter ablation: A minimally invasive procedure in which a doctor inserts a thin, flexible tube (catheter) into a blood vessel in the groin and guides it into the heart. Heat or cold energy is used to create small scars in the heart tissue, disrupt the irregular electrical pathways in the heart, and help restore a normal rhythm. Catheter ablation can sometimes cure A-fib altogether.
Maze Procedure: Performed during open-heart surgery, this procedure involves creating scar tissue in the heart using a scalpel. The scars disrupt abnormal electrical signals. Many people planning a coronary bypass or heart valve surgery also receive a Maze procedure.
Left atrial appendage closure: A procedure that seals off a small sac in the heart’s upper left chamber where blood clots often form. A closure device is advanced through a catheter to the left atrial appendage, where it remains permanently.
How Does Mindset Affect Atrial Fibrillation?
Mental stress, exhaustion, and negative emotions are all risk factors for A-fib. Researchers believe this is due to the strong interplay between the heart and brain—particularly when emotions like stress, depression, and anger are present.
These negative emotions have been shown to cause heart arrhythmia like A-fib, and studies also suggest that simply having a diagnosis of A-fib can cause increased stress, anxiety, and even suicidal ideation.
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