Atrial Fibrillation
Understanding Atrial Fibrillation (AFIB)
Atrial Fibrillation is the most common type of irregular heartbeat (arrhythmia).
What is Atrial Fibrillation?
AFIB is an irregular heartbeat or arrhythmia and can lead to blood clots, stroke, heart failure and other complications. There are 4 types of AFIB.
Paroxysmal
- Intermittent
- Episodes last for less than 7 days and usually are less than 48 hours
Persistent
- Recurrent episodes that last longer than a week
- May require medications or electrical cardioversion (electric shocks) to terminate
Longstanding Persistent
- Patients with persistent atrial fibrillation for longer than one year
Permanent
- Atrial fibrillation that has been present for more than one year and attempts at medical or electrical cardioversion have been unsuccessful OR
- Patients who remain in atrial fibrillation but are asymptomatic OR
- Patients who remain in atrial fibrillation and cardioversion is contraindicated
What Happens
- Upper chambers of the heart (atria) beat irregularly and extremely fast
- Not enough blood is being pumped out of the atria
- Blood pools in the atria and can clot
- If a blood clot forms there is a risk that it can be pumped out of the heart to the brain and can lead to a stroke
- Many patients do not have symptoms and do not know they are in AFIB
- AFIB is associated with an estimated fivefold increased risk for stroke
Causes and Risk Factors
Age
- Over time, structural and electrical changes occur as well as the development of other conditions that increase the risk of AFIB
- AFIB affects about 10% of patients >75 years old
Family History
Recent Cardio-thoracic Surgery (i.e. cardiac bypass)
Other Conditions
- Diabetes
- High Blood Pressure
- Thyroid Disease
- Alcohol Use
- Other cardiovascular conditions (i.e. heart failure, valvular disease, prior heart attack)
- Obesity and obstructive sleep apnea in patients <65 years old
Common Symptoms
- Dizziness or fatigue
- Palpitations (fluttering feeling)
- Chest pain
- Shortness of breath
- Loss of consciousness
Diagnosis and Treatment
How is AFIB diagnosed?
AFIB is a type of tachyarrhythmia, which is a fast and irregular heart rhythm
Initial workup includes an ECG/EKG which will show arrhythmia
Additional workup includes cardiac enzymes, electrolytes (potassium and magnesium) and an echocardiogram
Treatment Overview
There are three treatment goals:
Rate control
Rhythm control
Stroke prevention
Medications
- Generally rate control and prevention of thromboembolic events are the preferred strategy
- Rhythm control is for patients who remain symptomatic despite rate control
- Medications for rate control: beta blockers, calcium channel blockers, digoxin
- Anticoagulation (blood thinners): apixaban (eliquis), rivaroxaban (xarelto), dabigatran (pradaxa), edoxaban (Sayvasa), and warfarin (coumadin)
- Medications for rhythm control: amiodarone (most commonly used), dronedarone, dofetilide, flecainide, propafenone
Nonpharmacologic Treatments
- Electrical cardioversion: electrical shocks to acutely restore normal heart rhythm (sinus rhythm)
- Ablation: radiofrequency waves, extreme heat or extreme cold are used to destroy the tissue that is causing the problem
- Surgical management (Maze procedure): small cuts made and stitched together, creating scar tissue that blocks the electrical signals from passing through
- Watchman (left atrial appendage occlusion or closure): prevents blood clots from entering bloodstream, this procedure is for patients who cannot take blood thinners
Self-Management
Medication Management
- Take medications exactly as prescribed
- Don't skip doses
- Use a pill organizer
- Know what each medication does
- Don't stop without talking to doctor
Lifestyle Modifications
- Regular physical activity
- Heart healthy diet
- Management of cardiovascular risk factors (high blood pressure, diabetes, high cholesterol)
- Avoid excess alcohol and caffeine intake
- Treatment of sleep apnea if present