Atrial fibrillation
(say 'A-tree-uhl fih-bruh-LAY-shun') is an irregular heart rhythm (arrhythmia)
that starts in the upper parts (atria) of the heart.
Normally, the
heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with
the heart's electrical system causes the atria to quiver,
or fibrillate. The quivering upsets the normal rhythm between the atria and the
lower parts (ventricles) of the heart. The lower parts may beat fast and
without a regular rhythm.
Atrial fibrillation is dangerous
because it greatly increases the risk of
stroke. If the heart doesn't beat strongly, blood can
collect, or pool, in the atria. Pooled blood is more likely to form clots. If
the heart pumps a clot into the bloodstream, the clot can travel to the brain
and block blood flow, causing a stroke. Atrial fibrillation can also lead to
heart failure.
What causes atrial fibrillation?
Conditions that
damage or strain the heart commonly cause atrial fibrillation. These
include:
Other medical problems, such as lung
disease,
pneumonia, or a high thyroid level (hyperthyroidism).
Heart
surgery.
Heavy alcohol use. Having more than 3 drinks a day over
many years can cause long-lasting atrial fibrillation. Drinking a large amount
of alcohol at one time (binge drinking) may also cause a spell (episode) of
atrial fibrillation.
Use of stimulants. These include caffeine,
nicotine, medicines such as decongestants, and illegal drugs such as
cocaine.
Use of some prescription medicines, such as albuterol or
theophylline.
Sometimes doctors can't find the cause. Doctors call
this lone atrial fibrillation.
What are the symptoms?
Symptoms may
include:
Feeling dizzy or lightheaded.
Feeling out of breath.
Feeling weak and tired.
A
feeling that the heart is fluttering, racing, or pounding (palpitations).
Atrial fibrillation is common, especially in older
adults, and it may not cause obvious symptoms. If you have any of the symptoms
listed, see your doctor. Finding and treating atrial fibrillation right away
can help you avoid serious problems.
How is atrial fibrillation diagnosed?
The doctor
will ask questions about your past health, do a physical exam, and order tests.
The best way to find out if you have atrial fibrillation is to have an
electrocardiogram (EKG or ECG). An EKG is a test that
checks for problems with the heart's electrical activity.
You
might also have lab tests, a chest X-ray, and an
echocardiogram. An echocardiogram can show how well
your heart is pumping and whether your heart valves are damaged.
How is it treated?
A number of treatments may be
used for atrial fibrillation. Which treatments are best for you depend on the
cause, your symptoms, and your risk of stroke.
Doctors sometimes
use a procedure called cardioversion to try to get the heartbeat back to a
normal rhythm. This can be done using either medicine
or a low-voltage electrical shock (electrical cardioversion). Atrial fibrillation often comes back after
cardioversion.
If you have mild symptoms, or if atrial
fibrillation returns after cardioversion, your doctor may prescribe medicines
to control your heart rate and help prevent stroke. These may include:
Rhythm-control medicines (antiarrhythmics) to help return the heart to its
normal rhythm and keep it there.
Rate-control medicines to keep
the heart from beating too fast during atrial fibrillation.
Cardioversion and medicines don't
work for some people who continue to have bothersome symptoms. In these cases,
doctors sometimes recommend a procedure called ablation. Ablation destroys
small areas of the heart. This creates scar tissue, which blocks or destroys
areas that cause or maintain the irregular heart rhythm. Afterward, you may
need a
pacemaker to keep your heart beating regularly.
What can you do at home for atrial fibrillation?
Atrial fibrillation is often the result of heart disease or damage. So
making changes that improve the condition of your heart may also improve your
overall health.
Don't smoke. Avoid secondhand smoke, too. Quitting smoking can
quickly reduce your risk of stroke and heart attack.
Eat a
heart-healthy diet with plenty of fish, fruits, vegetables, beans, high-fiber
grains and breads, and olive oil.
Get regular exercise on most,
preferably all, days of the week. Your doctor can suggest a safe level of
exercise for you.
Control your cholesterol and blood pressure. If
you have diabetes, keep your blood sugar in your target range.
Manage your stress level. Stress can damage your heart.
Avoid
caffeine, alcohol, and stimulants.
Avoid getting sick from the
flu. Get a flu shot every year.
Conditions that damage the heart muscle or strain the heart may cause
atrial fibrillation. These include:
High blood pressure, a condition in which the force of blood against artery walls
is too strong. Normal blood pressure is 119 millimeters of mercury (mm Hg)
systolic over 79 mm Hg diastolic or below.
Coronary artery disease and heart attack. Coronary
artery disease is caused by the buildup of plaque on the inside of the coronary
arteries. These blood vessels supply oxygen-rich blood to the heart muscle.
Heart failure. Heart failure occurs when the heart is
not able to pump blood effectively.
Heart valve disease, most often
mitral valve disease. Heart valve disease occurs when
a heart valve is damaged or narrowed and does not properly control the flow of
blood through and out of the heart.
Cardiomyopathy.
Cardiomyopathy damages the heart muscle and decreases the amount of blood it
can pump.
Myocarditis, which is inflammation of
the heart muscle. Myocarditis may occur after a viral, fungal, or bacterial
infection or another illness, such as diphtheria, rheumatic fever, or
tuberculosis.
Rheumatic heart disease. Rheumatic
heart disease is damage to the heart muscle and heart valves that results from
rheumatic fever.
Congenital heart disease. Congenital
heart defects are structural heart problems or abnormalities that have been
present since birth.
Endocarditis. Endocarditis can damage the heart muscle
and heart valves.
Heart surgery, such as
coronary artery bypass or valve surgery, can trigger
atrial fibrillation. In people older than 65, any surgery can trigger atrial
fibrillation and raise the risk of complications, such as a stroke. In these
cases, atrial fibrillation may be short-lasting. Treatment can return the heart
to a normal rhythm.
Other conditions that cause atrial
fibrillation include:
Pneumonia, which is an inflammation of the lungs that
is most often caused by infection with bacteria or a virus.
Pulmonary embolism. Pulmonary embolism is the sudden
blockage of blood flow in an artery in the lungs.
Hyperthyroidism, a condition in which the thyroid
gland produces too much thyroid hormone.
Use of alcohol. Long-term, heavy alcohol use seems to be linked
to atrial fibrillation. Besides long-term use, drinking a large amount of
alcohol at one time (binge drinking) may also cause an episode of atrial
fibrillation.
Use of stimulants. These include medicines, such as
theophylline, amphetamines, and decongestants that contain stimulants (such as
pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank;
and excessive nicotine or caffeine.
Use of some prescription
medicines, such as albuterol or theophylline.
Pericarditis, which is an inflammation of the sac
around the heart. Pericarditis can temporarily irritate the heart
muscle.
Atrial fibrillation caused by a condition that is
treatable, such as pneumonia or hyperthyroidism, often goes away when that
condition is treated.
Atrial fibrillation can sometimes develop in
people who do not have heart disease or other health conditions. This is called
lone atrial fibrillation.
Atrial fibrillation is often discovered during routine
medical checkups because many people do not have symptoms. Others may notice an
irregular pulse but do not have other symptoms.
Mild symptoms may
develop immediately. More serious problems may develop after the start of
atrial fibrillation and over the course of several days. So it is important to
identify and treat atrial fibrillation as soon as possible to avoid serious
problems.
Serious complications such as a
stroke or
heart failure may occur before atrial fibrillation is
discovered.
Use of alcohol. Long-term, heavy
alcohol use seems to be linked to atrial fibrillation.
Use of
stimulants. These include medicines, such as theophylline, amphetamines, and
decongestants that contain stimulants (such as pseudoephedrine); illegal drugs,
such as cocaine, methamphetamines, or crank; and excessive nicotine or
caffeine.
Use of some prescription medicines, such as albuterol or
theophylline.
In general, the extent to which you will need
specialized care will depend upon the severity of your symptoms and the
complexity of your individual case. Many people who have only mild symptoms or
whose arrhythmia is not causing other problems may continue to see their
primary care doctors for the ongoing management of the condition.
But some people with atrial fibrillation have severe symptoms and may
benefit from regular monitoring and treatment by a more specialized physician,
such as a:
An
electrocardiogram (EKG, ECG) is the best and simplest
way to determine whether you have
atrial fibrillation. An electrocardiogram is a
recording of the electrical activity of your heart. It is usually done along
with a
medical history and physical exam. During your exam,
your doctor will take your blood pressure to determine whether you have
high blood pressure. Your doctor will also listen to
your heart to see if you have a
heart murmur.
If your doctor suspects
that you have atrial fibrillation that comes and goes, he or she may ask you to
use a device to record your heart rhythm on a continuous basis. This is
referred to by several names, including
ambulatory electrocardiogram, ambulatory EKG, Holter
monitoring, 24-hour EKG, or cardiac event monitoring.
Your doctor
may do more tests to see whether you have damage to your heart or heart valves.
An
exercise electrocardiogram, also called a stress test,
will help your doctor see whether you have
coronary artery disease. An
echocardiogram gives your doctor a lot of information
about your heart. It can show whether your
heart valves are damaged, how well your heart is
pumping, and whether you have
heart failure or have had a
heart attack.
You may also have a blood
test to check for
hyperthyroidism. Hyperthyroidism develops when the
thyroid gland makes too much thyroid hormone.
You may get an X-ray
if your exams show that you might have heart failure or a problem in your
lungs, such as pneumonia.
If you take
anticoagulant medications for atrial fibrillation, you
will need to have frequent blood tests to monitor how long it takes for your
blood to clot (prothrombin time).
Treatment Overview
Treating
atrial fibrillation is important for several reasons.
An irregular, rapidly beating heart can weaken the heart muscle and cause it to
dilate or stretch out. This can increase your risk of developing
heart failure or having
chest pain or even a
heart attack. Also, atrial fibrillation can greatly
increase your risk of having a
stroke. Atrial fibrillation can also cause symptoms
that are hard to live with.
Many people are able to live full and
active lives while being treated for atrial fibrillation. To stay healthy, you
will probably need to take medicines, including an anticoagulant or aspirin,
medicines to slow heart rate, or possibly rhythm-control medicines.
Initial treatment
If
atrial fibrillation is causing your heart to pump
dangerously fast or your blood pressure to drop dramatically, you will probably
be taken to the hospital for treatment to restore your blood pressure and heart
rate to normal. If atrial fibrillation is not causing severe symptoms, you may
be treated on an outpatient basis. Treatment for people who have just started
having episodes of atrial fibrillation usually includes trying to convert the
heart to a normal rhythm. Sometimes anticoagulant medicines are used to prevent
clots and stroke.
If you have had atrial fibrillation forless than 48 hours, your doctor may perform a procedure
called cardioversion, using either medicine or a low-voltage electrical shock
(electrical cardioversion), to return the irregular
heartbeat to a normal rhythm (normal sinus rhythm).
If
atrial fibrillation has lasted for more than 48 hours,
attempting cardioversion could cause a stroke. In this case, you may need to
take the
anticoagulant medicine warfarin (such as Coumadin) for
several weeks before your doctor tries cardioversion. Taking anticoagulants
reduces the chance that a clot might travel from the heart to the brain after
cardioversion.
If you are not sure how long
you have had atrial fibrillation, you are also at risk of having a clot in your
heart. If you are not having severe symptoms, such as fainting, your doctor
will probably also recommend that you take anticoagulants for several weeks
before cardioversion to prevent a stroke.
If you have
severe symptoms and you are not sure how long you have
had atrial fibrillation, your doctor may try to restore your heart to a normal
rhythm immediately. In this case, your doctor will use a
transesophageal echocardiogram to determine whether
you have a clot in your heart that could cause a stroke. The results of this
test will determine what your doctor does next:
If the heart is clear of clots,
cardioversion can be attempted. Anticoagulants are used after to prevent
strokes.
If there is a clot in the heart, your doctor will
prescribe anticoagulants before trying cardioversion.
Cardioversion usually works to restore a normal sinus
rhythm. But in many cases the heart rhythm goes back to atrial
fibrillation.
When
atrial fibrillation comes on suddenly, lasts a short
time, and goes away on its own, it is called
paroxysmal atrial fibrillation. Typically, episodes of
paroxysmal atrial fibrillation come on more often and last longer over
time.
Having paroxysmal atrial fibrillation can raise your risk of
stroke. If you are at an average to high risk of having a stroke, your doctor
may prescribe long-term use of an
anticoagulant medicine, warfarin (such as Coumadin),
to reduce this risk. You may be at average to high risk of stroke if you are
older than 75 or have a history of heart disease,
high blood pressure,
diabetes, or stroke. If you are at low risk of having
a stroke or you cannot take warfarin, you may need to take
aspirin daily.
You may also need to take
rhythm-control medicines (antiarrhythmics) to try to prevent
paroxysmal atrial fibrillation from recurring.
Doctors may
recommend the "pill in the pocket" approach for people with paroxysmal atrial
fibrillation. With this approach, you can take a single dose of an
antiarrhythmic drug when you feel palpitations instead of taking the medicine
every day. For some people, this stops atrial fibrillation episodes. It may
also reduce medicine side effects and the need to be seen in the emergency room
or be hospitalized. But not everyone can use this treatment. Before you can
take the "pill in the pocket" approach, your doctor will want to make sure that
you do not have any other heart disease and that your heart's electrical system
is normal.
Over time, episodes of
atrial fibrillation typically last longer and often do
not go away on their own. This is called persistent atrial fibrillation. When
you have had atrial fibrillation for a long time, it is more difficult to
return your heart to a normal rhythm (also called a
normal sinus rhythm). When cardioversion is not an
option or does not work, medicines are usually given to control the heart rate
and prevent stroke.
Rate-control medicines.
Rate-control medicines are used if your heart rate is too fast. These medicines
include
beta-blockers,
calcium channel blockers, and/or
digoxin. They usually do not return your heart to a
normal rhythm-in other words, your heartbeat will still be irregular. But these
medicines can keep your heart from beating at a dangerously fast rate. Most
people tolerate an irregular heart rhythm if the rate is kept between 60 and
100 beats per minute.
Rhythm-control medicines.Rhythm-control medicines (antiarrhythmics) are still considered valuable for the
treatment of atrial fibrillation. If symptoms persist despite rate-control
medicines and in certain other cases, rhythm-control medicines are often
prescribed. These medicines help return the heart to its normal rhythm and keep
atrial fibrillation from returning.
Research studies have changed
the way persistent atrial fibrillation is treated in many cases. The studies
found that traditionally prescribed rhythm-control medicines were expensive,
often had side effects, and did not produce better results than rate-control
medicines. Still, rate-control and rhythm-control medicines are both effective
treatments for atrial fibrillation. Your doctor will likely talk with you about
which of these treatments might be best for you.
Anticoagulant medicines. Most people with atrial fibrillation
should take warfarin (such as Coumadin), an
anticoagulation medicine, to prevent blood clots that
can lead to a
stroke. Warfarin can prevent stroke and save lives in
people who have an average to high risk of stroke. If you have high blood
pressure, diabetes, heart failure, or a history of
transient ischemic attack (TIA) or stroke, you may be
at average to high risk of stroke. Talk to your doctor about whether you should
take warfarin.
For people with a low risk of stroke or those who
cannot take warfarin, daily
aspirin may be recommended.
If you take warfarin, don't suddenly change your intake
of foods that are rich in vitamin K. Vitamin K can interfere with the action of
anticoagulants, making it more likely that your blood will clot. For more
information, see:
For some
people with
atrial fibrillation, medicines to slow the heart rate
or control its rhythm do not work. These people continue to have a rapid,
irregular heart rate. In these cases, doctors sometimes recommend a nonsurgical
procedure called
catheter ablation or a surgical procedure called the
maze procedure. Experts suggest that these procedures
should be performed in a medical center where the staff has experience with the
procedures.
Catheter ablation
Catheter ablation for atrial fibrillation is
relatively new and is still being studied. Catheter ablation destroys the heart
tissue that causes atrial fibrillation and keeps atrial fibrillation going
after it starts. Thin wires are inserted into a vein in the groin and guided
into the heart. The wires have an attachment at the tip. The attachment sends
out very hot or very cold temperatures. This heat or cold destroys the tissue
that causes atrial fibrillation or the tissue that keeps it happening.
Catheter ablation is most successful at treating paroxysmal atrial
fibrillation. In people with persistent or chronic atrial fibrillation, the
success rate is lower. Catheter ablation is an invasive procedure and has some
serious risks. Catheter ablation should only be done in people who have tried
other treatments but continue to have serious symptoms. As the procedure
becomes more effective and safe, doctors may use it as one of the first
treatments for atrial fibrillation.
Ablation procedures either
try to cure atrial fibrillation (focal ablation, circumferential ablation, or
pulmonary vein ablation) or try to control your symptoms (nodal ablation).
Ablation to cure atrial fibrillation.
Focal, circumferential, and pulmonary vein catheter ablation are used to try to
cure atrial fibrillation. Focal ablation, also known as targeted ablation, is
used to destroy the specific areas that are firing off abnormal electrical
impulses and causing atrial fibrillation. Circumferential ablation is used to
destroy the tissue that lets atrial fibrillation continue. Sometimes a doctor
uses both focal and circumferential ablation.
Sometimes, abnormal
impulses come from inside a pulmonary vein and cause atrial fibrillation. (The
pulmonary veins bring blood back from the lungs to the heart.) Catheter
ablation in the pulmonary vein can block these impulses and prevent atrial
fibrillation from happening.
A pacemaker device is usually not
needed when only specific areas are destroyed.
Ablation to control symptoms of atrial fibrillation. Nodal
catheter ablation may be used to control symptoms of atrial fibrillation when
the cause cannot be stopped. Nodal catheter ablation destroys your
atrioventricular (AV) node and blocks electrical
signals to your lower heart chambers (ventricles). After nodal catheter
ablation, you will need a
permanent pacemaker to regulate your heart rhythm.
Nodal ablation can control your heart rate and reduce your symptoms, but it
does not prevent or cure atrial fibrillation. So you will probably need to take
the anticoagulant warfarin (Coumadin, for example).
A
surgical procedure to cure atrial fibrillation is called the
maze procedure. The maze procedure is usually done
during open-heart surgery. The procedure creates scar tissue that blocks excess
electrical impulses from traveling through your heart. Because of the risks
involved with open-heart surgery, this procedure is used only in people who
have severe symptoms and are having heart surgery for other reasons. Doctors
are developing less invasive surgical maze techniques. These may be less
painful and easier to recover from.
At first, people usually have
paroxysmal atrial fibrillation. Paroxysmal episodes go
away on their own. They may last anywhere from a few seconds to a few weeks and
may not cause symptoms.
Paroxysmal atrial fibrillation episodes
may recur for weeks or years, although usually the disease progresses, and
atrial fibrillation becomes persistent, meaning that it no longer goes away on
its own. Your doctor may try a procedure called cardioversion, using either
medicine or low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm
(normal sinus rhythm). The decision to try
cardioversion is based upon how bothersome you find the symptoms and how long
the episode of atrial fibrillation has persisted.
If the heart
cannot be converted to a normal rhythm or does not stay in a normal rhythm,
medicines are used to control the heart rate and prevent it from becoming
dangerously fast. Many people are able to live full and active lives while
being treated for atrial fibrillation. Others may need further treatment
because they develop shortness of breath, weakness, fainting, or other
significant symptoms.
Lone atrial fibrillation
In rare cases, doctors cannot find the cause
of atrial fibrillation. These cases are called lone atrial fibrillation. Lone
atrial fibrillation occurs more often in people younger than 65. It often stops
on its own, or it may need to be treated.
Treatment may be needed
if a rapid heartbeat causes discomfort, decreased energy, or other unacceptable
symptoms. Adults older than age 75 with lone atrial fibrillation are at risk
for
stroke and require treatment with the
anticoagulant medicine warfarin (such as
Coumadin).
Stroke risk
Atrial
fibrillation increases your chance of having a
stroke. When blood does not completely empty out of
the rapidly beating atria, a clot can develop in the blood that pools in the
atria. The clot may travel from the heart to the brain, causing a
stroke.
People with atrial fibrillation and no damage to the heart
valves are 6 times more likely to have a stroke than people without atrial
fibrillation. The risk of stroke is significantly higher if heart valve damage
is present. This risk of stroke also increases with age and with high blood
pressure, diabetes, heart failure, or a previous stroke or transient ischemic
attack (TIA). Taking
anticoagulant medicines greatly reduces your risk of
blood clots and stroke.
If atrial fibrillation is not
treated, it can further damage the heart and cause serious complications, such
as
heart failure.
You can lower your risk of
complications by controlling high blood pressure.
Prevention
A healthy lifestyle, proper nutrition,
treatment for high blood pressure, and other measures can prevent
atrial fibrillation by protecting you from heart
disease. Manage your stress, exercise regularly, control your blood pressure,
and do not smoke.
Experts also recommend that adults eat at least two servings
of fish each week, particularly fish such as salmon, trout, and tuna, for a
healthy heart. Also, one study found that eating baked or broiled fish may
reduce your risk for developing atrial fibrillation.1
For more information, see the topic Coronary Artery Disease.
Avoid
medicines, alcohol, and stimulants-such as caffeine or nicotine-that may
contribute to the development of atrial fibrillation.
Take
antibiotics when directed to do so by your doctor to
lower your chance of getting a heart infection (endocarditis).
Infection in the heart may lead to atrial fibrillation. For more information,
see the topic Endocarditis.
Because atrial fibrillation raises
your risk for
stroke and many people do not have symptoms of atrial
fibrillation, the U.S. National Stroke Association recommends that everyone,
particularly those ages 55 and older and those who have other stroke risk
factors, check his or her heartbeat once a month. To learn how to check your
pulse, see
taking your pulse. If you notice that your heartbeat does not have a regular
rhythm, talk to your doctor.
Living With Atrial Fibrillation
Because
atrial fibrillation is often the result of a heart
condition, making changes to improve your heart condition will usually improve
your overall health. Some of these changes include:
Quitting smoking and avoiding secondhand smoke. Quitting smoking
may be the most important step you can take to prevent
coronary artery disease. For more information, see the
topic
Quitting Smoking.
Controlling your blood pressure. Follow a
low-sodium, low-fat, and low-saturated fat diet; increase your exercise;
decrease alcohol intake; and take medicines, if needed, to control your blood
pressure.
Eating more fish. Experts recommend that adults
eat at least
two servings of fish each week, particularly fish such as salmon, trout, and
tuna, for a healthy heart. Also, a recent study found that eating baked or
broiled fish may reduce your risk for developing atrial fibrillation.1
Not using alcohol, caffeine, or stimulants, such
as methamphetamines or cocaine. Be aware that some nonprescription medicines,
especially cold and herbal remedies, contain stimulants that can trigger atrial
fibrillation. Talk to your doctor or pharmacist before taking any new
medicine.
Trying an
exercise program. Exercise has many positive effects:
weight management, cholesterol reduction, blood pressure control, blood sugar
leveling in diabetes, triglyceride reduction, mood elevation, and increased
strength. Try to exercise on most, preferably all, days of the week. Talk to
your doctor before starting an exercise program. For more information, see the
topic Cardiac Rehabilitation.
Avoid getting sick from the
flu. Get a flu shot every year.
Being on
the alert for signs of
obstructive sleep apnea because many people with
atrial fibrillation also have obstructive sleep apnea.
Using
complementary options to help control your stress. Examples include:
Do not switch medicine brands
without talking to your doctor.
Check with your doctor before using
any nonprescription medicines, especially ones that contain aspirin. To help
keep track of all of your medicines, use a
medication planner(What is a PDF document?)
.
Wear a medical alert ID bracelet, pendant, or
charm to let others know that you take anticoagulants. Ask your pharmacist for
information about ordering one.
Tell any new doctor you consult
that you are taking anticoagulant medicine. This includes your
dentist.
Be on the alert for
signs of bleeding, and call your doctor immediately if any of these signs
occur.
Get regular blood tests to check your clotting time. When
you are taking an anticoagulant, you will have your blood drawn and tested
regularly so that your doctor can monitor the level of the anticoagulant in
your blood. The test that measures how long it takes your blood to clot is
called prothrombin time, or pro-time.
Before a surgery or some
tests (such as a colonoscopy), talk to your doctor about whether you need to
stop taking your anticoagulant for a short time before the procedure. Stopping
the anticoagulant helps prevent extra bleeding during the surgery or test. Your
doctor will tell you when it is safe to start taking your medicine
again.
Eat a balanced diet. Don't suddenly change your intake of
foods that are rich in vitamin K. Vitamin K can interfere with the action of
anticoagulants, making it more likely that your blood will clot. For more
information, see:
Tell your doctor if you are not able to eat for
several days or have stomach upset, diarrhea, or fever or if you have a major
change in your diet for other reasons. It is important not to have sudden
changes in your diet.
Avoid excessive use of alcohol. If you drink,
do so only in moderation. Alcohol decreases the effect of anticoagulants.
Alcohol also affects your balance and coordination and raises your risk of
injury from a fall.
Don't smoke. And avoid secondhand smoke.
Smoking affects how the body uses medicine and increases the blood's clotting
effects.
Avoid activities that have a high risk for injury, such
as skiing, football, or other contact sports. An injury could result in
excessive bleeding if you are taking anticoagulants.
Because atrial fibrillation raises your risk for
stroke and many people do not have symptoms of atrial
fibrillation, the U.S. National Stroke Association recommends that everyone,
particularly those ages 55 and older, check his or her heartbeat once a month.
To learn how to check your pulse, see
taking your pulse. If you notice that your heartbeat does not have a regular
rhythm, talk to your doctor.
Medications
Medicine treatment decisions are based
on the cause of your
atrial fibrillation, your symptoms, and your risk for
complications. You will likely take a medicine to help prevent a
stroke. You may also take a medicine that controls
your heart rate or your heart rhythm.
Treatment with medicine is
often needed for many years when heart disease is the cause of atrial
fibrillation.
Rate-control medicines are used if your heart rate
is too fast. Your doctor may give them to you to see if your atrial
fibrillation symptoms are present when your heart rate is under control. These
medicines include
beta-blockers,
calcium channel blockers, and/or
digoxin. Rate-control medicines may not be an option
if you have a lot of symptoms with atrial fibrillation.
In a
study called the AFFIRM trial, rate-control medicines were found to be
preferable to
antiarrhythmic medicines as a first treatment for
certain people with atrial fibrillation, specifically older people at risk for
stroke who did not have severe symptoms. The study found that antiarrhythmic
medicines were expensive, often had side effects, and did not produce better
results in this group of people.3
Unlike
antiarrhythmic medicines, rate-control medicines usually do not return your
heart to a normal rhythm. In other words, your heart rhythm will still be
irregular. But these medicines can keep your heart from beating at a
dangerously fast rate. Most people tolerate an irregular heart rhythm if the
rate is kept between 60 and 100 beats per minute.
Rhythm-control
medicines are sometimes used to try to convert atrial fibrillation to a
normal sinus rhythm. Rhythm-control medicines, also
called
antiarrhythmic medicines, are also used to try to
maintain normal sinus rhythm when symptoms persist despite rate-control
medications and in certain other cases.
Anticoagulant medicines, such as warfarin (Coumadin, for example), are recommended for
most people with atrial fibrillation who are at average to high risk of
stroke.
If you are at low risk of stroke or cannot take
anticoagulants, your doctor may recommend that you take
aspirin. It is not as effective as anticoagulant
medicines in preventing clots, but it does not have as many side effects. Other
antiplatelet medicines, such as clopidogrel (Plavix),
may be used if you are unable to tolerate aspirin.
The
maze procedure, a surgery to correct
atrial fibrillation, may be an option. Usually
medicines and catheter ablation are tried before surgery is considered. But you
may be a candidate for this surgery, especially if you are already having heart
surgery for another reason, such as mitral valve replacement or coronary artery
bypass surgery. If this is the case, the maze procedure can be done at the same
time.
The maze procedure involves creating scar tissue that blocks
excess electrical impulses from traveling through your heart. It usually
requires open-heart surgery, but less invasive surgical methods are being
developed.
Other Treatment
Electrical cardioversion is frequently used for atrial fibrillation to restore a
normal sinus rhythm if the heart rhythm does not
convert on its own. You may also elect to have cardioversion if you find your
symptoms bothersome.
If your
atrial fibrillation has recently started and it has
been continuously present for less than 48 hours, your doctor may consider
using
electrical cardioversion or
antiarrhythmic medicines to convert your heart to a
normal rhythm. If your atrial fibrillation has lasted for more than 48 hours,
it is possible that the blood that is pooling in the quivering upper heart
chambers (atria) has led to the formation of blood clots. Cardioversion could
cause a blood clot to be pumped into the bloodstream, travel to the brain, and
cause a stroke.
If you've had atrial fibrillation for more than 48
hours, your doctor will probably prescribe anticoagulants for several weeks to
reduce the risk of
stroke before attempting cardioversion.
But if you have severe symptoms, such as very low blood pressure, you may
have cardioversion immediately. In this case, your doctor may use a
transesophageal echocardiogram to assess whether you
have any clots in your heart that could cause a stroke. If the transesophageal
echocardiogram shows that your heart is clear of clots, you may have
cardioversion.
Anticoagulant medicine is taken for at least 3 weeks
after cardioversion.
If medicines do not keep you in normal rhythm
and you continue to be bothered by your symptoms,
catheter ablation might help you. Catheter ablation is
used to try to cure atrial fibrillation or to control the heart rate. The
procedure destroys small areas in the heart that might be causing atrial
fibrillation or keep it going. You may need a
permanent pacemaker along with catheter ablation.
Call the American Heart Association (AHA) to find your
nearest local or state AHA group. AHA can provide brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support. AHA's Web site also has information on
physical activity, diet, and various heart-related conditions.
Heart Rhythm Society
1400 K Street NW
Suite 500
Washington, DC 20005
Phone:
(202) 464-3400
Fax:
(202) 464-3401
Web Address:
www.hrsonline.org
The Heart Rhythm Society provides information for
patients and the public about heart rhythm problems. The Web site includes a
section that focuses on patient information. This information includes causes,
prevention, tests, treatment, and patient stories about heart rhythm problems.
You can use the Find a Specialist section of the Web site to search for a heart
rhythm specialist practicing in your area.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI)
information center offers information and publications about preventing and
treating heart, lung, and blood diseases.
Mozaffarian D, et al. (2004). Fish intake and risk of
incident atrial fibrillation. Circulation, 110(4):
368-373.
American Heart Association (2006). Diet and lifestyle
recommendations revision 2006. Circulation, 114(1):
82-96. [Erratum in Circulation, 114(1): e27.]
Wyse DG (2002). Rate Versus Rhythm Control in the Management of Atrial Fibrillation. Available online:
http://www.americanheart.org/presenter.jhtml?identifier=3005618.
Other Works Consulted
American Heart Association and American College of
Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients
with coronary and other atherosclerotic vascular disease: 2006 update.
Circulation, 113(19): 2363-2372. [Erratum in
Circulation, 113(22): 847.]
Boos CJ, et al. (2007). Atrial fibrillation (chronic),
search date August 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Hirsch J, et al. (2008). Executive summary: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
ed.). Chest, 133(6): 71-109.
Lip GYH, Watson T (2007). Atrial fibrillation (acute
onset), search date October 2007. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Mozaffarian D, et al. (2008). Physical activity and
incidence of atrial fibrillation in older adults. The Cardiovascular Health
Study. Circulation. Published online August 4, 2008
(doi:10.1161/circulationaha.108.785626).
Prystowsky EN, Waldo AL (2008). Atrial fibrillation,
atrial flutter, and atrial tachycardia. In V Fuster et al., eds.,
Hurst's the Heart, 12th ed., pp.953-982. New York:
McGraw-Hill Medical.
Shea JB, Sears SF (2008). A patient's guide to living
with atrial fibrillation. Circulation, 117(20):
e340-e343.
Sherman DG, et al. (2005). Occurrence and
characteristics of stroke events in the atrial fibrillation follow-up
investigation of sinus rhythm management (AFFIRM) study. Archives of Internal Medicine, 165(10): 1185-1191.
Snow V, et al. (2003). Management of newly detected
atrial fibrillation: A clinical practice guideline from the American Academy of
Family Physicians and the American College of Physicians. Annals of Internal Medicine, 139(12): 1009-1018.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Mozaffarian D, et al. (2004). Fish intake and risk of
incident atrial fibrillation. Circulation, 110(4):
368-373.
American Heart Association (2006). Diet and lifestyle
recommendations revision 2006. Circulation, 114(1):
82-96. [Erratum in Circulation, 114(1): e27.]
Wyse DG (2002). Rate Versus Rhythm Control in the Management of Atrial Fibrillation. Available online:
http://www.americanheart.org/presenter.jhtml?identifier=3005618.
