Atrial fibrillation, or Afib, is the most common heart rhythm condition in the United States. An estimated three million people in the U.S. and 20 million worldwide are affected by Afib and its prevalence is projected to increase significantly as the population ages. Afib causes the upper chambers of the heart, or atria, to beat rapidly and in an uncontrolled manner. This irregular beating of the heart affects blood flow and some patients experience a "fluttering" feeling in the chest. The condition can have a significant negative impact on an individual's quality of life in terms of physical, psychological, emotional, and social functioning.
Afib is a progressive disease and may increase in severity and frequency if left untreated and can lead to chronic fatigue, congestive heart failure or stroke. Patients with Afib face a five times increased risk for stroke.
Types of Atrial Fibrillation Afib is classified according to how often the episodes occur and how quickly they terminate.
There are three main classifications:
Paroxysmal (Intermittent)
Irregular heart rhythm episodes that reoccur two or more times and stops on its own within seven days. The heartbeat often normalizes as quickly as within a few seconds or after a few hours.
Persistent
Irregular heart rhythm episodes that last more than seven days, or last less than seven days but necessitates medical therapy or a procedure to restore a normal heart rhythm (cardioversion). Cardioversion is most often done by sending electric shocks to the heart through electrodes placed on the chest.
Longstanding Persistent
Irregular heart rhythm episodes that continue for more than a year. The heart is in a constant state of Afib and the condition is considered permanent.
Symptoms of Afib can range from a heightened awareness of a rapid heart rate to severe chest pain and fainting. Other symptoms may include:
- Anxiety
- Rapid or irregular heartbeat
- Weakness
- Difficulty exercising
- Sweating
- Shortness of breath
- Lightheadedness/dizziness
- Chronic fatigue
- Debilitating pain
The appropriate treatment will depend on the underlying cause and type of Afib, existing symptoms and the patient’s level of disability. It is important to seek medical attention for Afib as it is a progressive disease and may increase in severity and frequency the longer the disease is left untreated..
Treatment options for Afib may include:
Catheter Ablation
During this minimally invasive procedure, doctors insert a therapeutic catheter through a small incision in the groin where it is then weaved up to the heart through a blood vessel. Once it reaches the left upper chamber of the heart (atrium), a small lesion is created to block faulty electrical impulses that can cause heart rhythm disorders.
Electrical Cardioversion
This therapy involves sending electric shocks to the heart through electrodes placed on the outside of the chest wall. This procedure temporarily stops the heart’s abnormal electrical activity and helps normalize the irregular heartbeat.
Medical Management
Anti-arrhythmic drugs, or "rhythm control" medications, are often a first course of action in managing Afib. In addition, patients are also prescribed anticoagulants, or blood thinners, to help manage the increased risk of stroke they face. Medications help patients manage abnormal heart rhythms but they must be taken daily and indefinitely.
Pacemaker
A pacemaker is a small device that emits electrical impulses to try to maintain a steady rhythm in the heart. Newer pacemakers can monitor blood temperature, breathing rate, and can adjust heart rate to changes in activity. The device is implanted under the skin near the collarbone and wires connected to the device are placed on the heart.
Current treatment guidelines for the management of Afib recommend medical management as the first line treatment for Afib. Visit with your physician to determine the best treatment options for you.
Dr. Colby Halsey is a cardiac electrophysiologist at CHI St. Alexius Health Heart & Lung Clinic. He is board certified by the American Board of Internal Medicine in the sub-specialty of cardiovascular disease and electrophysiology. He has special training in catheter ablation of heart arrhythmias, sudden cardiac death, atrial fibrillation management, ventricular tachycardia/fibrillation management, and cardiac device implantation and extraction.