Understanding AFib: What you need to know

Commercials about atrial fibrillation (AFib) seem to be everywhere these days. Celebrities like Howie Mandel, Gene Simmons and Barry Manilow have publicly discussed it. Drug companies feature medications to treat the condition and others sell devices to help you detect it, but what is AFib?

Atrial fibrillation, or AFib, is an irregular and rapid heart rhythm that occurs when the atria beat out of sync with the ventricles. To understand the condition, it’s important to understand how a regular heart rhythm works. Elizabeth Guastello, MD, a cardiologist with Cardiovascular Specialists of Lawrence explained that the heart has four chambers – the atria (upper chambers) and ventricles (lower chambers).

“The sinus node, which is responsible for initiating the electrical activity in the heart, sends a signal for the heart to beat. The sinus node transmits that signal through the left atrium, causing it to beat,” she explained. “The signal then goes through the AV node and sends the signals to the ventricles to beat, resulting in a heartbeat.”

AFib is the most common type of heart arrhythmia, with the Centers for Disease Control and Prevention (CDC) estimating that 12.1 million people in the United States will have AFib in 2030.

“When you have AFib, you have an extra foci of electrical activity developed in the left atrium that takes over from the sinus node,” Guastello said. “It makes the heart beat irregularly and fast.” 

Do I have AFib?

Some people with AFib don’t exhibit any symptoms and don’t know that there’s anything wrong. It’s more common that you’ll experience one or more of these symptoms, including:

• Fast, fluttering or pounding heartbeat (palpitations)
• Chest pain
• Dizziness
• Fatigue
• Lightheadedness
• Shortness of breath
• Weakness

If you’ve got a wearable fitness device, it may also be able to provide early warning. Apple Watch users can enable heart health notifications on their device. These tell you if your heart rate is above or below your chosen beats per minute (BPM) or if you’ve got an irregular rhythm that could indicate you’re in AFib.

Take stock of your symptoms to determine your next steps. If you have an intermittent racing heartbeat or an irregular pulse that lasts for a short period of time, contact your primary care provider. They may fit you with a heart monitor to determine if you’re experiencing AFib.

“If you’re short of breath, having continuous palpitations at 150 beats per minute or more and you don’t feel well, it’s time to go to the emergency department,” Guastello said. “Call 911 if you experience symptoms of a stroke, including loss of balance, weakness, face droop or difficulty speaking. Time is of the essence.” 

Am I at risk?

Elizabeth Guastello, MD

The CDC reports that more than 454,000 hospitalizations with AFib as the primary diagnosis occur each year in the United States. These factors may increase your risk:

• Increasing age
• Poorly controlled high blood pressure
• Obesity
• Sleep apnea
• Moderate to heavy alcohol intake
• Smoking

“AFib may be hereditary for some people, especially if their parents and siblings also have the condition,” Guastello said. “If you’ve had prior cardiac procedures, you can also be at increased risk.”

It’s important to know that having AFib increases the risk of the left atrial appendage forming a blood clot inside the left atrium.

“This appendage is a little sac that hangs off the atrium and is a cozy spot for a clot to form,” she said. “If you get a clot there, it can leave the heart at any time and cause problems. The clot may travel to the carotid artery and into the brain, causing a stroke.” 

How do you treat AFib?

Although it’s scary, AFib is a treatable, chronic disease. Your cardiologist will typically begin by prescribing medication to try and slow down your heart rate or prevent the onset. Nodal blocking agents, such as beta blockers and calcium channel blockers, are used to slow the heart’s electrical signal. You could also be prescribed anti-arrhythmic drugs to prevent the body from going in and out of AFib.

Cardioversion is another route your cardiologist may take. This procedure to reset your heart’s rhythm is done by sending electric shocks to the heart through paddles or patches placed on your chest. It’s usually done as a scheduled procedure in a hospital. You may be prescribed anti-arrhythmic medications to help prevent AFib from recurring.

If medication or cardioversion doesn’t successfully control the condition, another option is a surgical procedure called an ablation. Your cardiologist starts the procedure by inserting two catheters into the groin and threading them up into the heart.

“We use them to map the electrical activity of your heart to induce and find the cause of your AFib,” Guastello explained.

After an ablation, you’ll spend several hours in the recovery room lying flat and being monitored by your care team. Most people spend the night in the hospital and return home the following day.  

What can I do to lower my risk?

While there are some factors that you can’t control, such as increasing age and family history, you can make lifestyle changes to lower your risk of developing AFib.

• Get regular exercise
• Maintain a healthy weight
• Keep your blood pressure under control
• Avoid excessive amounts of alcohol and caffeine
• Quit smoking

“It’s also important that if you have sleep apnea, get it treated. Talk with your primary care provider about getting a sleep study,” Guastello said.

AFib is common, treatable and many people with the condition live normal, active lives. If you’re concerned that you may have symptoms, talk with your primary care provider or cardiologist to learn more.