Atrial Fibrillation (AFib or AF)

Types of atrial fibrillation

There are different types of AFib including:

• Paroxysmal fibrillation — heart rhythm returns to normal without treatment.
• Persistent AFib — lasts more than 7 days, normal heart rhythm may returns without treatment or treatment may be required.
• Long-standing AFib — lasts longer than 12 months, may be resolved with treatment.
• Permanent AFib — heart rhythm cannot be corrected with treatment and does not resolve over time, also called chronic AFib.
• Valvular AFib — caused by heart valve issues, like stenosis or regurgitation.
• Nonvalvular AFib — not caused by heart valve issues.

Causes of atrial fibrillation

AFib occurs when the heart’s electrical system is damaged. Damage can be caused by:

• Overactive thyroid
• Alcohol use
• Pneumonia
• Heart valve diseases
• Congenital heart defects
• Heart attacks
• High blood pressure

Risk factors for atrial fibrillation

You are also more likely to develop AFib if you are over 60 years old and have a heart condition such as:

• Diabetes
• High blood pressure
• Coronary artery disease
• Cardiomyopathy
• Congestive heart failure
• Pericardial inflammation
• Structural heart disease

Symptoms for atrial fibrillation

Some patients with AFib do not experience any symptoms and may only find they have the condition in a physical exam. If you do experience symptoms of AFib, fluttering heartbeat is the most common symptom.

Other symptoms of AF include:

• Irregular heartbeat
• Dizziness or fainting
• Shortness of breath
• Anxiety
• Tiredness or fatigue
• Chest pain
• Feeling confused or trouble concentrating

Diagnosis for atrial fibrillation

Atrial fibrillation can be diagnosed in a physical exam with your cardiologist. The physician will ask you about your medical history and order diagnostic tests such as:

• Electrocardiogram (ECG or EKG) — can detect abnormal heart rhythms.
• Holter monitor — portable ECG that can record the electrical rhythms of the heart over a short period of time.
• Mobile cardiac monitoring — can records your heart rhythms for up to 30 days.
• Event monitor — portable ECG that tracks heart rhythms at the time when the patient feels the symptoms.
• Echocardiogram — diagnostic test that uses sound waves to produce images of the heart.
• Transthoracic echocardiogram (TTE) — takes images of the heart to see how well the heart is working, how large it is and how well the heart valves are working.
• Transesophageal echocardiogram (TEE) — takes a detailed picture of the back of the heart. Images are taken from the esophagus to get the closest image possible.
• CT (computed tomography) or MRI (magnetic resonance imaging) — takes detailed images of the heart and lungs.

Treatment of atrial fibrillation

AFib treatment can range from medication for mild cases to surgical ablation for more severe cases. Your doctor will evaluate your case and determine which treatment is most appropriate for you.

Goals of treatment are to normalize the heart rhythm, prevent blood from clotting and decrease stroke risk.

If an underlying condition is causing the atrial fibrillation, your doctor will treat that at the same time he or she treats your AFib.

Medications used to treat atrial fibrillation

• Heart rate controlling medications like beta blockers, calcium channel blockers and digoxin.
• Heart rhythm controlling medications like sodium channel blockers and potassium channel blockers
• Blood clot preventing medications like anticoagulants and antiplatelets

Nonsurgical treatments for atrial fibrillation

• Electrical cardioversion — a procedure where the heart is shocked in an effort to reset the heart to normal rhythm.
• Radiofrequency ablation (catheter ablation) — a procedure where tiny parts of the heart that cause the abnormal beats are destroyed with heat.

Surgical treatments for atrial fibrillation

• Pacemaker — device implanted under the skin and sends out a signal to the heart to maintain heart rhythm.  
• Open-heart maze procedure — a surgeon cuts into the heart and stitches back the pieces that were to produce scar tissue to interfere with the impulses that cause AFib.