Overview
What is atrial fibrillation?
Atrial fibrillation
(say "A-tree-uhl fih-bruh-LAY-shun") is the most common type of irregular heartbeat (arrhythmia).
Normally, the
heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with
the heart's electrical system causes the two upper parts of the heart, the atria, to quiver,
or fibrillate.
The quivering upsets the normal rhythm between the atria and the
lower parts of the heart, the ventricles. And the ventricles may beat fast and without a regular rhythm.
This is dangerous
because if the heartbeat isn't strong and steady, blood can
collect, or pool, in the atria. And pooled blood is more likely to form clots. Clots can travel to the brain, block blood flow, and cause a stroke.
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Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
Atrial fibrillation can also lead to
heart failure.
What causes atrial fibrillation?
Conditions that
damage or strain the heart commonly cause atrial fibrillation. These
include:
- High blood pressure.
- Coronary artery disease.
- Heart attack.
- Heart valve disease.
Other possible causes include:
- Other medical problems, such as heart failure, lung
disease,
pneumonia, or a high thyroid level.
- Heart
surgery.
- Heavy alcohol use. This includes having more than 3 drinks a day over
many years as well as drinking a large amount
of alcohol at one time (binge drinking).
- Use of stimulants. These include caffeine,
nicotine, medicines such as decongestants, and illegal drugs such as
cocaine.
- Use of some prescription medicines, such as albuterol or
theophylline.
Sometimes doctors can't find the cause. Doctors call this lone atrial fibrillation.
What are the symptoms?
Symptoms may
include:
- Feeling dizzy or lightheaded.
-
Feeling out of breath.
- Feeling weak and tired.
- Feeling like the heart is fluttering, racing, or pounding (palpitations).
- Feeling like the heart
is beating unevenly.
- Having chest pain (angina).
- Fainting.
Sometimes atrial fibrillation doesn't cause obvious symptoms.
If you have symptoms, see your doctor. Finding and treating atrial fibrillation right away
can help you avoid serious problems.
How is atrial fibrillation diagnosed?
The doctor will ask questions about your past health, do a physical exam, and order tests.
The best way to find out if you have atrial fibrillation is to have an electrocardiogram (EKG or ECG). An EKG is a test that checks for problems with the heart's electrical activity.
You might also have lab tests and an echocardiogram. An echocardiogram can show how well your heart is pumping and whether your heart valves are damaged.
How is it treated?
Your treatment will depend on the cause of your atrial fibrillation, your symptoms, and your risk for stroke.
Medicines are an important part of treatment. They may include:
-
Blood thinners
or aspirin to help prevent strokes.
- Rate-control medicines to keep your heart from beating too fast during atrial fibrillation.
-
Rhythm-control medicines
to help bring your heart rhythm back to normal.
Doctors sometimes
use a procedure called cardioversion to try to get the heartbeat back to normal. This can be done using either medicine
or a low-voltage electrical shock (electrical cardioversion).
If symptoms keep bothering you, ablation may help. It destroys
small areas of the heart to create scar tissue. The scar tissue blocks or destroys
the areas that are causing the abnormal heart rhythm.
What can you do at home for atrial fibrillation?
Atrial fibrillation is often the result of heart disease or damage. So
making changes that improve the condition of your heart may also improve your
overall health.
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Don't smoke. Avoid secondhand smoke too.
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Eat a
heart-healthy diet with plenty of fish, fruits, vegetables, beans, high-fiber
grains and breads, and olive oil.
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Get regular exercise on most,
preferably all, days of the week. Your doctor can suggest a safe level of
exercise for you.
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Control your cholesterol and blood pressure. If
you have diabetes, keep your blood sugar in your target range.
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Manage your stress. Stress can damage your heart.
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Avoid
caffeine, alcohol, and stimulants.
-
Avoid getting sick from the
flu. Get a flu shot every year.
Frequently Asked Questions
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Learning about atrial fibrillation:
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Being diagnosed:
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Getting treatment:
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Living with atrial fibrillation:
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Cause
Atrial fibrillation is a problem with the
heart's electrical system.
When something goes wrong with this system, it's usually because of other health problems that are causing wear and tear on the heart or making it hard for the heart to do its job. Sometimes it's because of lifestyle habits—such as smoking or heavy drinking—that are hard on the heart.
Problems that affect the heart's structure
Atrial fibrillation is often caused by a health problem that directly affects the heart, including:
Other health problems
Atrial fibrillation can also be caused by other health problems, including:
-
Hyperthyroidism
.
- Lung disease, such as COPD.
- Having heart surgery.
- Taking certain prescription medicines, such as albuterol or theophylline.
Atrial fibrillation caused by a condition that is
treatable, such as pneumonia or hyperthyroidism, often goes away when that
condition is treated.
In some cases, doctors cannot find the cause
of atrial fibrillation. These cases are called lone atrial fibrillation. Lone
atrial fibrillation occurs more often in people younger than 65. It often stops
on its own. But it may need to be treated.
Symptoms
Atrial fibrillation is often discovered during routine
medical checkups, because many people don't have symptoms. Others may notice an
irregular pulse but don't have other symptoms.
Mild symptoms of atrial fibrillation may
occur immediately. More serious problems may occur after the start of
atrial fibrillation and over the course of several days. So it is important to
identify symptoms and get treatment as soon as possible.
Symptoms include:
-
Heart palpitations
.
- Irregular pulse.
- Shortness of
breath, especially during physical activity or emotional
stress.
- Weakness, fatigue.
- Dizziness,
confusion.
- Lightheadedness or fainting (syncope).
- Chest pain (angina).
Checking your pulse
Checking your pulse
is important, because many people don't have symptoms of atrial
fibrillation. Ask your doctor how often you should check your heartbeat. Once a month might be right for you.
If you notice that your heartbeat doesn't have a regular
rhythm, talk to your doctor.
Paroxysmal atrial fibrillation
When atrial fibrillation comes on suddenly, lasts a short time, and goes away on its own, it is called paroxysmal atrial fibrillation. Typically, over time, episodes of paroxysmal atrial fibrillation come on more often and last longer.
Persistent atrial fibrillation
Over time, episodes of
atrial fibrillation typically last longer and often don't go away on their own. This is called persistent atrial fibrillation.
What Increases Your Risk
A risk factor is anything that increases your chances of getting sick or having a problem. Risk factors for
atrial fibrillation include:
- Age older than 60.
- Being white and
male.
- Obesity.
-
Sleep apnea
.
- A family history
of atrial fibrillation.
- Certain other health problems can cause atrial fibrillation. For a list of these problems, see Cause.
Lifestyle choices
You may have certain habits that increase your risk for atrial fibrillation because they can cause wear and tear on your heart. These lifestyle choices include:
- Long-term, heavy alcohol use, or drinking a large amount of
alcohol at one time (binge drinking).
- Use of illegal drugs, such as cocaine or methamphetamines.
- Too much caffeine.
- Smoking.
When to Call a Doctor
Some symptoms of
atrial fibrillation need urgent medical evaluation.
Call
911
or other emergency services immediately if you:
- Have symptoms of a heart attack, such as chest pain or pressure, shortness of breath, and nausea.
- Have
signs of a stroke, such as sudden vision changes; trouble speaking; or numbness, tingling, weakness, or loss of movement in your face or an arm or a leg.
- Feel faint and have an
irregular heartbeat.
If you see someone pass out, call 911 or other emergency services immediately.
Call your doctor if you
have:
- An irregular heart rate.
-
Heart palpitations
.
- Periods of unexplained lightheadedness,
dizziness, or confusion.
- An episode of fainting or you come close
to fainting for no apparent reason.
- Shortness of breath that gets worse with exercise.
If you take a blood thinner
If you take blood-thinning medicine, such as an anticoagulant or aspirin, watch for signs of bleeding.
Call
911 if:
- You cough up blood.
- You vomit blood or what looks like coffee grounds.
- You pass maroon or very bloody stools.
- You have a sudden, severe headache that is different from past headaches. (It may be a sign of bleeding in the brain.)
Call your doctor right away if:
- You have new bruises or blood spots under your skin.
- You have a nosebleed that doesn't stop quickly.
- Your gums bleed when you brush your teeth.
- You have blood in your urine.
- Your stools are black and look like tar or have streaks of blood.
- You have heavy period bleeding or vaginal bleeding when you are not having your period.
If you are injured, apply pressure to stop the bleeding. Realize that it
will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.
Who to see
The following health professionals can
detect, diagnose and, in some cases, treat atrial fibrillation:
The following specialists can treat people with severe symptoms:
Exams and Tests
An
electrocardiogram (EKG, ECG) is the best and simplest
way to find out whether you have
atrial fibrillation. It is usually done along
with a
medical history and physical exam.
If your doctor suspects
that you have atrial fibrillation that comes and goes, he or she may ask you to
use a device to record your heart rhythm for a while. This is
referred to by several names, including
ambulatory electrocardiogram, ambulatory EKG, Holter
monitoring, 24-hour EKG, and cardiac event monitoring.
Other tests
Other tests your doctor may recommend include:
Treatment Overview
It's hard to say exactly what your treatment for atrial fibrillation will be, because it depends so much on your symptoms and your risk for other health problems.
Treatments are aimed at helping you feel better and preventing future problems, especially stroke and heart failure. There are three main types of treatment:
- Treatment to control your heart rate.
- Treatment to control your heart rhythm.
- Treatment to prevent stroke.
Treatment to control your heart rate
Rate-control medicines are used if your heart rate is too fast.
They usually do not return your heart to a
normal rhythm—in other words, your heartbeat will still be irregular. But these
medicines can keep your heart from beating at a dangerously fast rate.
Treatment to control your heart rhythm
Treatment to control your heart rhythm is done to try to stop atrial fibrillation and keep it from returning. It may also help your symptoms. Treatments include:
Treatment to prevent stroke
Atrial fibrillation is dangerous
because if the heartbeat isn't strong and steady, blood can
collect, or pool, in the atria. And pooled blood is more likely to form clots. Clots can travel to the brain, block blood flow, and cause a stroke.
If you are at an average to high risk of having a stroke, your doctor may prescribe long-term use of an anticoagulant medicine, such as warfarin, to lower this risk.
If you are at low risk of having a stroke or you cannot take an anticoagulant, you may choose to take daily aspirin.
For more information, see Medications.
Living With Atrial Fibrillation
Many people are able to live full and
active lives with atrial fibrillation. Most people don't have to change their daily activities.
Because
atrial fibrillation is often the result of a heart
condition, making changes to improve your heart condition will usually improve
your overall health.
Make lifestyle changes
Prevent other health problems
- If needed, take medicines to control your cholesterol and blood pressure.
- Talk to your doctor or pharmacist before taking any new
medicine. Some nonprescription medicines,
especially cold and herbal remedies, contain stimulants that can trigger atrial
fibrillation.
- Get a flu shot every year.
- Know the signs of
sleep apnea. Many people with
atrial fibrillation also have this condition.
Take medicines safely
When you take an anticoagulant (also called a blood thinner), you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also get regular blood tests and watch how much vitamin K you eat or drink.
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Warfarin: Taking Your Medicine Safely
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Blood Thinners Other Than Warfarin: Taking Them Safely
For more information, see:
Medications
If you have atrial fibrillation, you will likely take a medicine to help prevent a
stroke. You may also take a medicine that controls
your heart rate or your heart rhythm.
Medicine to prevent a stroke
Anticoagulants
Anticoagulant medicines, also called blood thinners, are recommended for
most people with atrial fibrillation who are at average to high risk of
stroke.
Anticoagulant choices include:
If you are age 55 or older and have atrial fibrillation,
you can find your risk of having a stroke in the next 5 years using this
Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
For help deciding about an anticoagulant, see:
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Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
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Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?
Aspirin and other antiplatelet medicines
If you are at low
risk of stroke or cannot take anticoagulants, your doctor may recommend that
you take
aspirin. It doesn't work as well as anticoagulant
medicines in preventing clots, but it doesn't have as many side effects.
Your doctor may have you take other
antiplatelet medicines, such as clopidogrel (Plavix),
along with aspirin or instead of aspirin. When aspirin and
clopidogrel are used together, they may reduce the risk for stroke more than
aspirin alone. But this combination is also more likely to cause bleeding than
aspirin alone.
Medicine to control your heart rate
Rate-control medicines are used if your heart rate is too fast. These medicines
include:
Rate-control medicines may relieve symptoms caused by the fast heart rate. But these medicines may not be an option
if you have severe symptoms.
Medicine to control your heart rhythm
Rhythm-control medicines (also known as antiarrhythmics) help return the heart to its normal rhythm and keep
atrial fibrillation from returning. They may help relieve symptoms caused by an irregular heart rate.
Other Places To Get Help
Organizations
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American Heart Association (AHA)
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| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: |
1-800-AHA-USA1 (1-800-242-8721) |
| Web Address: |
www.heart.org |
| |
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Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
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Heart Rhythm Society
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| 1400 K Street NW |
| Suite 500 |
| Washington, DC 20005 |
| Phone: |
(202) 464-3400 |
| Fax: |
(202) 464-3401 |
| Web Address: |
www.hrsonline.org |
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The Heart Rhythm Society provides information for
patients and the public about heart rhythm problems. The website includes a
section that focuses on patient information. This information includes causes,
prevention, tests, treatment, and patient stories about heart rhythm problems.
You can use the Find a Specialist section of the website to search for a heart
rhythm specialist practicing in your area.
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National Heart, Lung, and Blood Institute
(NHLBI)
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| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: |
(301) 592-8573 |
| Fax: |
(240) 629-3246 |
| TDD: |
(240) 629-3255 |
| Email: |
nhlbiinfo@nhlbi.nih.gov |
| Web Address: |
www.nhlbi.nih.gov |
| |
|
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
- Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
|
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References
Other Works Consulted
- ACTIVE Investigators (2009). Effect of clopidogrel
added to aspirin in patients with atrial fibrillation. New England Journal of Medicine, 360(20): 2066–2078.
- Boos CJ, et al. (2008). Atrial fibrillation (chronic),
search date August 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Calkins H, et al. (2007). HRS/EHRA/ECAS Expert
consensus statement on catheter and surgical ablation of atrial fibrillation:
Recommendations for personnel, policy, procedures, and follow-up. A report of
the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of
Atrial Fibrillation. Heart Rhythm, 4(6):
816–861.
- Dronedarone (Multaq) for atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1322): 78–79.
- Fuster V, et al. (2006). ACC/AHA/ESC 2006 guidelines
for the management of patients with atrial fibrillation—Executive summary. A
report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines and the European Society of Cardiology Committee
for Practice Guidelines (Writing committee to revise the 2001 guidelines for
the management of patients with atrial fibrillation). Circulation, 114(7): 700–752. [Erratum in Circulation, 116(6): e137.]
- Lip GYH, Watson T (2008). Atrial fibrillation (acute
onset), search date October 2007. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- Mozaffarian D, et al. (2008). Physical activity and
incidence of atrial fibrillation in older adults. The Cardiovascular Health
Study. Circulation. Published online August 4, 2008
(doi:10.1161/circulationaha.108.785626).
- Prystowsky EN, Waldo AL (2008). Atrial fibrillation,
atrial flutter, and atrial tachycardia. In V Fuster et al., eds.,
Hurst's the Heart, 12th ed., pp.953–982. New York:
McGraw-Hill Medical.
- Roux, J-F, et al. (2009). Antiarrhythmics after ablation of atrial fibrillation (5A study). Circulation, 120(12): 1036–1040.
- Roy D, et al. (2008). Rhythm control versus rate
control for atrial fibrillation and heart failure. New England Journal of Medicine, 358(25): 2667–2677.
- Shea JB, Sears SF (2008). A patient's guide to living
with atrial fibrillation. Circulation, 117(20):
e340–e343.
- Sherman DG, et al. (2005). Occurrence and
characteristics of stroke events in the atrial fibrillation follow-up
investigation of sinus rhythm management (AFFIRM) study. Archives of Internal Medicine, 165(10): 1185–1191.
- Snow V, et al. (2003). Management of newly detected
atrial fibrillation: A clinical practice guideline from the American Academy of
Family Physicians and the American College of Physicians. Annals of Internal Medicine, 139(12): 1009–1018.
- Treatment of atrial fibrillation (2010). Treatment Guidelines From The Medical Letter, 8(97): 65–70.
- Van Gelder IC, et al. (2010). Lenient versus strict rate control in patients with atrial fibrillation. New England Journal of Medicine, 362(15): 1363–1373.
- Wang TJ, et al. (2003). A risk score for predicting
stroke or death in individuals with new-onset atrial fibrillation in the
community: The Framingham heart study. JAMA, 290(8):
1049–1056.
- Wann LS, et al. (2011). 2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(1): 104–123.
- Wann LS, et al. (2011). 2011 ACCF/AHA/HRS focused updated on the management of patients with atrial fibrillation (update on dabigatran): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): 1144–1150.
- Wilkoff BL, et al. (2008). HRS/EHRA expert consensus
on the monitoring of cardiovascular implantable electronic devices (CIEDS):
Description of techniques, indications, personnel, frequency and ethical
considerations. Heart Rhythm, 5(6): 907–925. Available
online:
http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/cieds_guidelines.pdf.
- You JJ, et al. (2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e531S–e575S.
Credits
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By
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Healthwise Staff |
|
Primary Medical Reviewer
|
E. Gregory Thompson, MD - Internal Medicine |
|
Specialist Medical Reviewer
|
John M. Miller, MD, FACC - Cardiology, Electrophysiology |
|
Last Revised
|
May 9, 2012 |
