Atrial Fibrillation (Afib)

Atrial fibrillation (Afib) is the most common cardiac arrhythmia and affects more than two million Americans. Although Afib can affect younger people, it is more common in people over the age of 60 and the risk of developing it increases with age. In developed countries, the number of patients with Afib is likely to increase over the next 50 years because of the growing proportion of older people. Atrial fibrillation is caused by abnormal electrical pathways in the heart and usually involves a rapid heart rate in which the upper heart chambers (atria) contract in a disorganized manner. In other words, the atria quiver rather than beat effectively.

Risk Factors

Hyperthyroidism
Hypertension (high blood pressure)
Hypertrophic cardiomyopathy
Heavy alcohol use
Recent cardiac surgery
Mitral valve disease (e.g., due to rheumatic heart disease or mitral valve prolapse)
Pericarditis
Age (higher occurrence in patients older than 60 years of age)
Coronary artery disease
Pulmonary diseases (i.e., pneumonia, lung cancer, pulmonary embolism)
Congenital heart disease
Valvular heart disease (i.e. aortic or tricuspid valve diseases)
Wolf-Parkinson-White Syndrome

Signs of Afib

Following are some of the signs of possible atrial fibrillation:

Pulse may feel rapid, pounding, fluttering, or it can feel too slow
Dizziness, light-headedness
Fainting
Fatigue
Shortness of breath
Sensation of tightness in the chest

Thromboembolism

Thrombosis is the formation of a clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. Thromboembolism refers to both thrombosis and its main complication, embolization, which occurs when an object (i.e., thrombus) migrates from one part of the body and causes the blockage of a blood vessel in another part of the body. The most feared consequence of disorganized atrial activity is the formation of a left atrial clot and the potential for thromboembolism.

Detection and Diagnosis

When a patient shows a number of signs, or has risk factors, the following tests are used to screen for Afib:

Electrocardiogram (EKG). A noninvasive and inexpensive diagnostic test that records the electrical activity of the heart over time. Characteristic findings of Afib include absence of P waves, unorganized electrical activity in their place and irregularity of the R-R interval due to irregular conduction of impulses to the ventricles.

Exercise electrocardiography. A stress test used to test a patient’s heart and to identify rhythm disturbances during exercise. The test gives a general sense of how healthy the heart is and screens for CAD.

Treatment Options

Several treatment options are available for atrial fibrillation:

Rate control. This treatment method seeks to reduce the heart rate to normal range (about 60 to 100 beats per minute) and is more commonly used to treat chronic Afib. Rate control medications include betablockers, cardiac glycosides and calcium channel blockers. These medications work by slowing the conduction of impulses from the atria to the ventricles.

Rhythm control. The goal of this procedure is to restore normal heart rhythm. Rhythm control strategy may include electrical cardioversion (restoration of the normal heart rhythm through application of a DC electrical shock) or chemical cardioversion (performed with drugs). However, cardioversion should not be performed without adequate anticoagulation in patients who have been in Afib for more than 48 hours.

Catheter ablation. This is a nonsurgical procedure, so recovery time is minimal and other surgical risks are avoided. An MRI or CT scan is completed before the ablation procedure is begun so that doctors have an accurate picture of the heart structure and size. During the ablation procedure, catheters (thin wires) are threaded through a blood vessel in the groin and up to the heart. The CT or MRI image is aligned with a three-dimensional (3-D) map of the heart using a 3-D mapping system and intracardiac echo. An intracardiac echo helps ensure safety and creates a roadmap for the Afib ablation procedure. The precision of this procedure reduces the incidences of short and long-term complications. Doctors apply radiofrequency energy to the target areas to destroy the abnormal electrical pathways.

More Information

Cardiovascular Services Main Page

Atrial Fibrillation

Cardiac Catheterization

Cardiovascular Surgery

Deep Vein Thrombosis

Electrophysiology

Noninvasive Diagnostic Services

Peripheral Arterial Disease (PAD)

Heart Attacks

Bypass Surgery

Patent Foramen Ovale (PFO)

Heart Disease Awareness for Women

Patient's Guide to Heart Surgery

Expectations

Afib can usually be controlled with treatment. However, the natural tendency of Afib is to become a chronic condition. Patients with Afib are at a significantly increased risk of stroke as well (about two to seven times the regular population).

Chest Pain Center

Valley Hospital Medical Center is accredited with percutaneous coronary intervention (PCI) by the Society of Chest Pain Centers (SCPS). The Society of Chest Pain Centers' goal is to reduce mortality from heart attacks by teaching the public to recognize and react to the early symptoms of a heart attack and to reduce the time that it takes to receive treatment.

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