Reddy Kartik, MD
When asked to describe how atrial fibrillation feels, often patients will say it’s like their heart just flutters. This seemingly benign symptom could signal a much bigger issue. Dean & St. Mary’s cardiac electrophysiologist Dr. Kartik Reddy says if you are experiencing heart symptoms – like a fluttering sensation – you should talk with your doctor.
“Heart palpations can be a sign that something in your heart is not working properly,” says Dr. Reddy. “It is vital to find the cause of these symptoms and treat them promptly and properly to avoid more serious conditions or complications.”
While heart palpations can indicate a number of heart conditions, one common condition is called atrial fibrillation.
What is atrial fibrillation?
Atrial fibrillation, also called AFib or AF, is a condition that causes a quivering or irregular heartbeat. It can lead to blood clots, stroke, heart failure and other heart-related complications. According to the American Heart Association, approximately 2.7 million Americans live with atrial fibrillation.
In a normal heart, the muscle contracts and relaxes to a regular beat. In patients with atrial fibrillation, the upper chambers of the heart – the atria – beat irregularly. This means the heart is unable to effectively move blood to the lower chambers – the ventricles. About 15 – 20 percent of people who have strokes also have atrial fibrillation.
“When blood slows down or is allowed to pool in the body, the risk of developing a blood clot increases,” says Dr. Reddy. “It can also increase your risk for stroke.”
If a blood clot comes loose, enters the blood stream and lodges in an artery leading to the brain, it can cause a stroke. This increased risk of blood clots is why patients with atrial fibrillation are typically put on blood thinners. Atrial fibrillation patients have an increased stroke risk of about five percent per year.
Even though atrial fibrillation is the most common serious heart rhythm abnormality in people over the age of 65, many patients are unaware that it is a serious condition. Untreated atrial fibrillation doubles your risk of heart-related death and causes a four- to five-fold increased risk for stroke.
What are the symptoms of atrial fibrillation?
For many patients, the first sign of atrial fibrillation is a quivering or fluttering heartbeat. The abnormal firing of electrical impulses in the heart causes the muscle to quiver. Sometimes people with atrial fibrillation do not notice any symptoms at all. For these patients, their condition is only detected during a physical exam by their doctor.
Or, for some patients, the following symptoms indicate something is wrong:
• General fatigue
• Rapid and irregular heartbeats
• Fluttering or “thumping” sensations in the chest
• Dizziness
• Shortness of breath coupled with anxiety
• Weakness
• Faintness or confusion
• Fatigue when exercising
• Sweating
• Chest pain or pressure
If you notice any of these symptoms, call your doctor to set up an appointment. If you experience chest pain or pressure, call 911. Chest pain or pressure is a sign you could be having a heart attack and medical care is needed immediately.
What are the types of atrial fibrillation?
The duration of atrial fibrillation and the underlying causes of the condition can help your doctor better classify the type of atrial fibrillation problem you are facing.
• Paroxysmal fibrillation happens when your heart returns to a normal rhythm on its own within seven days of its start. Patients with this type of atrial fibrillation may have episodes a few times a year. Others may experience symptoms every day. These symptoms are unpredictable and can turn into a permanent form of atrial fibrillation.
• Persistent atrial fibrillation is an irregular heart rhythm that lasts longer than seven days. This type of atrial fibrillation will not return to a normal rhythm on its own and requires medical treatment.
• Permanent atrial fibrillation happens when the condition lasts indefinitely.
Over time, paroxysmal fibrillation can become more frequent and longer lasting. This can lead to permanent or chronic atrial fibrillation. All types of atrial fibrillation increase your risk of stroke. Even if you have no symptoms, you are nearly five times more likely to have a stroke than someone without atrial fibrillation.
What’s the difference between atrial fibrillation and a heart attack?
Fluttering and heart palpations are the key symptoms of atrial fibrillation, but many heart problems have similar warning signs. Some heart attacks are sudden and intense, but most heart attacks start slowly with mild pain or discomfort.
“It is vital to call 911 immediately if you think you may be having a heart attack,” says Dr. Reddy. “When it comes to heart attacks, time is muscle. Don’t try to drive yourself to the emergency room. Call for an ambulance.”
Dr. Reddy says that emergency personnel can begin diagnostic testing and even provide treatment during the ambulance drive to the hospital, and receiving this immediate care can be the difference between life and death for some heart attack patients.
How is atrial fibrillation treated?
Finding the right treatment for your atrial fibrillation starts with proper diagnosis. Your doctor will order an in-depth exam. This will include questions about your medical history and an EKG or ECG. Some patients may also need an electrophysiology study (a study of the way your heart’s electrical impulses behave).
Preventing atrial fibrillation episodes is important in treatment of the condition. For some patients, that may mean avoiding activities that trigger an episode. For some – it’s as simple as giving up your morning cup of coffee or changing up your exercise routine. Or, if an underlying medical condition like hypothyroidism causes your atrial fibrillation, treating your thyroid condition may be enough to make your atrial fibrillation episodes stop.
For other patients, medical treatment is necessary. Many patients are successful in controlling their atrial fibrillation with medications like beta blockers and calcium channel blockers. These medications can slow down your heart rate and improve symptoms. While they do not cure atrial fibrillation, they can help. Patients with atrial fibrillation will also require blood thinning medication to prevent strokes.
If medication is not enough to restore regular heart rhythms your doctor may recommend more aggressive treatment including electrical cardioversion or ablation therapy.
Electrical cardioversion uses an electrical shock to “reset” the heart to a normal rhythm. Patients undergoing electrical cardioversion are typically under a mild anesthesia when paddles or patches are used to administer the shock to the outside of their chest. You may need a transesophageal echocardiograph, which is a test that takes photos of your heart and the arteries leading to it using a tube-like ultrasound that is passed through your esophagus. This test will show your doctor any blood clots present inside your heart. If blood clots are present, you may need to take a blood thinner before undergoing electrical cardioversion.
Radiofrequency ablation or catheter ablation can be used when long-term medications or electrical cardioversion are either not preferred or were not effective. Prior to ablation surgery, your healthcare team will perform electrical mapping of your heart. To do this, an electrically sensitive catheter is threaded through the heart muscle and the origin site of any “extra” electrical activity in your heart. This mapping tells your doctor which areas of the heart are creating problematic electrical signals that disrupt your normal heart rhythm.
Once the electrical map is complete, your cardiac electrophysiologist – a doctor who specializes in the electrical process of your heart – will use a catheter to carefully destroy and scar malfunctioning tissue in the areas of your heart that cause problems. The scarred areas will no longer send abnormal signals. This minimally invasive procedure usually has a short recovery and patients usually take a short course of anti-arrhythmic medication while the procedure takes full effect.
Who is at risk for atrial fibrillation?
Any person can develop atrial fibrillation, including children. But, the likelihood of developing atrial fibrillation increases with age and there are certain people who are at higher risk.
Typically, people with one or more of the following conditions are at a higher risk for atrial fibrillation:
• Athletes: a rapid heart rate called supraventricular tachycardia (SVT) is common among athletes and can trigger atrial fibrillation.
• Advanced age: the number of adults who develop atrial fibrillation increases with age. While atrial fibrillation is rare in children, it can and does happen.
• Underlying heart disease: anyone with heart problems including valve problems, hypertrophic cardiomyopathy, acute coronary syndrome, Wolff-Parkinson-White (WPW) syndrome and a history of heart attack can develop atrial fibrillation. The condition is also the most common complication following heart surgery.
• Drinking alcohol: binge drinking may put you at a higher risk.
• Family history: having a family member with atrial fibrillation can increase your chances of being diagnosed with the condition.
• Other chronic conditions: some people are at a higher risk because of underlying medical conditions including thyroid problems, diabetes, asthma and other chronic medical problems.
Because atrial fibrillation is a serious condition and can increase your chances of heart attack and stroke, it is important to discuss your risk with your doctor.
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