A racing heart can be reason to worry though it is usually harmless. Stress or anxiety can cause it. Too much caffeine or alcohol can do it too. Problems can arise when it is due to an underlying condition known as atrial fibrillation or AFib. AFib is an abnormal rhythm of the upper chambers of the heart that can cause problems when not under control.
“AFib is a serious heart condition that increases the risk of stroke. It can occur with or without symptoms,” says Douglas Gibson, MD, a cardiologist and director of cardiac electrophysiology at Scripps Clinic. “The good news is that AFib is a manageable condition with the help of a good medical team.”
If you have AFib, your health care provider may include an electrophysiologist who is a doctor that specializes in the heart’s electrical signaling. Scripps is a leader in diagnosing and treating patients with abnormal heart rhythms, including AFib, and a leader in electrophysiology research for cardiac arrhythmia treatment.
The following are commonly asked questions about AFib. The information can help you better understand and control this manageable heart condition.
With AFib, the heart stops pumping blood effectively and this causes two problems.
First, it may cause symptoms, such as lightheadedness, dizziness and shortness of breath. Second, AFib increases an individual’s risk of stroke.
“When the upper chambers quit pumping blood effectively, blood can pool in those chambers, causing blood clots to form. Those blood clots can then leave the heart and travel to the brain causing stroke,” Dr. Gibson says.
AFib causes one in seven strokes in the United States, according to the Centers for Disease Control and Prevention (CDC).
About six million people have AFib in the US, according to the CDC. That number is likely to grow as people are living longer. Age is one of the main risk factors.
AFib is the result of abnormal or damaged heart muscle that can lead to rapid electrical firing. Conditions that damage heart muscle and are often associated with AFib include:
- High blood pressure
- Heart attack
- Coronary artery disease
- Abnormal heart valves
- Heart defects you're born with
- An overactive thyroid gland
- Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
- Sick sinus syndrome — improper functioning of the heart's natural pacemaker
- Lung diseases
- Previous heart surgery
- Viral infections
- Sleep apnea
- High level athletic activity such marathon running, long distance biking or swimming
Sometimes the cause of AFib is unknown.
The medical term for an abnormally fast heartbeat is tachycardia. There are many heart rhythm disorders that can cause tachycardia. AFib is the most common.
People with AFib are at higher risk for severe illness from COVID-19, according to the American Heart Association (AHA). COVID-19 is an acute respiratory illness that triggers inflammatory responses that can harm people with heart disease and other pre-existing conditions.
“People with AFib should avoid exposure to the coronavirus,” Dr. Gibson says. “They should practice physical distancing, take their medications as prescribed and consult with their doctor.”
Heart failure means the heart isn’t pumping enough blood to meet the body’s needs. AFib can lead to heart failure as it affects the heart’s ability to pump blood effectively.
“If the heart beats too fast for too long, that can cause the lower pumping chambers to fail and that can cause fluid to retain in the lungs and swelling in the legs. These are symptoms that we would typically associate with heart failure,” Dr. Gibson says.
“Atrial fibrillation can worsen heart failure as well,” he adds.
AFib is diagnosed with an electrocardiogram (ECG or EKG). In this test, electrodes are attached to the chest to record the electrical activity of your heart and check for a heart rhythm condition.
An EKG can be performed during an office visit. Sometimes patients are asked to wear a monitor at home to record their heart rhythm over time.
Women with AFib are at higher risk of stroke than women without the condition.
In some studies, women are at higher risk of stroke when compared to men with AFib. “This increase in risk appears to be mild but significant when other risk factors for stroke are present in a female patient,” Dr. Gibson says.
The most commonly used stroke risk score is known as CHADS2-VASC. It includes coronary artery disease, hypertension, age, diabetes, stroke history (2 points) and vascular disease. “When a person has a score of 2 or greater, stroke prevention strategies need to be carefully considered,” Dr. Gibson says.
The severity of symptoms — if present — stroke risk factors and other associated conditions are considered when deciding on the best treatment strategy for AFib.
Treatment goals generally include symptom management and stroke prevention. Your doctors will emphasize lifestyle modifications, such as weight loss and exercise, as part of the treatment plan.
Managing risk factors is an important part of AFib treatment. “Issues, such as sleep apnea and blood pressure control, need to be addressed,” Dr. Gibson says.
Medications are often given to reduce the risk of stroke and control heart rate and rhythm. Procedures may be considered for carefully selected individuals.
Stroke prevention strategies include blood thinning medications or procedures to occlude or close the left atrial appendage, which is a small structure in the heart where blood clots can form. It is not needed for normal heart function.
Occlusion is for people who have AFib that is not caused by a heart valve problem. The goal is to reduce the risk of stroke and need for blood thinning medication. Scripps is a national leader in placement of the Watchman device for occlusion of the left atrial appendage to prevent stroke-causing clots from forming there.
Some patients will not require any specific therapy for stroke prevention because of a low stroke risk.
AFib symptoms are controlled with medications or catheter ablation procedures. Catheter ablation is a minimally invasive procedure that targets the abnormal heart muscle that causes AFib.
When ablation is performed for the treatment of AFib, the procedure is referred to as an atrial fibrillation ablation. “This procedure may be part of a comprehensive treatment plan and is done only after carefully considering a patient’s situation,” Dr. Gibson says.
Scripps was the first San Diego health system to use catheter ablation to treat arrhythmias.
Scripps is nationally recognized as a heart care leader and consistently ranked by U.S. News & World Report as one of America’s Best Hospitals for cardiology and heart surgery.