Does your heart sometimes feel like it's going crazy? Could it be Atrial Fibrillation (AFib)? Let's talk!

Have you ever suddenly felt a strange, strange change in the way your heart beats? Maybe your heart is just beating like crazy, or it feels like it stops and then starts again. Although we don't think much about these things, sometimes they can be a sign of a health condition. Today we are going to talk about one such condition, which can be related to the rhythm of the heart. That is Atrial Fibrillation, or AFib for short.

What is AFib (Atrial Fibrillation)? Let's understand it simply.

Simply put, Atrial Fibrillation (AFib) is an irregular heartbeat pattern that starts in the upper chambers of your heart (also called the atria). To be precise, the electrical system of a person with AFib does not work properly. Instead of sending out electrical signals in an orderly manner, as it normally should, it starts sending out many different signals at the same time. Imagine a large orchestra, but instead of a main conductor leading the orchestra, there are several people on each side giving commands at the same time. Then the musicians don't know who to listen to and what to play. The whole music is confused and out of tune, right? That's what happens to the upper chambers of our hearts with AFib. As a result, the upper chambers of the heart (atria) start beating in a fast, chaotic rhythm. As a result, these upper chambers cannot contract properly and cannot pump blood to the lower chambers (called the ventricles). The lower chambers, which act on signals from the upper chambers, also begin to contract irregularly. This is why you feel like your heart is beating fast and irregularly. The heartbeat you feel is actually coming from the contraction of these lower chambers (the ventricles). Atrial fibrillation can lead to serious complications such as stroke or heart failure. That's why it's important to be aware of its symptoms and talk to your doctor about your personal risk factors.

What are the symptoms of AFib? See if you have these too

Not everyone with AFib will have symptoms. However, there are some common symptoms:

• A strange feeling like a butterfly fluttering in your chest, or a fish struggling. Sometimes your heart may beat faster, like it's pounding in your chest (this is what we call `heart palpitations` ).
• Feeling extremely tired. Feeling too tired to do anything.
• Dizziness or feeling light-headed.
• Loss of consciousness (syncope).
• Difficulty breathing (dyspnea). It feels like you're just suffocating.
• Chest pain (`angina `).

If you have one or more of these symptoms, it is best to see a doctor for advice.

How serious is AFib?

Whether you have symptoms or not, AFib is a serious condition that needs to be taken seriously. It means that your heart rhythm is irregular. When your heart doesn't beat normally, you're at an increased risk of developing dangerous blood clots inside your heart. If these clots travel to vital organs like your brain and block them, they can cause serious conditions like a stroke. Other complications can also occur.

If you have symptoms of AFib, see your doctor immediately.

When should you seek immediate medical advice?

In some cases, you may need to go to an emergency room immediately. These include:

• If you have severe chest pain .
• If it becomes very difficult to breathe .
• If you lose consciousness or feel like you are losing consciousness.

At times like this, don't stay at home, go to a hospital immediately.

What can cause AFib?

Atrial Fibrillation is primarily caused by changes in the tissues and electrical system of your heart. There are several possible causes of these changes:

• Other cardiovascular conditions. For example, coronary artery disease , valve disease, and heart failure .
• Other medical conditions. Things like high blood pressure, obesity, hyperthyroidism, chronic kidney disease, and obstructive sleep apnea .
• Genetic variants. Recent research has found that certain genetic variants are associated with AFib. This is why some young people can also develop AFib.
• Heart surgery. If you have had heart surgery for another reason, AFib can start after that surgery. AFib can also occur during recovery from other non-heart-related surgery.

Risk Factors That Increase the Risk of Developing AFib

If you have any of the medical conditions mentioned above, you are at higher risk of developing AFib. There are several other risk factors:

• Increasing age. Your risk of developing AFib increases as you get older, especially after age 65.
• Excessive alcohol use.Drinking more alcohol than recommended limits, especially drinking a lot at once – we call it 'binge drinking' – also increases the risk of AFib.
• Critical illness. Illnesses that are serious enough to require hospitalization (such as sepsis or severe COVID-19) increase the risk of AFib.
• Lack of physical activity. Not getting enough exercise during the day can also be a cause of AFib.
• Extreme exercise training. Physical activity is good for the heart, but too much of anything is not good. People who exercise for more than three hours a day for years are also at increased risk of developing AFib.

How do doctors accurately diagnose AFib?

The main test used to diagnose AFib is an electrocardiogram, also known as an ECG (electrocardiogram) or EKG. This creates a graph of the electrical signals that travel through your heart. This can help you see if you have AFib or other irregular heartbeats (arrhythmias). In addition, your doctor will do a few other things:

• You will be given a physical exam and asked about your medical history.
• Blood tests are ordered to check for other conditions, especially those that could affect the AFib treatment plan.
• You may be asked to have an echocardiogram (echo) to check the structure and function of your heart.
• You may be asked to wear a monitor (a `Holter monitor` or `cardiac event monitor`) for 24 hours or more, which records the electrical activity of your heart as you go about your daily activities.

Are there different stages of AFib?

Yes, AFib is a `progressive condition`. This means it can go through different stages and get worse over time. Doctors use these stages when diagnosing and treating AFib:

• Scenario 1: Those at risk for AFib (`At risk for AFib`)
• Case 2: Pre-AFib (`Pre-AFib`)
• Case 3: AFib (`AFib`)
• Case 4: Permanent AFib

Let's look at each of these cases in a little more detail.

Stage 1: At risk for AFib

This means that you have certain risk factors that can make you more likely to develop AFib. For example:

• High blood pressure
• Obesity
• Diabetes
• Sleep apnea
• Excessive alcohol use
• Poor functioning of the cardiovascular system
• Over 65 years of age

If you have these things, you can say you are at risk for developing AFib.

Stage 2: Pre-AFib

At this point, there may be some changes in the electrical activity or structure of your heart. These increase your risk of developing AFib. Signs that doctors look for at this point include:

• Atrial tachycardia (rapid heartbeat)
• Atrial flutter
• Enlarged left and/or right atrium
• Frequent ectopic heartbeats

Also, if you have certain medical conditions that are associated with a higher risk of developing AFib, you are also in this second stage. Examples:

• Coronary artery disease
• Heart failure
• Heart valve disease
• Hyperthyroidism
• Hypertrophic cardiomyopathy (hardening of the heart muscle)
• Neuromuscular disorders

Stage 3: AFib

If an ECG test confirms that you have Atrial Fibrillation, you are in this stage. But there are different sub-stages to this stage. You may have symptoms that come and go on their own. Or you may have persistent AFib despite treatment. Even if symptoms go away after treatment, they may come back later. That's why doctors divide this stage into four sub-stages:

• Intermittent AFib (`Paroxysmal AFib`): Symptoms come and go. Each episode lasts less than a week, and often goes away on its own without treatment. You may still feel uncomfortable during this short period. You are at higher risk of having a stroke than people without AFib.
• Persistent AFib: Symptoms keep coming back, meaning they come back again and again. Each episode lasts for more than a week. Treatment is needed to stop this condition.
• Long-standing persistent AFib: Symptoms persist for a year or more.
• After successful AFib ablation: AFib has stopped after surgery or a catheter-based procedure.

Once you are diagnosed with AFib, you may switch between these subtypes. For example, you may experience a relapse of `Persistent AFib` shortly after successful ablation treatment.

Stage 4: Permanent AFib

This means that you will no longer be trying treatments to manage your AFib, and that you will always be in AFib. This decision is made by you and your doctor together, based on your situation.

What are the treatments for AFib?

Atrial fibrillation treatments may include one or more of the following:

• Lifestyle changes
• Medications
• Ablation therapy
• Other treatments

Let's take a look at these.

Lifestyle changes

These are things you can do every day to help prevent AFib from getting worse. These lifestyle changes are important at any time during AFib — even when you don't have any symptoms. Your doctor can help you with these things:

• Maintain a healthy weight for yourself.
• Limit alcohol consumption.
• Avoid using tobacco products.
• Engage in the recommended amount of physical activity.
• Control conditions that increase the risk of AFib, such as high blood pressure, obesity, obstructive sleep apnea, and diabetes.

Medication

Your doctor may prescribe medications to control your heart rate and/or heart rhythm. These medications can help prevent damage to your heart and reduce symptoms that make you uncomfortable or anxious. They may also prescribe medications to reduce your risk of blood clots that can cause a stroke. The medications you need to manage AFib may change over time. Usually, if you are at risk of having a stroke, you will need to take blood thinners (anticoagulants) . Doctors most often prescribe oral anticoagulants (DOACs). Examples:

• `Apixaban`
• `Rivaroxaban`
• `Dabigatran`
• `Edoxaban`

In some cases, a drug called `warfarin` is prescribed instead of `DOACs`. Medications that manage your heart rate include:

• `Carvedilol`
• `Digoxin`
• `Diltiazem`
• `Metoprolol`
• `Verapamil`

These are the medications that help your heart beat in a normal (sinus) rhythm:

• `Amiodarone`
• `Dofetilide`
• `Dronedarone`
• `Flecainide`
• `Propafenone`

Don't forget that all of these medications should be used only as directed by a doctor.

Ablation therapy (Ablation for AFib)

Ablation for AFib is a general term for a group of treatments that create scar tissue in your heart. Although we usually think of scar tissue as something harmful, in this case, this scar tissue helps your heart's electrical system work properly. This scar tissue blocks abnormal electrical signals and helps your heart beat in a normal rhythm. Specific treatments your cardiologist may recommend for AFib include:

• Catheter ablation: This is a minimally invasive treatment. The surgeon inserts thin tubes (catheters) through your blood vessels into your heart.Pulmonary vein isolation (PVI) ablation is a specific type of catheter ablation most commonly used for AFib.
• Maze procedure: Also called surgical ablation, this procedure involves the surgeon creating a maze-like pattern of scar tissue that blocks abnormal signals. This surgical ablation is usually done at the same time as heart surgery for another reason (such as CABG or valve surgery).

Other treatments

There are several other ways to treat AFib:

• Cardioversion: The doctor uses a device (defibrillator) or medication to return your heart rhythm to normal.
• Left atrial appendage (LAA) closure: If you can't tolerate blood thinners, you may be eligible for a left atrial appendage occlusion device to reduce your risk of stroke. This procedure closes off a small sac in the heart where blood clots can easily form.

Will the heart return to normal after AFib? Is there a complete cure?

Yes, sometimes your heart can return to a normal rhythm on its own. This is what happens to people with `Paroxysmal AFib`. If you have `Persistent` or `Long-standing AFib`, you will need treatment to stop the condition.

But it's important to know that there is no cure for AFib. Once you have it, it's something you have for life.

Your doctor can help you manage this condition. Treatment can reduce your risk of stroke and make your symptoms less severe.

How long can you live with AFib?

A study published in 2024 found that people with AFib have a shorter life expectancy than those without AFib. The number of years lost from their life expectancy depends on their age at diagnosis. The younger they are at diagnosis, the shorter their life expectancy and the more years they lose compared to their peers without AFib. But remember, statistics only tell one side of the story. By working closely with your medical team to manage AFib and any other medical conditions, you have the best chance of living a long life.

How should I take care of myself?

The same habits that reduce your risk of developing AFib will help you stay healthy even when you have AFib.

• Eating nutritious foods and getting 30 minutes of physical activity five days a week is very good for your heart. To make it easier for you to exercise, you can break it up into 10-minute chunks.
• Giving up tobacco products and alcohol is also very good for the heart.

Following these things properly will go a long way in helping you live a healthy life even with AFib.

When should I see the doctor?

There is no set schedule for this. It depends entirely on your symptoms, treatment plan, and whether you need follow-ups after any treatment. So, it's important to talk to your doctor and come up with a plan together.

• Attend all your scheduled appointments.
• Keep a list of the medications you take and bring it to every doctor's appointment. It's also a good idea to keep the list in your purse, as it can come in handy in an emergency.
• Tell your doctor about any new symptoms or problems you have (e.g., side effects from medications) at each appointment.
• Always ask your doctor before taking over-the-counter (OTC) medicines – for example, cold and flu medicines – and nutritional supplements, as these products can sometimes affect your heart rate or interact with medications you are taking.

What questions should you ask the doctor?

Here are some questions you can ask your doctor:

• How can I reduce my risk factors?
• Can you help me contact a dietitian?
• Can you recommend any health and fitness programs in this area?
• At what stage is my AFib?
• What treatments are best for me?
• What are the possible side effects of treatment?

Ask questions like these to gain a better understanding of your situation.

Can you check for AFib at home?

If you think you have symptoms of AFib, it's important to talk to your doctor right away and tell them how you're feeling. Your doctor may ask you to check your pulse. If it feels irregular or weak, that could be a sign that you have AFib. But sometimes, you may not notice any changes in your pulse, especially if your AFib is not severe. Instead, you may just feel tired or short of breath. You may not be able to tell if your symptoms are due to AFib or something else. That's why it's important to talk to your doctor. You can never diagnose yourself with AFib.

How common is AFib?

More than 33 million people over the age of 55 worldwide have been diagnosed with AFib. In the United States alone, 12 million people are expected to have AFib by 2030. AFib causes nearly half a million hospitalizations each year in the United States, and the number of deaths from it is increasing every year. Finding out you have AFib can be scary, confusing, or overwhelming. But you are not alone. You are one of millions of people learning new ways to manage AFib while still living a happy life. Your doctor can tell you more about treatment options, resources, and support communities.

In summary (Take-Home Message)

Okay, so I hope you now have a better idea of ​​what AFib we've been talking about.

AFib is an irregular heartbeat. It can be serious, but if managed properly, you can live a healthy life.

• Be aware of symptoms. If you experience frequent chest pain, extreme fatigue, or dizziness, see a doctor.
• Reduce risk factors. Live a healthy lifestyle.
• Follow the treatment exactly as the doctor says. Take your medicine on time, and go for the scheduled tests.
• You are not alone. There are many people living with this condition. Ask for help if you need it.

Taking care of your heart is very important for your overall health, so it's a good idea to be aware of this information!

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