Atrial Fibrillation Explained

Atrial fibrillation is a common condition that stems from an electrical disturbance in the upper chambers of the heart and leads to a rapid, unsteady heartbeat. While it is fully treatable, it can be a signal of more dangerous underlying conditions – and should be examined thoroughly.

Patients who experience atrial fibrillation usually feel a rapid and irregular pounding in the chest sometimes associated with shortness of breath, chest discomfort or dizziness. These symptoms can range from severe to moderate; some patients may not feel any symptoms at all.

When we see patients with atrial fibrillation, we have three jobs. The first is to make sure the heart rate is not too fast. If it is, we use medications to control the rate, such as beta blockers (metoprolol, atenolol or propanolol), calcium blockers (cardizem, diltiazem or verapamil), or digitalis (digoxin). If a person is unstable and has severe chest pain, low blood pressure, a heart attack, we may have to put him or her to sleep and use a defibrillator (paddles) to “reboot” or resynchronize the heart. Another treatment is ablation, where we thread a catheter into the heart, map the electrical pathways, and cut any short circuits.

Our second job is to determine what caused the problem to begin with. Atrial fibrillation occurs more frequently in the elderly and overweight individuals. Weakness of the heart muscle, narrowing or leaky heart valves, or problems with the sack that surrounds the heart also can cause atrial fibrillation. In some cases, a non-cardiac cause such as diabetes, overactive thyroid, lung disease, overuse of stimulants such as caffeine or alcohol, or use of recreational drugs such as cocaine or “speed” contributes to the problem.

As part of the diagnostic process, we take a detailed history and examine the heart and other organs as part of a physical exam. An ECG helps confirm atrial fibrillation. We usually perform an echocardiogram or ultrasound of the heart to determine the heart structure and function. Somewhat like sonar for submarines and Doppler 2000 in weather forecasting, echocardiography gives us a moving picture of the heart and the blood moving inside. Sometimes holter monitoring of the heart rhythm and stress testing can help determine the problem and guide us to the best treatment.

Because the upper chamber of the heart is not pumping during atrial fibrillation, blood stagnates and tends to clot. Clots can “break off” and travel to other organs, causing damage. For example, a clot in the brain can lead to a stroke. However, few people with atrial fibrillation will have a stroke. The frequency of strokes also depends on other factors, such as previous stroke, diabetes, age, and hypertension. To prevent clotting, we usually prescribe blood thinners.

In general, the risk of a heart attack, stroke, or death from atrial fibrillation is low. Any risk is predominantly related to the underlying condition that caused atrial fibrillation in the first place.

We are always available to you and your family members to discuss the specifics of your situation.

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