Understanding atrial fibrillation and reducing your risk

You may have heard about a heart condition called atrial fibrillation recently — celebrities such as Howie Mandel, Gene Simmons and Barry Manilow have publicly discussed it, drug companies sell medications to treat it, and there are devices to help you detect it. But what is atrial fibrillation, and what happens when you have it?

Atrial fibrillation, or AFib, is an irregular and rapid heart rhythm that occurs when the two upper chambers of the heart, called the atria, beat out of sync with the lower chambers, or the ventricles. It’s the most common type of abnormal heart rhythm, or arrhythmia. The Centers for Disease Control and Prevention estimates that 12.1 million people in the United States will have AFib by 2030.

Dr. Elizabeth Guastello, a cardiologist with Cardiovascular Specialists of Lawrence, said that in a normal heartbeat, a part of the heart called the sinus node produces an electrical signal that causes the heart to beat regularly. However, in atrial fibrillation, there’s other electrical activity going on in the heart, too, which causes an irregular heartbeat.

“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.”

Signs and symptoms

Some people with AFib don’t exhibit any symptoms and don’t know that there’s anything wrong. However, many people with the condition will experience one or more of these symptoms:

• Fast, fluttering or pounding heartbeat (palpitations)

• Chest pain

• Dizziness

• Fatigue

• Lightheadedness

• Shortness of breath

• Weakness

If you have a wearable fitness device, it may also be able to provide an 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 or if you’ve got an irregular rhythm.

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.”

Risk factors

According to the CDC, more than 454,000 hospitalizations with AFib as the primary diagnosis occur each year in the United States. These are some of the risk factors for AFib:

• Increasing age

• Poorly controlled high blood pressure

• Obesity

• Sleep apnea

• Moderate to heavy alcohol intake

• Smoking

Guastello said that AFib can run in families, and it’s especially important to be aware of it if your parents or siblings have had it. She also said people who have had heart procedures in the past may also be at higher risk.

Having AFib can also increase the risk of certain other dangerous conditions. For example, Guastello said, a blood clot can form in part of the heart called the left atrial appendage, and that can cause life-threatening problems down the line.

“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.”


AFib is a chronic disease and may sound frightening, but it is treatable. Your cardiologist will typically begin by prescribing medication to try to slow down your heart rate. Medicines called 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 into and out of AFib.

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

If medication or cardioversion can’t control the condition, another option is a surgical procedure called an ablation. where a cardiologist inserts catheters into the groin and threads 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 said.

After an ablation, patients spend several hours in the recovery room lying flat and being closely monitored. Most people spend the night in the hospital and return home the following day.

Lowering your risk

While there are some factors that you can’t control, 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,” Guastello said. “Talk with your primary care provider about getting a sleep study.”

AFib is common and 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.

— Autumn Bishop is the marketing manager and content strategist at LMH Health, which is a major sponsor of the Journal-World’s Health section.


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