The Centers for Disease Control and Prevention (CDC) estimate that between 2.7 and 6.1 million people currently have A-fib.
Age is a key risk factor for developing the disorder. According to the CDC, 9 percent of people over the age of 65 years have A-fib in the U.S., but only two percent under 65 years have it.
The heartbeat usually starts from one spot in the right atrium, the upper-right chamber of the heart. However, people with A-Fib have a heartbeat that triggers from multiple spots, which means both atria and the ventricles, or lower chambers, beat at their own pace.
The arrhythmia may or may not produce symptoms. Recognizing and treating A-Fib early in its development can greatly improve the chances of avoiding complications.
Symptoms
A-Fib may not cause any symptoms at all, and, when there are symptoms, they may only occur intermittently.
Often the heart rate is higher than usual with AFib, but this depends on how many signals get from the atria to the ventricle.
Common symptoms include:
- palpitations, or the feeling of an irregular heartbeat
- breathlessness, particularly when lying flat
- chest pain or pressure
- low blood pressure
- dizziness, light-headedness, and fainting
People who do not have symptoms will not be aware of A-fib, so it goes untreated. The first sign of A-fib might be a complication, such as a stroke or heart failure.
Keep a close eye on the symptoms and when they occur or change in severity. Make a note of them for your doctor. This will help them make the diagnosis and decide on the best treatment.
Hypertension: Long-term high blood pressure can add strain to the heart and increase the risk of A-fib
Pulmonary embolism: A blood clot in the lung increases the risk of A-fib.
Heart disease: People with the following conditions have a higher risk of A-fib:
- heart valve disease
- heart failure
- coronary artery disease
- previous heart attack
Excessive alcohol consumption: Men who have more than two drink a day and women who have more than one drink daily are at increased risk of A-fib .
Family members with AFib: A family history of the disease increases the risk of getting it.
Other chronic conditions: Other long-term medical problems, including thyroid problems, asthma, diabetes, and obesity, may contribute to the risk of AFib.
Sleep apnea: People with this condition, especially when it is severe, have a higher risk of developing AFib.
Surgery: A-fib commonly occurs directly after receiving heart surgery.
These medications include:
- warfarin
- direct-acting oral anticoagulants (DOACs), including rivaroxaban, apixaban, and edoxaban
Elderly people with an increased risk of falling often use aspirin but also have a high risk of forming a clot. Aspirin reduces clotting factor but not to the same extent as other medications, so any bleeding is easier to manage.
People taking warfarin or other anti-clotting agents should advise any medical professional treating them of their current medications, especially if they will be having a procedure or surgery or have been in an accident.
While taking anticoagulants, make sure the doctor knows about any planned or existing pregnancy or any signs of bleeding, such as:
- very large bruises
- nausea and light-headedness
- vomiting blood
- coughing up blood
- unusually heavy menstrual flow
- gums that bleed regularly
- bloody or black stool
- blood in the urine
- sudden back pain that is very severe
Take blood thinners exactly as the doctor advises for the best chance of preventing a clotting-related complication and avoiding excessive thinning of the blood.
Managing heart rate
If the heart rate is high, bringing it down is important to avoid heart failure and reduce the symptoms of A-Fib.
Several medications can help by slowing conduction of the signals that tell the heart to beat.
These include:
- beta-blockers, such as propranolol, timolol, and atenolol
- calcium-channel blockers, such as diltiazem and verapamil
- digoxin
Normalizing heart rhythm
Instead of putting a person on blood thinners and heart rate-controlling medicine, doctors may try to return the heart rhythm to normal using medication.
This is called chemical or pharmacologic cardioversion.
Medications called sodium channel blockers, such as flecainide and quinidine, and potassium channel blockers, such as amiodarone and sotalol, are examples of medications that help to convert A-fib to regular heart rhythm.
Procedures
When a person does not tolerate A-fib medication needed for someone who has an irregular heart rhythm or doesn’t respond to pharmacologic cardioversion, surgical and non-surgical procedures can be used to control the heart rate or try to convert to a regular rhythm to help prevent complications from A-fib.
Options for converting A-fib to a regular rhythm include:
Electrical cardioversion: The surgeon delivers an electric shock to the heart, which briefly resets the abnormal rhythm to a regular beat. Before carrying out cardioversion, they will often perform an echocardiogram by inserting a scope down the throat to produce an image of the heart to make sure no clots are present in the heart.
If they find a clot, a doctor will prescribe anticoagulant medication for several weeks to dissolve it. Cardioversion will then be possible.
Catheter ablation: This destroys the tissue that is causing the irregular rhythm, returning the heart to a regular rhythm. The surgeon may need to repeat this procedure if the A-fib returns.
The surgeon sometimes destroys the area in which the signals travel between the atria and ventricles. This stops the A-fib, but the heart can no longer send a signal to orchestrate a beat. In these instances, the surgeon will then fit a pacemaker.
Surgical ablation: The heart tissue that is causing the irregular rhythm can also be removed in an open-heart surgery called a maze procedure. A surgeon will often carry out this procedure alongside a heart repair.
Pacemaker placement: This device instructs the heart to beat regularly. A surgeon will sometimes place a pacemaker in a person with intermittent A-fib that only occurs intermittently.
When a doctor feels that another condition is responsible for the A-fib, such as hyperthyroidism or sleep apnea, they will treat the underlying condition alongside the arrhythmia.
Takeaway
A-fib is a disorder that causes an irregular heart rhythm.
It occurs more often after the age of 65 years and may or may not cause symptoms. The condition can lead to a stroke when blood pools in the heart and forms a clot that travels to the brain.
Lifestyle adjustments that can help to prevent A-fib include a heart-healthy diet, limiting alcohol intake, not smoking, and getting regular exercise.
There are two treatment options. A doctor might allow an irregular rhythm to continue but control the heart rate and prescribe an anticoagulant to help prevent a stroke. Alternatively, the doctor might try to convert the irregular rhythm back to a regular one with medication or a procedure.
Q:
If A-Fib does not show symptoms, how can I take steps to stop it before it causes complications?
A:
The first step is recognizing you have it. Without symptoms, you won’t know you have A-fib unless your doctor finds it while listening to your heart during an examination or while testing for a different health issue.
Increase the odds of finding A-fib by regularly visiting your doctor for ongoing or preventative care.
Once you have AFib, unless it stops spontaneously on its own, the only way to avoid complications is through appropriate treatment.
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