Irregular heartbeat: Understanding atrial fibrillation

John Erwin, MD

Cardiology

If you’ve ever felt your heart “flutter,” race unexpectedly, skip beats or pound in your chest, you may have wondered whether these sensations are normal or something more serious. For cardiologist John Erwin, MD, the potential cause of these feelings is one of the most common heart rhythm issues he sees in his practice, atrial fibrillation.

“As a cardiologist with nearly three decades of clinical experience,” said Dr. Erwin, “it’s my goal to help my patients and the community at large to understand what AFib is, what symptoms of AFib to watch for and how modern treatments have the potential to dramatically reduce not just your symptoms but also your risk of stroke, heart failure or hospitalization.”

What is atrial fibrillation?

Atrial fibrillation is an irregular and usually rapid heart rhythm that starts in the top chambers of the heart, called the atria.

“Your heart’s job is simply to pump blood efficiently to the rest of your body,” said Dr. Erwin. “In AFib, the atria quiver, or “fibrillate”, instead of squeezing in a coordinated way. Blood may not move through the heart as smoothly, sometimes swirling or stagnating. This increases your risk of forming blood clots.”

In the end, when you’re experiencing atrial fibrillation, your heart just isn’t beating efficiently. While it can cause symptoms that seem harmless, it can also result in serious, even life-threatening complications.

What are the symptoms of AFib?

Some people don’t have symptoms at all. But there are still some symptoms of AFib for you to watch out for, including:

• Palpitations
  • A flip-flopping sensation within the chest
  • Heart racing or fluttering
  • Chest tightness
  • Anxiety
• Lower energy
  • Fatigue
  • Shortness of breath
  • Poor exercise tolerance
  • Dizziness or light-headedness

How can I prevent AFib?

“Risk-factor management is a cornerstone of treatment when it comes to AFib,” said Dr. Erwin. “In so many cases, improving whatever risk factors we can not only reduces AFib episodes, but can also prevent the condition entirely.”

Risk factors for atrial fibrillation you can influence include:

• Obesity or weight gain
• High blood pressure
• Sleep apnea (diagnosed or suspected)
• Physical inactivity
• Excess alcohol (especially binge drinking)
• Smoking
• Chronic conditions such as diabetes or thyroid disease
• Heart failure or structural heart disease

Unfortunately, some risk factors like age, family history or genetics are outside of our control. That’s just one reason that taking action on what risk factors you can change is so important.

How is AFib diagnosed?

“Because AFib can come and go, it can sometimes be tricky to catch,” said Dr. Erwin. “If you report palpitations, shortness of breath or fatigue, your clinician may use one of several testing methods to try and record it.”

Ways to detect AFib include:

• Electrocardiogram (ECG): A snapshot of your heart’s rhythm at that moment.
• Home rhythm monitors: FDA-approved patch monitors, smart devices/watches or handheld ECG monitors that record rhythm during symptoms.
• Implantable loop recorder: A tiny device placed under the skin of the chest for long-term rhythm monitoring.

The earlier the diagnosis, the better, as AFib is linked to a higher stroke risk.

What are the treatment options for AFib?

The right treatment depends on your symptoms, stroke risk and other medical conditions or personal goals. Treatment tends to focus on preventing stroke, controlling your heart rate and rhythm and restoring the correct heart rhythm moving forward.

“Many people believe blood thinners are the go-to treatment for AFib,” said Dr. Erwin. “Not everyone will benefit significantly from using them, but in the right patients they help reduce the risk of stroke by up to 70% and have a lower bleeding risk than older medications like warfarin. However, there are still some patients where a treatment like warfarin is the better option.”

Since some patients cannot safely take blood thinners, there are left atrial appendage closure devices, such as the Watchman, that offer an alternative.

“Some patients feel better once the heart is slowed and allowed to beat more regularly,” said Dr. Erwin. “In those cases, medications like beta blockers or calcium channel blockers can make a big difference by reducing palpitations, improving your energy and stamina and supporting overall heart function.”

Finally, working on returning the heart rhythm to normal and controlling it from there is a major focus of treatment for AFib, especially for patients whose symptoms are impacting their quality of life, or if they’re younger, active or currently have heart failure.

“We may rely on antiarrhythmic medications in some cases, but those require very careful selection and monitoring,” said Dr. Erwin. “One of the biggest advances in cardiology over the past decade is making a big impact, and that’s catheter ablation.”

Using minimally invasive tools, your care team can identify and isolate the abnormal electrical triggers in the heart. For many patients, this significantly reduces or even eliminates AFib episodes.

“In the past, ablation was often considered a last resort,” added Dr. Erwin. “Today, it’s usually suggested earlier in the course of treatment for appropriate patients, as it makes such a big difference in quality of life.”

In some cases where a patient is experiencing a slow heart rate or problems with conduction in the heart, a pacemaker may be implemented. Pacemakers use electrical signals to regulate the rhythm of your heart.

Treatment for AFib isn’t one-size-fits-all

“Managing AFib is not a quick fix,” said Dr. Erwin. “It’s a combination of treating underlying risk factors, preventing stroke, controlling the heart’s rate or rhythm and tailoring therapy to each patient’s needs and goals.”

The good news is that with today’s tools, most patients live full, active lives with dramatically reduced risk of stroke and heart failure.