That feeling when your heart flutters, misses a beat, speeds up or slows down can be alarming. Though these palpitations are often harmless, they can signal serious malfunctions in the heart’s muscles and nerves.
The most common type of irregular heartbeat, or arrhythmia, is atrial fibrillation—AFib for short. At least 2.7 million Americans are living with AFib, and that number is expected to grow as the average age of the population rises. Untreated AFib significantly increases both risk of heart-related death and risk of stroke.
What is AFib?
When the heart beats, it squeezes and that pushes blood through each of the heart’s four chambers. With AFib, the top two chambers of the heart quiver instead of beating regularly. This means the heart can’t pump well so some blood is left sitting. And when blood is stationary, clots form. Blood flowing through the heart can sweep clots out into the circulatory system, where they can cause blockages that lead to complication such as stroke.
The first step in assessing an arrhythmia is a thorough patient history. Physicians such as Christopher Thoresen MD with the TriHealth Heart Institute look for clues: When do symptoms occur? Are they associated with specific activities? Do lifestyle factors contribute? Will weight loss help? For instance, sleep apnea, associated with obesity, can cause arrhythmia, including AFib. Stress and medications also can play roles.
Several tests are used to diagnose AFib. An electrocardiogram (ECG) records electrical signals as they move through the heart and can show irregularities. To further evaluate how the heart is working, patients may be asked to wear a portable ECG device called a Holter monitor for 24 hours or longer. An event recorder is a portable device that monitors heart activity over longer periods—a few weeks to a few months. Patients activate the device when they experience symptoms and doctors are able to review the heart’s rhythm at the time symptoms occurred.
Treatment for AFib aims to regulate the heartbeat and prevent clots from forming. If the AFib is caused by an underlying condition, that will be treated first. The heart’s regular rhythm (called sinus rhythm) can be re-established using medication, an electrical shock or a combination of the two.
If those treatments don’t work, a minimally invasive procedure can be used to ablate, or destroy, the tissues that trigger or maintain the disruptive rhythms. This stops the arrhythmia at its source.
Blood thinners are prescribed to help prevent blood clots. Because AFib can occur without symptoms, many patients continue taking these medications even after normal heart rhythm is reestablished.
With active monitoring, patients who have AFib can reduce their risk of complications. It’s important to keep follow-up appointments with a primary care provider, who will watch for and help manage additional stroke risk factors, including high blood pressure, diabetes, high cholesterol, smoking and obesity.