Understanding Atrial Fibrillation (AFib): Types, Symptoms, and Procedures

Afib refers to atrial fibrillation (AF), a kind of arrhythmia, or irregular heartbeat. Afib is caused by highly rapid and irregular heartbeats from the heart’s upper chambers (often exceeding 400 beats per minute).

It happens when the upper chambers of the heart, known as the atria, quiver or fibrillate instead of contracting properly. This abnormal electrical activity can cause a variety of symptoms.  

In the patient with Afib, false electrical signals cause the atria to contract irregularly and significantly more rapidly than usual.

The atria become out of rhythm with the ventricles. Blood may collect in the atrium, potentially leading to blood clots and strokes. If ignored, it raises the risk of stroke and other consequences such as heart failure.

What are the types of Atrial Fibrillation?

There are several types of AFib, which include:

  1. Paroxysmal AFib: Occasional bouts that start and stop by themselves within 7 days. You may experience no symptoms or intense physical sensations. The event typically ends in less than 24 hours but can extend up to a week. Paroxysmal atrial fibrillation may occur more than once. Your symptoms might require treatment, or they could go away on their own.
  2. Persistent AFib: Constant AFib lasting more than seven days. It may gradually return to normal by itself, but you may require treatment to control your heartbeat.
  3. Long-standing persistent AFib: AFib that lasts for longer than a year. 
  4. Permanent AFib: Continuous AFib in which attempts to restore normal rhythm fail or are no longer pursued. Even after your doctor has tried medications or alternative treatments to achieve a normal heart rhythm, atrial fibrillation may not improve. This atrial fibrillation is now viewed as permanent. Atrial fibrillation frequently develops from paroxysmal to persistent to long-term, particularly in the absence of treatment.

What are the common symptoms of Atrial Fibrillation?

A few people with Afib experience no symptoms. It is dependent on how quickly your ventricles beat. If they’re beating at a regular or slightly higher rate, you’re unlikely to feel anything. However, if your ventricles beat quicker, you will begin to experience symptoms. These may include:

  • Extreme tiredness.
  • An unpredictable heartbeat.
  • Heart palpitations.
  • A feeling like butterflies in your chest.
  • dizziness or lightheadedness
  • Fainting (or syncope)
  • Dyspnea (shortness of breath)
  • Angina (chest pain)

Risk factors involve age, high blood pressure, heart disease, obesity, diabetes, and a history of heart surgery or other cardiac problems.

AFib can have severe consequences, the most serious of which is a higher chance of stroke due to the development of blood clots in the atrium. Other concerns may include heart failure and an increased risk of developing other heart-related diseases.

AFib is diagnosed with a physical examination, an electrocardiogram (ECG or EKG) to record the heart’s electrical activity, and further tests such as Holter monitoring or event monitoring to capture intermittent episodes.

The most common techniques of managing AFib include the use of several medications to regulate heart rate, rhythm, and lower the risk of stroke.

To control Afib, lifestyle improvements like dietary changes, weight management, and exercise are also necessary. Blood thinners (anticoagulants) are necessary to prevent blood clots and lower the risk of stroke. 

Diagnosis of Atrial Fibrillation

A physical exam, blood pressure reading, and family history may be used for diagnosing atrial fibrillation (AFib). Doctors can further request one or more tests, such as:

  1. Electrocardiogram (ECG or EKG): It is a rapid and painless examination that examines the electrical activity of the heart. Electrodes are sticky patches that are implanted on the chest, arms, and legs. Wires link the electrodes to a computer, which prints or shows the test findings. An ECG may indicate the heart’s rhythm as well as how slowly or quickly it beats. It is the primary test for detecting atrial fibrillation.
  2. Holter monitor: This compact, portable ECG equipment measures cardiac activity. It is worn for a day or two as you go about your daily routines.
  3. Blood testing: Blood tests are used to detect health issues or compounds that could affect the heart or beating.
  4. Event recorder: This gadget is similar to a Holter monitor, however it only records at specific times for a few minutes at a time. It is normally worn for around 30 days. When you experience symptoms, you typically hit a button. When an irregular cardiac beat is identified, specific devices immediately record it.
  5. Echocardiogram: Sound waves are utilized to produce pictures of the beating heart. This test can demonstrate how blood flows through the heart and its valves.

Treatment Options for Atrial Fibrillation

There are a few treatments that can be used to treat Afib when medication and lifestyle modifications are not effective. They are as follows:

  • Electrical cardioversion: To control your heartbeat, the doctor administers a shock. They will apply paddles or electrode patches to your chest. First, you will be given medication to induce sleep. Your doctor proceeds to place the paddles on your chest and, in some cases, back. These will deliver a moderate electrical shock to restore your heart rhythm to normal.
  • Ablation Therapy: There are two major options in ablation therapy. 
    • Catheter ablation: Also known as radiofrequency or pulmonary vein ablation, is a less invasive ablation procedure that does not need surgery. Your doctor will insert a small, flexible tube into a blood artery in your leg or neck. Then they direct it towards your heart. When it reaches the location that is producing the arrhythmia, it produces electrical impulses that damage the cells. The treated tissue helps to restore your heartbeat to normal. This can be done with Radiofrequency energy or Cryo energy. Dr.Nikhil says, “Paroxysmal Afib is best treated with catheter ablation. However in Persistent Afib and especially Long Standing Persistent Afib, Catheter ablation has high failure rates”.
    • Surgical ablation includes cutting into your chest. Maze procedure:  This is often performed while you are undergoing open-heart surgery for another condition, such as a bypass or valve replacement. The surgeon makes tiny incisions in the top portion of your heart. They’re sewn together to generate scar tissue, which blocks abnormal impulses.

Cox Maze IV is the gold standard treatment for all types of Afib. Though it is open surgery it has shown consistent results!

Dr. Nikhil
  • Pacemaker: This is a small gadget that detects your heartbeat and gives a signal to stimulate it if it beats too slowly. It consists of a tiny device called a generator, that includes a battery and a little computer. Leads are very small cables that connect the pacemaker to your heart.

Getting a pacemaker may seem like a major issue, but it’s actually a rather basic operation. First, your doctor puts a needle into a major vein near your shoulder, guiding the leads to your heart. The pacemaker is then inserted into your chest through a tiny incision. Once it’s in place, your doctor will test it to ensure it works.

Understanding atrial fibrillation (AFib) is critical for treating this common but potentially dangerous heart rhythm problem. AFib can take many different forms, ranging from paroxysmal to persistent, each with its own set of problems and therapeutic effects. Recognising the symptoms is critical for early detection and treatment.

Early identification of AFib can dramatically improve patient outcomes. Patients who work together with healthcare experts can understand the complexity of this condition and take active steps towards better heart health.

Our expert, Dr. Nikhil P.J. Theckumparampil, has been trained at Harvard University, Ohio State University, Vanderbilt University, and Temple University. To consult with our expert cardiologist for managing heart failure and other cardiac-related issues, book an appointment with our Clinic Heart360 Care.

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