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Atrial fibrillation (also called AF or A Fib) is the most common form of sustained arrhythmia (heart rhythm disorder). Atrial fibrillation is more common in older people, people with high blood pressure, and people with other kinds of heart disease. It can lead to serious health problems such as stroke, fatigue, and heart failure. The January 27, 2010, issue of JAMA includes an article about treatments for atrial fibrillation. This Patient Page is based on one previously published in the December 19, 2007, issue of JAMA.
Atrial fibrillation occurs when the electrical impulses that cause the heart to beat in a regular rhythmic manner become disorganized, causing the heart to beat irregularly and often too fast with too little force. The irregular pulse can be felt and can be seen on an electrocardiogram. An electrocardiogram (ECG or EKG) is a recording of the electrical activity of the heart made from electrodes (electrical conductors) placed on the surface of the skin, usually on each arm and leg and across the chest. On a normal ECG, the electrical activity of the heart appears as regular peaks and valleys. On an ECG of a person with atrial fibrillation, the peaks and valleys are not regular and often are closer together, representing a faster heartbeat. Atrial fibrillation decreases the efficiency of the pumping action of the heart. It also increases the risk of formation of blood clots inside the heart. These blood clots can break off and go to other parts of the body, including the brain, where they can cause a stroke.
Some people with atrial fibrillation may not experience any symptoms at all. Others report feeling palpitations (a sensation of the heart "flopping") or may have chest discomfort or dizziness. A few people develop sudden and severe shortness of breath.
The two most important treatment goals involve slowing the heart rate to improve heart pumping efficiency and using anticoagulants (blood thinners) to prevent stroke.
Beta-blockers and calcium channel blockers are types of medication that can slow the heart rate.
Warfarin and aspirin are blood thinners. Warfarin is more effective in preventing strokes but can lead to bleeding and requires careful medical supervision.
Electrical cardioversion is a procedure that can reestablish regular rhythm for patients with severe symptoms. The patient is sedated and an electrical charge is given to the heart through the chest. Antiarrhythmic drugs may also be administered.
Other procedures involving surgery or use of a catheter (a tube inserted into the heart through a blood vessel) are available for individuals with symptoms due to atrial fibrillation.
American Heart Associationhttp://www.americanheart.org
National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. A Patient Page on electrocardiograms was published in the September 13, 2006, issue.
Sources: American College of Cardiology; National Heart, Lung, and Blood Institute; American Heart Association
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
TOPIC: HEART DISEASE
Torpy JM, Lynm C, Glass RM. Atrial Fibrillation. JAMA. 2010;303(4):380. doi:10.1001/jama.303.4.380
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