Atrial fibrillation is a fast and abnormal pattern of contractions in the upper part of the heart. The two upper chambers of the heart are called the atria. The main job of the atria is to push blood into the lower chambers of the heart which then send blood out to the body. Atrial fibrillation can decrease the amount of blood that reaches the lower chambers and the body. Blood can also pool in the atria during atrial fibrillation. This increases the risk of blood clots and stroke. Atrial fibrillation may be:
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The contractions of the heart are stimulated and controlled by electrical impulses. Normally these impulses start from a collection of cells in the heart called the SA node and travel through the heart in an organized pattern. The top part of the heart normally contracts first, then the lower chambers called the ventricles.
If the electrical signal starts in other areas of the heart or can't travel normally through the heart it can cause atrial fibrillation. The change in electrical signals may be due to:
Sometimes the cause of atrial fibrillation is unknown.
Atrial fibrillation is more common in men and in people aged 55 years and older. Other factors that may increase your chance of atrial fibrillation include:
Certain lifestyle habits and dietary options can also stimulate the heart and increase the risk of atrial fibrillation:
Atrial fibrillation may not cause any symptoms. Symptoms that do occur may range from mild to severe depending on the impact of blood flow through the heart and your overall health.
The rapid contractions may cause:
If the atrial fibrillation is affecting the amount of blood that is being pumped out to the body it may cause:
The doctor will ask about your symptoms and medical history. A physical exam will be done to look for any signs of heart disease. The doctor will also listen to your heart and take your pulse to look for any abnormalities. To examine the electrical activity of your heart you doctor may do the following tests:
To help determine potential causes or look for potential complications your doctor may order:
The goal of treatment will depend on the cause of the atrial fibrillation and how much it impacts your life. When possible the overall goal is to stop the fibrillation or slow it down and decrease complications. In some cases, atrial fibrillation may return to normal without treatment.
If a medical condition is causing the atrial fibrillation, treatment will focus on the underlying condition. The doctor may also adjust or eliminate medications that are causing the fibrillation.
Options for atrial fibrillation that needs treatment include:
Medications may be used to:
If the atrial fibrillation continues, medication may be recommended to decrease the chance of blood clots. This will decrease the risk of a stroke from blood clots but can also increase the risk of severe bleeding. Most anti-clotting medication require regular monitoring.
If anti-clotting medication can not be tolerated a procedure called left atrial appendage closure (LAAC) may be considered. This procedure seals a small area of the atria where clots tend to form.
Certain habits can increase the incidence or severity of atrial fibrillation. Recommended changes to help manage atrial fibrillation may include:
American Heart Association
Heart Rhythm Society
Canadian Cardiovascular Society
Heart and Stroke Foundation
Atrial fibrillation. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation. Updated September 27, 2016. Accessed September 29, 2016.
Atrial fibrillation. CardioSmart website. Available at: http://cardiosmart.org/HeartDisease/CTT.aspx?id=222. Accessed November 9, 2012.
Cardioversion. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/heart/services/cversion. Updated December 28, 2011. Accessed November 9, 2012.
Explore atrial fibrillation. National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/af. Updated July 1, 2011. Accessed November 9, 2012.
Left atrial appendage and closure. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/heart/services/arrhythmia-treatment/left-atrial-appendage-closure. Updated May 2016. Accessed July 14, 2016.
12/13/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation: Lubitz SA, Yin X, et al. Association between familial atrial fibrillation and risk of new-onset atrial fibrillation. JAMA. 2010;304(20):2263-2269.
5/11/2012 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation: Osbak PS, Mourier M, et al. A randomized study of the effects of exercise training on patients with atrial fibrillation. Am Heart J. 2011;162(6):1080-1087.
1/2/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation: Abed HS, Wittert GA, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: A randomized clinical trial. JAMA. 2013;310(19):2050-2060.
7/1/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation: Qureshi WT, O'Neal WT, Khodneva Y, et al. Association between opioid use and atrial fibrillation: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. JAMA Intern Med. 2015;175(6):1058-1060.
Last reviewed December 2016 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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