Afib (Atrial Fibrillation): Symptoms, Causes, Diagnosis and Treatment

Atrial fibrillation (Afib) is a common heart rhythm disorder where the upper chambers (atria) beat irregularly and out of sync with the lower chambers (ventricles). This irregular rhythm disrupts normal blood flow, leading to symptoms like palpitations, fatigue, breathlessness, and dizziness. However, for some individuals, it may remain undetected as there are no obvious symptoms, making it a potentially silent condition. Fortunately, with timely diagnosis and effective treatment, the condition can be managed, and its impact on health can be reduced. To understand Afib better, this blog provides a detailed overview of its symptoms, causes, diagnostic methods, and treatment options, offering insights into how it can be managed and prevented.

What is Atrial Fibrillation?

Atrial fibrillation (Afib) is a rapid and irregular heart rhythm caused by erratic electrical signals in the atria. It occurs when the atria send chaotic electrical impulses, causing uncoordinated contractions with the ventricles. As a result, the heart’s ability to pump blood effectively is reduced, which can affect overall circulation. The irregular rhythm may cause noticeable symptoms, but in some cases, it may go undetected, especially if symptoms are mild or absent. 

What are the Types of Atrial Fibrillation?

Afib can be classified into different types, depending on how long the irregular heart rhythm lasts and whether it resolves on its own or requires medical intervention. The main types are:

Paroxysmal Atrial Fibrillation

Sudden episodes of irregular heartbeat that resolve within 48 hours, often without medical intervention. These episodes may last from a few minutes to a couple of days. In many cases, they don’t require medical intervention as they resolve without treatment, but the condition tends to recur over time. People with paroxysmal Afib may feel symptoms like palpitations, dizziness, and fatigue during these episodes.

Persistent Atrial Fibrillation

Persistent Afib is an irregular rhythm lasting beyond seven days, requiring medical intervention to restore normal heart function. This type of Afib often requires medical intervention, such as medications to restore a normal rhythm or procedures like electrical cardioversion. With persistent Afib, the symptoms are more consistent, and without treatment, the condition can lead to complications like heart failure or stroke.

Long-standing Persistent Atrial Fibrillation

A chronic form lasting over a year, often resistant to treatment aimed at restoring normal heart rhythm. In this case, managing the symptoms becomes a priority. Long-standing persistent Afib can have a significant impact on quality of life, as it may cause ongoing fatigue and other related health issues. Though it’s not always reversible, the goal of treatment is to prevent stroke and manage the heart rate effectively.

Permanent Atrial Fibrillation

Permanent Afib is a long-term condition where normal rhythm cannot be restored, requiring symptom management and stroke prevention. In this type, doctors focus on controlling the heart rate and reducing the risks of complications like stroke and heart failure. Treatment may involve anticoagulants (blood thinners) to prevent clots, along with medications to control the heart rate and rhythm. Unlike other types, permanent Afib typically does not improve with treatment, but symptom management is key to maintaining a good quality of life.

What are the Causes of Atrial Fibrillation?

Atrial fibrillation can be triggered by several factors, often related to underlying health conditions or lifestyle choices. Some of the most common causes include:

• Hypertension: Chronically elevated blood pressure strains the heart, leading to atrial enlargement and electrical disturbances that increase Afib risk. 
• Heart Disease: Conditions such as coronary artery disease, heart valve problems, and previous heart attacks can damage the heart muscle, making it more likely for the condition to occur.
• Heart Failure: When the heart is unable to pump blood effectively, it can cause changes in the heart’s electrical system, leading to irregular rhythms.
• Diabetes: People with diabetes are at a higher risk due to the damage high blood sugar can do to the heart and blood vessels, as well as the associated risk of other conditions like high blood pressure.
• Thyroid Problems: An overactive thyroid can increase the heart rate and trigger the condition. The thyroid regulates metabolism, and imbalances in thyroid hormone levels can disrupt the heart’s normal rhythm.
• Sleep Apnea: Repeated oxygen deprivation during sleep increases cardiac stress, contributing to electrical instability and Afib.
• Alcohol and Caffeine Consumption: Excessive alcohol intake or high levels of caffeine can trigger episodes in some individuals. This is often referred to as "holiday heart syndrome," where an increase in alcohol consumption leads to temporary episodes.
• Age: As people age, the heart’s electrical system naturally changes, increasing the likelihood of developing the condition. Older adults are more prone to the condition, even without underlying heart disease.
• Genetics: A family history of the condition can increase the risk. Certain genetic factors may make individuals more susceptible to heart rhythm disorders.

What Are the Symptoms of Atrial Fibrillation?

The symptoms of atrial fibrillation can vary from person to person. Some individuals may experience noticeable symptoms, while others may have no symptoms at all. When symptoms do occur, they include:

• Palpitations: A fluttering sensation or racing heartbeat, often irregular or skipping beats.
• Shortness of Breath: Difficulty breathing or feeling out of breath, even with light activity or at rest.
• Fatigue: Persistent tiredness, often due to inefficient blood circulation from an irregular heart rhythm.
• Dizziness or Light-headedness: A sensation of being unsteady or about to faint, which may happen due to reduced blood flow.
• Chest Pain or Discomfort: Some individuals may experience mild chest pain or a tight feeling in the chest, which should be taken seriously, as it can signal complications.
• Reduced Exercise Capacity: A feeling of weakness or limited ability to engage in physical activities that were previously manageable.

In some cases, afib symptoms may be intermittent or occur only during episodes of irregular heart rhythm. For others, symptoms can be constant and more severe. It's important to seek medical attention if any of these symptoms are experienced, as they may indicate the presence of atrial fibrillation or other serious health conditions.

How Is Atrial Fibrillation Diagnosed?

Atrial fibrillation is diagnosed through a combination of medical history, physical examination, and diagnostic tests. Here’s how it is typically identified:

Medical History

The doctor will begin by asking about symptoms, such as palpitations, dizziness, or shortness of breath. It’s important to provide any relevant information about previous heart conditions, lifestyle habits, and any family history of heart disease.

Physical Examination

During the physical exam, the doctor will check the pulse for irregularities in heart rate and rhythm. Listening to the heart with a stethoscope can help detect unusual sounds, such as an irregular heartbeat, which is often a sign of atrial fibrillation.

Electrocardiogram (ECG or EKG)

An electrocardiogram is the primary test used to diagnose atrial fibrillation. It records the electrical activity of the heart and can identify the irregular rhythm that characterises the condition. This test is usually quick and non-invasive.

Holter Monitor

A wearable ECG device that continuously tracks heart rhythm for 24-48 hours, detecting intermittent Afib episodes.

Echocardiogram

An echocardiogram uses sound waves to create an image of the heart’s structure and function. It helps doctors assess whether there is any underlying heart disease, such as heart valve problems, that might be contributing to atrial fibrillation.

Blood Tests

Used to detect thyroid imbalances, electrolyte disturbances, or infections that may trigger Afib. 

Chest X-ray

A chest X-ray may be done to look for signs of heart failure or other lung conditions that could be related to the symptoms of atrial fibrillation.

Electrophysiological Study (EPS)

In some cases, if the cause of atrial fibrillation is unclear or the condition is difficult to manage, a more invasive test called an electrophysiological study may be performed. This test involves threading a catheter through the blood vessels to the heart to measure electrical signals and determine the source of the abnormal rhythm.

What Are the Treatment Options for Atrial Fibrillation?

The treatment options for atrial fibrillation aim to manage symptoms, prevent complications, and restore normal heart rhythm if possible. The approach to treatment depends on the type of atrial fibrillation, its underlying causes, and the individual's overall health. Common treatment options include:

Medications

Medications play a crucial role in controlling heart rhythm and preventing blood clots. These may include:

• Rate Control Medications: These drugs, such as beta-blockers, calcium channel blockers, and digoxin, help slow the heart rate and improve symptoms by making the heart beat more steadily.
• Rhythm Control Medications: Antiarrhythmics such as amiodarone or flecainide stabilize heart rhythm, preventing recurrent episodes.
• Anticoagulants: Warfarin or direct oral anticoagulants (DOACs) reduce stroke risk by preventing clot formation in the atria. 

Cardioversion

Cardioversion is a procedure used to restore a normal heart rhythm. It can be done using:

• Electrical Cardioversion: A controlled electric shock is delivered to the heart to reset its rhythm. This is usually done under sedation and is often used in cases of persistent atrial fibrillation.
• Pharmacologic Cardioversion: This involves using medications to restore normal rhythm. It may be an option for those who are not candidates for electrical cardioversion.

Catheter Ablation

Catheter ablation is a procedure used when medications and other treatments don’t work effectively. During the procedure, a catheter is threaded through blood vessels to the heart, where it uses heat or cold to destroy small areas of heart tissue that are causing the abnormal rhythm. This can be an effective long-term solution for some people with atrial fibrillation.

Pacemaker

In cases where the heart rate becomes too slow, particularly after catheter ablation, a pacemaker may be implanted. This device helps regulate the heart’s rhythm and ensures the heart beats at an appropriate rate.

Surgical Procedures

For individuals who do not respond to other treatments, certain surgical options may be considered:

• Maze Procedure: A surgical approach that forms strategic scar patterns in the atria to disrupt erratic electrical pathways. It is typically reserved for those with persistent or long-standing atrial fibrillation.
• Left Atrial Appendage Closure: A surgical procedure that may be done to reduce the risk of stroke in patients with atrial fibrillation by closing off the left atrial appendage, where blood clots are more likely to form.

How Can You Manage Life with Atrial Fibrillation?

Here are key steps to managing the condition:

• Follow Your Treatment Plan: Adhere to prescribed medications for heart rhythm control and blood clot prevention.
• Monitor Heart Rhythm: Attend regular check-ups and monitor heart rhythm to adjust treatment as needed.
• Eat a Heart-Healthy Diet: Focus on low sodium, plenty of fruits and vegetables, and omega-3 fatty acids.
• Exercise Regularly: Engage in moderate activities like walking or swimming to stay fit and reduce heart strain.
• Manage Stress: Practice relaxation techniques like deep breathing or yoga to improve heart function.
• Ensure Adequate Sleep: Get enough rest and address any sleep disorders like sleep apnoea.
• Avoid Triggers: Reduce intake of alcohol, caffeine, and nicotine, as these substances can provoke or worsen Afib episodes.
• Seek Medical Help When Needed: Recognise warning signs like chest pain or severe dizziness and seek help.
• Stay Informed: Stay updated on Afib treatment options through discussions with your doctor.

Consult Today

Managing atrial fibrillation requires careful attention and the right support. If you or someone you know is experiencing symptoms or needs guidance, seeking professional help is essential. Max Hospital provides specialized Afib care, offering advanced diagnostic tools, personalized treatment plans, and expert cardiac management. Book an appointment with one of our specialists and take the next step toward better heart health.