What is Atrial Fibrillation (Afib)?

Atrial Fibrillation or Afib, is a heart rhythm disorder (arrhythmia) that occurs in the top chambers of your heart – the atria. When in atrial fibrillation there is fast and chaotic electrical activity in the atria. In other words, instead of the atria having organized rhythm and motion (normal sinus rhythm), the atria goes so fast that there is no meaningful contraction. Many impulses will reach the AV node and that will govern how fast the lower chambers – the ventricles, will contract, or how fast your heart beat will be.

What causes Atrial Fibrillation?

Afib may occur in patients with no heart disease or even patients with no medical problems at all. More commonly it is associated with cardiovascular diseases such as Hypertension, Coronary Artery Disease or Congestive Heart Failure. There is also a strong link between Afib, obesity and obstructive sleep apnea. Recent studies have shown that many patients have genetic traits that will predispose them to atrial fibrillation.

The most common causes and risk factors for Afib include:

• Age Older than 60 years of age
• Obesity – as the size of the body increases, the size of the heart and the stress on it increases, making the risk of Afib higher
• Obstructive sleep apnea – in patients with OSA, there are changes in the pressure inside the chest that can cause stretch in the atria and increased risk of Afib. CPAP and weight loss can help significantly
• Diabetes – it can cause many changes in the heart, including risk of blockages and increase in scar tissue formation
• Heart problems:
  • ​High blood pressure
  • Coronary artery disease
  • Prior heart attacks
  • Congestive heart failure
  • Valvular heart disease (most commonly, mitral valve leakage)
  • Prior open heart surgery
• Thyroid disease – some forms of Afib seen in patients with thyroid problems can be cured by treating the thyroid
• Chronic lung disease – patients with advanced lung disease are not only at higher risk of developing Afib, but also have difficult to control Afib
• Excessive alcohol or stimulant use
• Serious illness or infection
•  Pectus Excavatum

What​ are the dangers of atrial fibrillation?

Atrial fibrillation and the lack of organized electrical activity have two consequences that are the root cause of all the problems and symptoms created by this condition:

• The atria cannot contract, or squeeze to help push blood forward
• Electrical impulses will reach the AV node very fast, and the AV node will regulate how many impulses will be conducted to the ventricle

The lack of contraction and the fast irregular pulse led to the problems created by atrial fibrillation:

• Increased risk of stroke
• Symptoms associated with Afib
• Risk of developing Congestive heart failure

Some people live for years with atrial fibrillation without problems. However, if not properly treated atrial fibrillation can lead to future problems.

Symptoms associated with Afib

Afib can cause many symptoms, and while some patients are extremely symptomatic, others can’t even tell. The right treatment option for you will depend on how symptomatic you are.

Most patients start by having occasional spells, lasting minutes or few hours. The disease then progresses to more frequent and long lasting spells. This progression varies from patient to patient. Lifestyle modification and treatment of other conditions that can cause or worsen Afib (such as hypertension, obesity, obstructive sleep apnea) may affect the progression.

Atrial fibrillation can feel like different things to different people. A few of the symptoms of Afib include:

• Racing, irregular heartbeat
• Fluttering in the chest
• Heart palpitations
• Dizziness
• Weakness
• Chest pain
• Shortness of breath
• Sweating
• Fatigue when exercising
• Faintness

Atrial Fibrillation and Congestive Heart Failure

Atrial fibrillation can decrease the heart’s pumping ability. The irregularity can make the heart work less efficiently. In addition, atrial fibrillation that occurs over a long period of time and that is not well treated can significantly weaken the heart and lead to heart failure.

Heart Failure is typically seen in patients that have had very fast heart beats for long periods of time – many months. If diagnosed and treated quickly it can be reversible.

Types of atrial fibrillation

Parox​ysmal Afib

Short episodes of AFib (ranging from seconds to hours) that stop on their own. Treatment of AFib that stops on its own is more likely to be successful.

Persistent Afib

Episodes of AFib that do not stop on their own and require medications or procedures (electrical shock or ablation) to help the heart rhythm return to normal. If left untreated, the heart will stay in AFib. The longer you stay in AFib, the more difficult it is to return the heart to a normal rhythm.

Longstanding persistent Afib

Continuous AFib lasting longer than a year. Treatment with a combination of medicine and procedure is less likely to restore a normal rhythm.

Perm​a​nent Afib

Patients that we can no longer restore normal sinus rhythm. Either because a decision has been made not to try by any means (including catheter or surgical ablation) or because attempts have failed.  The main goal is to control your heart rate and protect against strokes.