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Atrial fibrillation is an irregular and often rapid heart rate.
The heart has 4 chambers through which blood flows before being sent to the rest of the body to deliver oxygen and vital nutrients. The top 2 chambers are the atria and are important in helping blood reach the bottom 2 chambers, the ventricles. The right ventricle squeezes blood into the lungs to pick up oxygen, while the left ventricle distributes the blood to the rest of the body. Atrial fibrillation (AF) is a condition in which the electrical signals in the atria are rapid and disorganized, producing an irregular heartbeat. The most serious of possible consequences of AF are stroke and heart failure.
About 1 in 4 adults develop AF during their lifetime. Risk increases with age. Other risk factors include heart failure, excessive alcohol consumption, obstructive sleep apnea, obesity, high blood pressure, chronic kidney disease, heart valve problems, and thyroid disease. Some people have AF that comes and goes, lasting for minutes to weeks. These episodes can be triggered by alcohol intake, stress, or infection and can go away on their own or by addressing the underlying trigger. Some people experience AF continuously and permanently.
Symptoms of AF
Symptoms include palpitations (a sense that the heart is racing, beating irregularly, or skipping beats); fatigue; lightheadedness, dizziness, or fainting; shortness of breath; and stroke. Many patients have no symptoms while experiencing AF, but the risk of stroke and heart failure are still present.
Diagnosis and Treatment
Atrial fibrillation is diagnosed with an electrocardiogram in an office or hospital. There are several treatment strategies.
Rate control: Because AF tends to cause fast heart rate, a doctor can prescribe drugs that lower heart rate to improve symptoms and stabilize heart function, such as β-blockers (eg, metoprolol or carvedilol), calcium channel blockers (eg, diltiazem), or digoxin. If medications are not working, placing a pacemaker and performing an ablation of the conduction system can be considered.
Rhythm control: A medical team may recommend a procedure to help the heart come out of AF and restore a normal rhythm.
Antiarrhythmia drugs are designed to maintain normal rhythm.
Electrical cardioversion is a procedure in which a shock is sent to the heart to restore normal electrical activity. If AF continues to return and cause symptoms, long-term use of antiarrhythmia drugs can be prescribed.
Catheter ablation uses catheters inside the heart to eliminate sources of AF and reduce the number of AF episodes.
Stroke prevention: Because AF increases risk of stroke, patients at high stroke risk should consider taking anticoagulants (blood thinners). Aspirin and clopidogrel are not useful for prevention of stroke due to AF.
Many patients use wearable technologies and smartphone-based devices to monitor heart rate and heart rhythm. Many such devices are approved by the US Food and Drug Administration for their intended use. However, the results should be confirmed by a clinician since these devices, while reasonably accurate, are not perfect. They sometimes miss AF or incorrectly classify a rhythm as AF. Because many of these technologies are new, their exact role in helping the diagnosis and treatment of AF is still evolving.
US National Library of Medicinemedlineplus.gov/atrialfibrillation.html
JAMA Patient Pages on atrial fibrillation were published in the August 7, 2018, July 21, 2015, and March 10, 2015, issues of JAMA.
Conflict of Interest Disclosures: Dr Passman reported serving on advisory boards for Medtronic and Abbott; receiving research support from the American Heart Association and Pfizer/Bristol-Myers Squibb; and receiving royalties from UpToDate. No other disclosures were reported.
Source: January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. J Am Coll Cardiol. 2014;64(21):e1-e76. doi:10.1016/j.jacc.2014.03.022
Baman JR, Passman RS. Atrial Fibrillation. JAMA. 2021;325(21):2218. doi:10.1001/jama.2020.23700
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