Irregular heartbeat: Understanding atrial fibrillation

Benjamin Holmes, MD

Cardiology

A racing heart or fluttering in your chest can be a sign of atrial fibrillation, or AFib. Atrial fibrillation is an irregular heart rhythm (or arrhythmia) that affects the top chambers of the heart. Cardiologist Ben Holmes, MD, explained more about the condition and how it can be managed.

“The heart’s job is to pump blood to the remainder of the body. With AFib, the heart’s rhythm is irregular and, therefore, doesn’t pump blood as efficiently as it should. Instead of blood flowing through the heart in a normal manner, AFib can cause blood to swirl within the heart. Simply put, the heart is not working as efficiently as it should when it is in atrial fibrillation,” said Dr. Holmes.

What are the symptoms of AFib?

While not everyone experiences symptoms with AFib, there are certain signs you can watch out for. They include:

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

How can I prevent AFib?

Dr. Holmes said risk factors play an important role in the diagnosis and management of patients with atrial fibrillation. The good news is that you have the ability to control certain risk factors with lifestyle choices. These risk factors include:

• Obesity
• Sleep apnea
• Physical activity
• Hypertension
• Drinking alcohol
• Smoking
• High blood pressure
• Heart failure
• Other chronic conditions

“Other factors such as age and family history can also play a role in AFib, but those are things largely outside of your control,” said Dr. Holmes. “For the risk factors that you can control, you need to manage them. This will take both time and effort, but managing atrial fibrillation is very difficult without addressing these risk factors.”

How is AFib diagnosed?

“It can be difficult to diagnose AFib, as it is hard to document an irregular heart rhythm that may or may not be happening regularly,” said Dr. Holmes. If you experience any palpitations or poor energy symptoms, it is important to talk to your doctor. Methods of diagnosis include:

• Electrocardiogram (ECG)
• Implant loop recorder
• FDA approved commercially available rhythm monitors

What are the treatment options for AFib?

Atrial fibrillation is associated with strokes, so it is important to assess your risk of a stroke and discuss the appropriateness of blood thinners in preventing strokes. It is also important to control your heart rate and maintain a normal rhythm, especially patients who are highly symptomatic or have heart failure. 

• Medications include:
  • Beta blockers or calcium channel blockers. These medications can help control an irregular heart rhythm by slowing the heart rate. Palpitations and fatigue experienced because of AFib can be improved with these medications.
  • Blood thinners. In appropriate patients, these medications have been shown to reduce the risk of a stroke significantly.

• Procedures include:
  • Catheter ablation. A procedure that scars small areas in your heart aimed at keeping your heart in a normal rhythm.
  • Pacemaker. A small medical device surgically placed in your chest to help control your heartbeat.
  • Watchman. A minimally invasive procedure that implants a small device to close the left atrial appendage for an alternative to blood thinners in appropriate patients.

“There’s no magic bullet for treating atrial fibrillation,” said Dr. Holmes. “It is usually a process that involves addressing any underlying risk factors, which takes both time and effort.”