Five Facts About Atrial Fibrillation

Atrial fibrillation, or AFib, is a fast, irregular heart rhythm that, if left untreated, can lead to blood clots, stroke, and heart failure. It is the most common type of arrhythmia, a potentially serious condition in which the heart beats too fast, too slow, or in an irregular pattern.

RUSH electrophysiologist Erica Engelstein, MD, who specializes in treating heart rhythm disorders, shares five facts about AFib, including tips to prevent or help manage the condition, which affects at least 2.7 million Americans.

1. You can have AFib and not even feel any symptoms

“The symptoms of AFib can feel scary and debilitating, or they can be mild,” Engelstein says. These symptoms can include:

• Palpitations
• A rumbling or galloping feeling in the chest
• Dizziness
• Shortness of breath
• Extreme fatigue
• Chest pain

But some AFib episodes cause no symptoms at all.

“About half of patients do not experience these initial symptoms, but develop other symptoms within days or weeks, such as fatigue, shortness of breath on exertion, lack of energy, or swelling of the feet. These delayed symptoms are related to congestive heart failure due to the abnormal heart rate and rhythm. A small subset of patients develop no symptoms at all even years after atrial fibrillation,” says Engelstein.

That is why it is so important to visit your GP regularly and, if you have been diagnosed, to consult a specialist.

2. AFib causes up to one in four strokes, and these are more serious

AFib is the culprit in a staggering number of strokes. That’s because it can cause blood to pool in the upper chambers of the heart and form clots that can travel to the brain, blocking blood flow and leading to a stroke.

“People with AFib are generally five times more likely to have a stroke, although the individual risk can range from less than one percent to 20 percent, depending on the presence of certain additional risk factors,” Engelstein says. The risk of AFib-related stroke also increases with age.

“AFib strokes tend to be more severe, with more damage to the brain and worse long-term effects,” Engelstein says. “The vast majority of AFib-related strokes can be prevented with blood thinners or special procedures that close off the left atrial appendage, where most strokes originate.”

3. Lifestyle changes and medications can help you prevent AFib or manage risk factors

Some risk factors for AFib are beyond your control, including age, gender, or genetics. Age in particular can increase your risk, even in the healthiest people.

“Fortunately, most risk factors for AFib can be controlled, either with medications or lifestyle changes,” Engelstein says.

Risk factors for AFib that you can manage with lifestyle changes and medications include obesity, sleep apnea, diabetes, hypertension, coronary artery disease, valvular heart disease, thyroid disease, alcohol use, and lack of exercise.

Here are some tips to manage your risk factors for AFib:

• Exercise regularly. “As long as the heart rate is well controlled, patients with AFib should exercise at least 30 minutes a day, five times a week,” Engelstein says. “It’s a good idea to monitor the heart rate during exercise to make sure you don’t exceed the physiological heart rate.”
• Eat healthy and maintain a healthy weight. A diet designed for people with heart disease can be helpful for people with AFib. American Heart Association advises to focus on fruits and vegetables and to eat foods that are low in sodium.
• Keep an eye on your alcohol intake. “There’s probably no safe amount of alcohol when it comes to AFib, although some people are more susceptible than others,” Engelstein says. “One large study showed that drinking even one drink a day increased your risk of developing AFib by 16 percent.”
• Manage other health conditions. Talk to your doctor about medications and other treatments for risk factors such as sleep apneahigh blood pressure and diabetes, and many more.
• Quit smoking. Smoking has toxic effects on all aspects of the heart, including its rhythm. Talk to your doctor about ways to quit smoking.
• Manage stress levels. “While stress doesn’t directly cause AFib, it can affect conditions like blood pressure and diabetes, which in turn can increase your risk,” Engelstein says. “On the other hand, yoga, meditation, and other ways to reduce stress have been shown to reduce the risk of recurrence in patients who have had and relapsed AFib.”

4. Treatment options have improved tremendously and are getting better

“The treatment of atrial fibrillation has evolved rapidly over the past two decades,” Engelstein says. “The most effective treatment is catheter ablation, a minimally invasive procedure performed the same day that treats the source of AFib in the left upper chamber of the heart.”

With best results, ablation can reduce the time a person has atrial fibrillation by more than 98%.

“Newer catheters, energy sources and imaging techniques have made this procedure safer and more effective. If this treatment can be performed early, it can stop the progression of heart disease related to AFib.”

Medications such as blood thinners (to prevent strokes) have also become more effective and manageable, no longer requiring dietary restrictions or frequent monitoring and dosage adjustments. “Specific anti-arrhythmic medications are still used as adjunctive therapy for AFib and to control the heart rate,” Engelstein says.

But some people with AFib can’t take blood thinners, especially those who have a history of internal bleeding or frequent falls. One alternative is the WATCHMAN implant, a minimally invasive, one-time procedure to close off the left atrial appendage, a small sac connected to the upper left chamber of the heart where clots form.

Treatments are improving and many patients with AFib are able to control the condition so well that they can live their lives optimally again, with few limitations or restrictions.

“Equally important in preventing the progression of AFib is managing risk factors if they are present,” says Engelstein.

5. Your smartwatch or device can help you detect AFib

If you have an Apple Watch, Fitbit, or other device that monitors your heart rate, it can help detect an abnormal heart rhythm. While it can’t diagnose your AFib, detecting an arrhythmia can be the first sign that you should see a doctor.

“Smartwatches that reliably detect atrial fibrillation are a game changer in the management of patients with AFib,” says Engelstein. “They are important for initial diagnosis in patients who do not have symptoms. They are also important for long-term follow-up of patients to detect recurrences and assess the effect of treatment.”

If you use a wearable device that can measure your heart rate, watch for any abnormalities and report them to your doctor.