Varicose Veins Masthead
Atrial Fibrillation (AFib)

An estimated 2.7 million Americans are living with atrial fibrillation (AFib). According to the American Heart Association, that makes it the most common heart rhythm abnormality in the United States.

AFib itself usually isn't life-threatening, but it can lead to serious problems such as chronic fatigue, congestive heart failure, and stroke. At Health First, our team of experienced physicians and staff can help you to get you back into the "rhythm" of life.

What is AFib?
What are the causes of AFib?
Symptoms of AFib
What are the risks and dangers of AFib?
Evaluation and Treatments
How to reduce your risk

What is AFib?

AFib is an irregular heartbeat. In a normal heart, an electrical impulse passes through the top portions of the heart (atria) in an orderly fashion. With AFib, impulses are very rapid and uneven. In response to these impulses, the atria contract quickly and unevenly. This means the heart is unable to pump blood the way it should. Sometimes rapid AFib impulses cross to the ventricles causing them to beat rapidly and irregularly as well.

AFib is generally classified in three categories

  • Paroxysmal is when the AFib episode is intermittent.
  • Persistent AFib occurs more frequently and may or may not be responsive to drug therapy
  • Permanent AFib means the heart is in a constant AFib state.

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What are the causes of AFib?

Often the cause of AFib is unknown, but certain factors can make you more likely to develop it. AFib often affects people who have coronary heart disease or who have had a heart attack. Other conditions linked to AFib include:

  • High blood pressure
  • Recent heart surgery
  • Valvular heart disease
  • Inflammation of the heart muscle (myocarditis) or lining of the heart (pericarditis)
  • Congenital heart defect
  • Overactive thyroid gland
  • Acute or chronic lung disease

People over the age of 50 are more likely to have AFib, as the risk of AFib increases with age. Diabetes, excessive alcohol use and stimulant drug use are other factors that increase the risk of AFib.

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Some people with AFib don't feel a thing, but others notice changes in their heartbeat right away. It may feel fast, uncomfortable, irregular heartbeat much like a fluttering feeling in the chest. Dizziness, sweating, lack of energy, shortness of breath, and chest pain or pressure can also occur.

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What are the risks and dangers of AFib?

Many people live for years with AFib without problems. However, even without symptoms, the real danger is the increased risk for stroke and heart problems. The most serious risks of AFib include stroke, heart failure, chronic fatigue, additional heart rhythm problems, and inconsistent blood supply.

AFib and Stroke

During AFib, some blood may not be pumped from the atria into the ventricles efficiently. Blood that is left behind can pool in the atria and form blood clots. If a blood clot leaves the heart and enters the bloodstream, it can travel to the brain blocking an artery or blood vessel causing a stroke.

Everyone with AFib is at risk for stroke, but those over the age of 75, those who have hypertension, heart failure, or diabetes, and those who have had a stroke or ischemic attack before, are at greater risk.

AFib and Heart Failure

Heart failure means the heart isn't pumping enough blood to meet the body's needs. AFib can lead to heart failure because the heart is beating so fast that it never properly fills with blood to pump to the body. Because of this, blood can back up in the pulmonary veins which can cause fluid to back up into the lungs. This fluid in the lungs can cause fatigue and shortness of breath. Fluid can also build up in the feet, ankles, and legs causing heart-failure related weight gain.

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Evaluation and Treatments

One of our health care professionals will work with you on the best way to treat your AFib. To determine what treatments are right for you, your health care provider will perform an evaluation that includes:

  • A review of your medical history
  • An echocardiogram
  • Complete physical exam
  • Holter monitor test
  • Electrocardiogram (ECG)
  • Other tests as needed

After the evaluation, your treatment options will be discussed as well as the next steps in treating your AFib.

There are a variety of treatments for AFib. Your health care provider may choose to start you on an anti-clotting medication to prevent blood clots.

Other treatments may control or stop the electrical impulses that cause AFib which include:

The WATCHMAN Procedure

Health First Heart & Vascular Services is proud to be the first and only comprehensive cardiology program in Brevard County to offer the WATCHMAN Implant. WATCHMAN is a one-time procedure that reduces the risk of stroke in people with atrial fibrillation and is as effective at reducing the risk of stroke as Warfarin. But unlike Warfarin, the WATCHMAN implant also reduces the long-term risk of bleeding.

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Electrical Cardioversion

Electrical cardioversion is a procedure that delivers a small electrical shock to the heart from outside the chest wall. This stops the heart's electrical activity briefly in order for the normal rhythm produced by the sinus node to take over. Cardioversion can treat AFib, but it is not a cure.

Catheter Ablation

To control the ventricular rate during AFib, a catheter (thin wire) is inserted through a blood vessel to the heart. It delivers radiofrequency energy to destroy abnormal electrical cells. This catheter ablation prevents the ventricles from beating too fast. If a catheter is done, a permanent pacemaker will be implanted to maintain a normal heart rate. This procedure will control the ventricular heart rate and reduce your symptoms, however, your atria will still have AFib. This means you will still have an ongoing risk for blood clotting and stroke.

Maze Procedure

The Maze Procedure is a surgical procedure to control AFib. Incisions are made on the atria to create scar tissue, which does not conduct electricity and disrupts the path of abnormal electrical impulses. The scar tissue also helps prevent abnormal electrical signals from recurring.

This procedure is usually done in conjunction with open chest surgery, such as coronary artery bypass grafting, mitral valve repair and/or valve replacement. However, the procedure can be done minimally invasive.

Hybrid Maze Procedure

A Hybrid Maze Procedure is a combination of minimally invasive Maze surgery with electrophysiology testing. After the Maze portion is completed, the electrophysiologist and the cardiovascular surgeon test to be sure the abnormal electrical pathways are disrupted. The advantage of the Hybrid Maze is that any erratic electrical pathways remaining after the Maze are identified. This allows the physicians to eliminate all pathways during one procedure.

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How to reduce your risk

You can help reduce your risk by following the treatment plan your physician has given you:

  • Take your medications — take all medications exactly as directed.
  • Live a healthy lifestyle — make healthy choices.
  • Don't smoke — if you do smoke, quit now.
  • Get active — choose a physical activity program that you can stick to and enjoy.
  • Ask for support, if you need it — explain your conditions, treatment plan, and lifestyle changes to friends and family.

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What caused my Atrial Fibrillation (AFib)?

Many AFib cases seem to have no apparent cause or trigger that can be identified. AFib is usually not something we cause or bring on ourselves.

What are the risks of AFib?

Most episodes of AFib are not life threatening. The biggest danger from AFib is the risk of stroke. Blood clots can form, travel to the brain, and cause a stroke. If you have AFib, you are five times more likely to have a stroke than the general population.

Is AFib a prelude to a heart attack?

In general, no. A heart attack is a physical problem with your heart muscles or heart functions. However, AFib that goes untreated over a period of time greatly increases the risk for stroke and could eventually lead to a weakened heart and serious heart problems.

What can I do for someone who has an episode of AFib?

If the person is in great discomfort and his or her heart is beating very rapidly and irregularly, you can call 911 or get him or her to a hospital emergency department. The emergency department staff can use a defibrillator and medications to electrically shock him or her back into normal rhythm. Unlike a heart attack, most episodes of AFib are usually not life threatening.

Can AFib be effectively treated or do I just have to live with it?

AFib is definitely curable. If you have AFib, no matter how long you've had it, your goal should be to obtain a complete and permanent cure.

How can I tell when I'm in AFib or just having something like indigestion?

Without medical help, you may not be able to tell if you have AFib or something like indigestion. Many people have "silent AFib" which is AFib with few or no symptoms. To verify if you have AFib, a physician can give you an EKG/ECG test and/or can have you wear a monitoring system such as a Holter monitor. Only a physician can determine if you have AFib.

My physician says I have AFib. Should I get a second opinion?

AFib is fairly easy to diagnose using non-invasive diagnostic tests. If you have AFib symptoms and your cardiologist says you have AFIB, you probably have AFib. What you may want a second opinion on is how to be treated for your AFib. At Health First Heart & Vascular Services, our physicians offer consultations to determine if you meet the clinical criteria for non-surgical and/or surgical intervention.

Is my AFib genetic?

Some research has identified a familial link where AFib is passed on genetically, but it is relatively rare. However, there are many causes or triggers of AFib that are not genetic.

I have a defective mitral valve. Is it causing my AFib?

Mitral valve problems seem to be related to AFib, possibly because the extra strain a defective mitral valve puts on the heart may cause stretching and put extra pressure on the pulmonary vein openings where most AFib originates.

Which medications are best to control my AFib?

In general, current medications don't work very well on AFib. What medications are best for you is a judgment call only you and your physician can make.

I've had a successful pulmonary vein ablation/isolation or minimally invasive surgery to cure my AFib. Do I still need to be on anticoagulants?

If you don't have any symptoms, you probably are cured of AFib and have less chance of getting AFib again. However, though "cured" of your AFib, you may still be experiencing silent AFib (AFib with no symptoms) which can be just as dangerous as regular AFib. Since pulmonary vein ablation/isolation of AFib is a relatively new procedure, there are not enough historical perspectives and case studies yet to answer definitively whether or not you need to continue taking anticoagulants. The ultimate decision is best made between you and your physician.

I'm getting by with my AFib. With the recent improvements in minimally invasive surgery techniques, should I wait until a better technique is developed?

AFib is a progressive condition. The longer you have it, in general, the worse it gets. It's important to be treated as soon as possible.

What's the difference between blood thinners and aspirin?

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets, so that they adhere to each other less and are less likely to form blood clots. Blood thinners, on the other hand, work by slowing the production of blood-clotting proteins made in the liver. However, current research indicates that aspirin is not as effective in preventing blood clots as blood thinners. Aspirin is less likely to cause abnormal bleeding than blood thinners. People with fewer risk factors for stroke are often on aspirin. People more at risk for stroke, such as those over 65 years old with frequent AFib episodes, are often on blood thinners.

Can I exercise if I have AFib?

In AFib, when you first start exercising, your heart rate tends to be very rapid. Also, the AFib reduces your overall capacity to exercise, because your heart isn't pumping properly. These observations aside, if you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should.

Can I drive my car if I have AFib?

In general, yes. With most types of AFib, you can drive safely. If your AFib episodes cause you to become dizzy, as soon as you feel the beginning of an episode, pull off to the side of the road and stop. Wait there until the episode passes. If this happens often or if your episodes of AFib last a long time, you may have to stop driving entirely.

*Statistics and some information on this page were gathered from the American Heart Association.

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