Atrial Fibrillation: Symptoms, Causes, and Treatment Options

Atrial fibrillation, commonly abbreviated as AFib or AF, is a cardiac disease in which the heart beats irregularly due to the abnormal electrical activity of the heart. AFib may lead to stroke, blood clots, or heart attack if left untreated.

According to the Centers for Disease Control and Prevention, around 12.1 million people in America will suffer from atrial fibrillation by 2030. Currently, it affects nearly 40 million people worldwide and 6 million people in the U.S. 

Controlling high blood pressure, cholesterol, and diabetes are the essential elements to prevent atrial fibrillation. Other factors like a healthy diet, regular exercise, and avoiding excessive use of caffeine and alcohol also help prevent AFib.

In this article, we will discuss atrial fibrillation in detail, including its symptoms, causes, treatment, and prognosis.

What Is Atrial Fibrillation? 

Atrial fibrillation is the most prevalent type of heart arrhythmia (irregular or fast heartbeats or rhythm). 

As the name indicates, atrial fibrillation is the irregular heart rhythm that occurs in the atrium. As a result, the atria beat irregularly or abnormally fast.

The atria or atrium is the upper chamber of the heart that receives blood from the rest of the body to the heart.

Due to abnormal electrical conduction in the heart, the heart rate may be higher than 100 beats per minute in patients with AFib, while a normal heart rate is around 60 to 100 beats per minute at rest.

Types of Atrial Fibrillation 

There are four common types of AFib, depending on the extent and duration of the disease:

Paroxysmal Atrial Fibrillation 

Paroxysmal atrial fibrillation is a type of AFib that is usually brief, occurs occasionally, and stops automatically typically within 24 hours (although it may last up to 7 days in some cases). 

The episodes of AFib may last for a few seconds, minutes, hours, or days before returning to normal. It commonly occurs without any symptoms.

Persistent Atrial Fibrillation 

Persistent AFib lasts for more than 7 days and requires treatment for the heart rate to return to normal. In this type of AFib, the patient is given electric shocks to restore the heart rhythm.

Long-Standing Persistent Atrial Fibrillation 

This type of AFib is like persistent atrial fibrillation but occurs for more than a year.

Permanent Atrial Fibrillation 

This is a chronic type of AFib that doesn’t restore after treatments like medications, surgery, or electric shocks. It is also the progression of untreated paroxysmal or persistent atrial fibrillation.

Symptoms 

The common symptoms of AFib include:

• Difficulty breathing 
• Fatigue 
• Chest pain
• Fast or pounding heartbeat (palpitations)
• Dizziness 
• Discomfort in the jaw, neck, back, or one or both arms.
• Sweating 
• Sleep apnea
• Anxiety 
• Fainting 
• Lightheadedness
• Nausea 

Causes 

The three common causes of AFib include:

• Heart diseases, like coronary artery disease, heart valve disease, heart attack, or high blood pressure.
• Chronic health conditions, like obstructive sleep apnea, lung disease, or thyroid disease.
• Abnormality in the structure of the heart, for example, sick sinus syndrome or heart disease present at birth (congenital heart defect). 

Some lifestyle factors may also lead to atrial fibrillation, for example: 

• Excessive consumption of tobacco, alcohol, or caffeine
• Smoking 
• Stress
• Illegal drugs
• Aging 
• Obesity
• Genetics (family history)

Prognosis 

The prognosis of atrial fibrillation depends on various factors, like:

• Age
• Disease history 
• Type and duration of atrial fibrillation 
• Severity of AFib and complications from AFib
• Quality of treatment the patient is receiving 

The mortality or survival rate of AFib is not affected directly by the disease, but from other complications that arise because of AFib, like stroke, heart disease, or heart failure. 

On average, AFib may decrease a person’s life expectancy by up to two years, particularly if not treated or optimally managed with proper medication. A study showed that patients hospitalized with atrial fibrillation who suffered from complications, such as stroke and heart failure, had an average loss in life expectancy of 2.6 years with high mortality rates.

Diagnosis 

The diagnosis of atrial fibrillation includes checking the patient’s heart rhythm and heart rate through the following methods: 

• A physical examination 
• ECG (electrocardiogram) 

Further diagnostic tests to assess the cause of AFib may be done through the following:

Blood Test 

A blood test helps determine the cause of atrial fibrillation. For example, checking the levels of thyroid hormone and electrolyte imbalance (such as abnormal potassium levels) through blood tests helps identify if AFib may be present due to hyperthyroidism or dysfunction of the kidneys. 

Cardiac MRI 

A cardiac MRI gives a complete picture of the upper chambers of the heart (the atria). It helps evaluate the structure of the atria and how well it’s functioning.

Echocardiography 

Echocardiography is an ultrasound of the heart that shows the chamber size, heart valves, and how the heart is pumping.

It also reveals previous injuries of the heart, blood clots, parts of the heart muscles that are pumping improperly, and heart valve diseases. 

Portable Monitors 

Some portable monitors are also available that help patients check the electrical activity of their heart during normal day-to-day activities and identify any abnormal heart rhythm. This may be particularly important to check if a patient may have paroxysmal AFib.

Examples include a Holter monitor, implantable monitor, and event monitor.

Common Risk Factors of Atrial Fibrillation 

The common risk factors of atrial fibrillation include:

• Age above 50 years
• Obesity 
• Being Male 
• Stress
• Alcohol use
• Heart diseases 
• Thyroid disease 
• Sleep apnea
• Hypertension 

Treatments  

The treatment of AFib depends on factors such as: 

• The cause of AFib
• The symptoms of the disease 
• The patient’s age
• The duration of the disease 
• The risk of other complications, like stroke or heart failure

Some of the treatments for AFib are:

1. Medications 

If the patient has an increased risk of stroke in atrial fibrillation, medications like anticoagulants may be prescribed to prevent blood clots and reduce the risk of stroke.

Similarly, if the patient with AFib has an increased heart rate or high blood pressure, medications to lower heart rate and heart rhythm will be prescribed, like antiarrhythmic drugs, beta-blockers, digoxin, or calcium channel blockers.

2. Surgery or Cardiac Ablation 

Surgical procedures are commonly done when medications are ineffective in treating AFib.  

Common surgical procedures for treating atrial fibrillation include:

• Pacemaker: This is a device that is implanted under the skin to regulate and control irregular heartbeat. This is particularly important in patients where the heart rate continues to be poorly controlled despite medications.
• Cardiac Ablation: Cardiac ablation is a minimally invasive procedure that inserts a thin tube inside the heart and uses cold energy or heat to break electrical signals that cause irregular heartbeats.

3. Cardioversion 

There are two types of cardioversion: electric and drug cardioversion. In electrical cardioversion, electric shocks are given to the patient’s chest through patches or paddles. 

In cardioversion with drugs, the patient is given antiarrhythmic drugs through intravenous injection or pills, and the heart condition is continuously monitored by cardiologists.