Atrial Fibrillation (AFib or AF)
What is Atrial Fibrillation (AFib)?
Atrial fibrillation, also called AFib or AF, is a fast and irregular heartbeat that causes the upper chambers of your heart (atria) to quiver. When this happens, your heart can no longer pump sufficient oxygenated blood to meet the needs of all the organs and tissues in your body.
Watch Video - What is Atrial fibrillation (Afib or AF)?
AFib, the most common chronic heart rhythm disorder (arrhythmia), has become a global public health problem. This condition affects between 2.7 and 6.1 million people in the United States, as estimated by the Centers for Disease Control and Prevention. More than 30 million people worldwide are living with AFib.
Some people experience short episodes of AFib that stop spontaneously after a few seconds. More severe episodes of AFib that do not go away on their own require medical attention. It is important to understand that having AFib increases your risk of developing health conditions that can be life-threatening, such as stroke and heart failure.
Certain medical conditions that you may already have increase your risk of developing AFib. These conditions, known as risk factors, include:
- Sleep apnea
- Thyroid disorders
- Previous heart attack
In addition to these health conditions, certain infections (e.g., influenza, or the flu) and exposure to certain chemicals (e.g., drinking alcohol) also increase the risk for AFib.
A cardiac electrophysiologist (EP) is a cardiologist who has advanced training in diagnosing and treating arrhythmias, including AFib. To manage AFib, EPs typically develop an individualized treatment plan for each patient with AFib.
Treatment plans usually combine medications, procedures such as catheter ablation, and interventions that help keep your risk factors in check. The doctor will also work with you to avoid or minimize the impact of factors that may trigger your AFib.
If you have been diagnosed with AFib or have symptoms that suggest AFib, schedule an evaluation with Dr. Alireza Nazeri in Houston, Texas. Call (713) 790-9125.
Atrial Fibrillation and Stroke
Did you know that people who have AFib have a five times higher chance of experiencing a stroke compared to those who do not have AFib? Having certain characteristics or health conditions in addition to AFib further increases your stroke risk. These include:
- Female gender
- Age over 65 years
- High blood pressure
- Previous stroke
- Heart failure
- Blockages in the heart or peripheral arteries
During an AFib episode, the blood does not move properly through the chambers of the heart, which can cause a clot to form. Clots that develop in the heart chambers can be pumped out of the heart and end up in the bloodstream. A circulating clot can cause a stroke if it blocks an artery that supplies blood to the brain and prevents it from receiving all the oxygen it needs.
Ischemic stroke, the most common type, accounts for 87% of all strokes in the United States. The majority of clots caused by AFib (90%) forms in the left atrial appendage (LAA), an area found in the heart’s upper left chamber, or left atrium.
A stroke causes brain damage that may result in permanent disability. Every 40 seconds, a person living in the United States has a stroke. The condition claims a life every 4 minutes. Nearly 800,000 people residing in the United States have a stroke every year. AFib causes more than 100,000 of all strokes every year.
Watch Video - Your Risk of Stroke
Atrial Fibrillation and Heart Failure
AFib and heart failure are two heart conditions that are closely connected.
A healthy heart pumps more than 7,600 liters (2,000 gallons) of blood each day. Heart failure occurs when the heart muscles become too weak to pump enough blood to feed the tissues of the body. Heart failure can result from various causes, including heart attack, pregnancy, viral infections, and uncontrolled arrhythmias such as AFib. Because heart failure reduces the supply of oxygen to the body, it disrupts the normal function of critical organs such as the brain, the kidneys, and the heart itself.
Atrial fibrillation can lead to heart failure because the fast and irregular heartbeats caused by Afib constantly stress the heart. Over time, this stress weakens the heart muscles. Getting your AFib treated may improve your heart function and will help to better treat your heart failure at the same time.
On the other hand, heart failure increases your risk of developing AFib. In heart failure, the abnormal blood flow and pressures inside the heart chambers damage the left upper chamber of the heart (left atrium), which can lead to AFib.
If you already have heart failure, having uncontrolled AFib may worsen this condition, increasing your chance of hospitalization for life-threatening complications related to heart failure.
Watch Video - Understanding Heart Failure (overview)
Atrial Fibrillation and Sleep Apnea
If you have sleep apnea, you are four times more likely to develop AFib. Half of the people who have AFib also have sleep apnea.
Sleep apnea is a disorder in which breathing frequently stops and restarts during sleep. An estimated 18 million people in the United States have sleep apnea. However, more than half of these cases are undiagnosed.
People who have sleep apnea feel tired during the day, snore loudly, and wake up from sleep gasping for air or chocking. Uncontrolled sleep apnea can increase the chance of having diabetes, depression, stroke, heart disease, and arrhythmias such as AFib.
If you have AFib, you may benefit from screening for sleep apnea. Detecting and treating this disorder will help to manage your AFib better.
Watch Video - What is Obstructive Sleep apnea?
Atrial Fibrillation and Influenza (Flu)
Influenza (flu) is an infection caused by the influenza virus. Flu can increase the risk for heart attack, stroke, and atrial fibrillation (AFib).
You can avoid this important AFib trigger by getting a yearly flu vaccine.
Risk Factors and Triggers of AFib
- Advanced age: Although younger people may have AFib, getting older is the most important risk factor for this arrhythmia; an estimated 9% of individuals over the age of 65 have atrial fibrillation
- High blood pressure
- Sleep apnea
- European ancestry
- Heart failure
- Heart attack
- Influenza virus infection
- Thyroid disease
- Chronic kidney disease
- Excessive alcohol use
- Excessive intake of caffeine (e.g., from energy drinks)
- Certain weight loss and herbal supplements
- Enlargement of the left upper chamber of the heart (left atrium)
- Family history of AFib
Symptoms of Atrial Fibrillation
Most individuals who have AFib do not notice any specific symptoms. Some people may feel constantly exhausted, but, in many cases, this state of fatigue is attributed to work overload. Unfortunately, many people find out they have AFib only after they have had a stroke.
The symptoms of AFib may include:
- Palpitations (a sensation that your heart is beating fast and irregularly, fluttering, flip-flopping, or pounding)
- Fainting (syncope)
- Near fainting
- Dizziness and/or lightheadedness
- Shortness of breath
- Chest pain and/or discomfort
- Sleeping problem
Types of Atrial Fibrillation
To design a treatment plan that is right for you, your doctor will classify your AFib based on its duration:
- Paroxysmal AFib: occurs occasionally and stops within 7 days of onset
- Persistent AFib: continues for more than 7 days, up to a year
- Long-standing persistent AFib: persists for more than 12 months
What Is Your Risk for AFib?
Atrial fibrillation (AFib) can cause permanent damage to your heart and brain. AFib weakens the heart muscle (heart failure) and can cause small or large strokes, which may result in permanent damage to the brain. If you suspect that you have AFib, consider consulting an electrophysiologist (EP), who can perform a thorough evaluation for this disease.
The Heart Rhythm Society in Washington, DC offers an online risk assessment tool to estimate your risk of having or developing AFib.
Take the quiz now to find out if you’re at risk: What is my AFib Risk?
If you have been identified as having a medium or high risk for AFib, schedule a risk evaluation visit with Dr. Nazeri today.
Do You Have AFib?
You may be able to determine if you have AFib by checking your pulse. There are several methods you can use:
Manual pulse check
Place the tips of your index and middle fingers on the opposite wrist and count the number of heartbeats you feel in 10 seconds. Multiply this number by 6 to get the number of beats per minute.
Make a note if your pulse rate is more than 100, feels weak, or seems irregular. Any of these may be signs of AFib. Although a pulse self-check can be a useful screening tool, it should be followed by a professional evaluation for AFib.
Smartphone and Smartwatch Apps
There are smartphone and smartwatch apps that are designed to detect AFib. Not all of these applications provide valid, accurate results. If an app suggests that you have AFib, schedule a visit with an electrophysiologist (EP) like Dr. Nazeri who can address your concerns and make an accurate diagnosis.
Home blood pressure monitors
You can use a standard home blood pressure monitor to check your heart rate. Some of these machines have features that can detect irregular heartbeats. If your device detects an irregular heart rhythm or signals AFib, consult your doctor.
If you have any concerns about having AFib, schedule a risk evaluation visit with Dr. Nazeri today.
AFib Risk Evaluation and Diagnosis
During your visit, Dr. Nazeri will ask questions about your symptoms, risk factors, and triggers, as well as your family history, medical and surgical history, and other relevant information. He will check your heart for murmurs and any unusual rhythms, and will evaluate you for other conditions that may contribute to or result from AFib, such as thyroid disease and heart failure.
Dr. Nazeri may recommend one or a combination of the following tests:
- Heart Rhythm Monitoring
- EKG or ECG, short for electrocardiogram, is the most common test doctors use to evaluate your heart rate and look for an abnormal heart rhythm.
- Holter heart monitors are wearable devices that record heart rhythm continuously over several days; Dr. Nazeri may ask you to wear a Holter monitor from 2 to 30 days as you engage in your usual activities.
- An implantable loop recorder is a device that Dr. Nazeri can place under your skin in the chest area to find out if you have AFib or to assess the effectiveness of your treatment; this device can be used to monitor your heart rhythm for up to 3 years.
- Echocardiogram (heart ultrasound) is a noninvasive test designed to collect images from your heart, which are used to assess its size, function, structure, and motion.
- Evaluation for Coronary Artery Disease: Dr. Nazeri may decide to order certain tests to check for blockages in the blood vessels that supply your heart muscles with blood and oxygen, known as the coronary arteries. These can include a cardiac stress test, computed tomography (CT) scan of the heart, or coronary angiogram, also known as heart catheterization. While the stress test and heart CT scan are considered noninvasive because they do not require cuts or breaks in the skin, the coronary angiogram is considered invasive, because it is performed by placing a tube into a blood vessel.
- Blood tests to check your thyroid function, cholesterol levels, blood sugar (glucose) level, electrolytes (e.g., potassium, magnesium), kidney function, liver function, and concentrations of other substances in the blood.
Dr. Nazeri and his team offer a comprehensive care program for patients with atrial fibrillation and will work with you to control your AFib. Treatment of AFib includes the following components:
- Modification of risk factors
- Reduction of stroke risk
- Blood thinners
- Left atrial appendage (LAA) closure
- Heart rate control
- Restoring and maintaining normal heart rhythm
Modification of Risk Factors
Addressing risk factors is the single most important part of the AFib care plan. If the risk factors are not treated or managed, the efficacy of therapies used to control AFib, such as medications and ablation, will decrease.
Dr. Nazeri will identify the factors that are most likely to increase your risk of developing AFib and will lay out some strategies to eliminate or reduce the impact of these risk factors. Lifestyle changes that can help reduce your risk for AFib include:
- Establishing an exercise routine
- Adopting healthy dietary patterns
- Developing strategies to manage stress
- Reducing or stopping alcohol consumption
- Limiting caffeine intake
- Seeking treatment for your sleep apnea and/or thyroid disorder
- Weight loss
Reduction of Stroke Risk
If you have AFib, Dr. Nazeri will assess your risk for stroke and may prescribe aspirin or a blood thinner to decrease this risk. Two types of blood thinners are currently available to reduce the risk of stroke related to AFib:
- Less expensive than new blood thinners
- Frequent blood tests are necessary to ensure the medication dosage is effective
- Certain foods must be avoided while taking this medication
- If you experience bleeding or need urgent surgery, Dr. Nazeri can give you a medication to reverse the action of warfarin.
New (novel) blood thinners: The four new blood thinners that are currently available in the United States are apixaban (Eliquis®), dabigatran (Pradaxa®), rivaroxaban (Xarelto®), and edoxaban (Savaysa®):
- More expensive than warfarin
- Routine blood tests to monitor their action are not necessary
- Very few interactions with food
- If you experience bleeding or need urgent surgery, Dr. Nazeri can give you a medication to reverse the action of these blood thinners.
What if you cannot take blood thinners?
The most critical side effect of blood thinners is bleeding. When it affects certain organs, such as the brain or the digestive system, this side effect can become life-threatening.
Some people are more likely to experience bleeding when taking blood thinners. These patients may benefit from left atrial appendage (LAA) closure—a procedure in which Dr. Nazeri will implant a device that seals off the LAA, a small structure in the left atrium, to stop blood clots from forming inside this structure.
This is an important intervention because approximately 95% of blood clots in the heart form in the LAA. After this procedure, you may no longer have to take blood thinners.
Heart Rate Control
The fast, fluttering pace of your heart plays a significant role in how AFib affects your body. Certain medications, including those known as beta-blockers (e.g., metoprolol) and calcium channel blockers (e.g., diltiazem), can be used to control your heart rate. Dr. Nazeri may prescribe a medicine called digoxin to improve your symptoms.
Maintaining Normal Sinus Rhythm
The more prolonged and frequent your AFib episodes, the more AFib will damage the heart muscle, making it harder for your heart to beat in a regular rhythm.
During AFib episodes, blood flow to the rest of the body is less than ideal, which can result in damage to vital organs such as the kidneys and brain. Dr. Nazeri will recommend one or a combination of the following therapies to restore your heart's normal rhythm, maintain it, and prevent future AFib episodes:
- Antiarrhythmic medications
- Catheter ablation
- Pacemaker implantation
Antiarrhythmic Medications. To treat AFib, doctors often prescribe antiarrhythmic medications, which are used to control the irregular heart rate or rhythm that affects individuals with different disorders. These medications can be used to prevent additional AFib episodes. Even with these therapies, you may still experience some episodes of AFib, although they will likely occur less frequently.
Some of the antiarrhythmic medications prescribed for AFib include:
- Dofetilide (Tikosyn®)
- Flecainide (Tambocor®)
- Propafenone (Rythmol®)
- Amiodarone (Cordarone®, Pacerone®)
- Sotalol (Betapace®, Sorine®, Sotylize®)
- Dronedarone (Multaq®)
No medication is risk-free. While antiarrhythmic medications help manage AFib, they can cause side effects. It is important to discuss potential side effects with Dr. Nazeri, who can explain your risks and educate you about signs and symptoms that you should be aware of when taking these medications.
Preventing and managing side effects requires teamwork. While you need to pay close attention to your body, Dr. Nazeri will also monitor you carefully if you are prescribed these medications.
Catheter Ablation for AFib: During this minimally invasive procedure, an electrophysiologist like Dr. Nazeri delivers either cold energy (cryoablation) or heat energy (radiofrequency ablation) through long, narrow tubes (catheters) to certain areas of your heart, which eliminates the heart tissues that are responsible for the faulty electrical signals that cause AFib. Learn more about catheter ablation for AFib.
Watch Video - Catheter Ablation for Arrhythmias and Atrial Fibrillation
Cardioversion: Dr. Nazeri can use either injectable medications or a high-voltage electric current to correct your arrhythmia and restore your heart's regular rhythm (sinus rhythm).
Pacemaker for AFib: The medications used to control AFib can slow your heart rate and cause a decrease in blood pressure. Dr. Nazeri may have to insert a pacemaker to prevent an alarmingly slow heart rate while you continue to take antiarrhythmic medications.
Some people who have AFib may develop severe abnormalities in the electrical system of their heart, which may also require implantation of a pacemaker. Learn more about pacemakers.
Living with Atrial Fibrillation (AFib)
While AFib can affect your quality of life, you can still regain control of your health by working with your doctor and playing an active role in your care. Here are some helpful tips to better control your AFib and improve your quality of life:
- Tell your doctor how AFib is affecting your life.
- Take your medications exactly as prescribed, but pay attention to any changes in your body.
- Tell your doctor about any side effects or changes in your body that you suspect might be related to the medications.
- Never stop taking your medications or make changes to your medication regimen without talking to your doctor.
- Certain medications can interact with your AFib therapy and cause serious problems; tell your doctor if you are planning to start a new medication.
- Take an active role in managing any medical conditions you may have, including those that may worsen your AFib, such as high blood pressure, high cholesterol, diabetes, thyroid disease, sleep apnea, and heart failure.
- Eat a diet that is low in salt, fat, and processed foods.
- Reduce your caffeine intake; remember that caffeine can be found not just in coffee, but also in teas, soft drinks, energy drinks, and chocolate.
- Limit alcohol consumption, as consuming alcohol in high quantities can trigger AFib; moreover, alcohol interacts with many medications.
- If you smoke, it is always a good idea to stop.
- Maintain a healthy weight; being obese or even overweight increases your risk for AFib, as well as your chances of AFib recurrence after ablation therapy.
- Manage stress, which is a trigger for AFib episodes. Work with your doctor to develop a stress management plan; exercise, massages, and meditation are good stress-management tools.
- Get enough sleep; more than 50 percent of people with AFib have a condition called sleep apnea, in which they experience interrupted breathing during sleep. If you snore, wake up feeling exhausted, or are constantly tired, ask your doctor about sleep apnea.
What Should I Ask My Doctor If I Have AFib?
Preparing a list of questions for your doctor will help you remember what to ask during your appointment. You might want to ask your doctor any of the following:
- What is AFib, and what causes it?
- What kind of AFib do I have?
- What are the risk factors for Afib?
- What triggers AFib?
- Does AFib run in the family? If AFib is genetic, does this mean that my children or siblings should be screened for this condition?
- How does AFib affect my heart?
- How often should I see you, and how will you monitor my condition?
- How can I monitor myself at home for AFib?
- What are the symptoms I may experience if I have Afib?
- What should I do If I feel like I am having an AFib episode?
- What are the physical activities or exercises I should avoid?
- Does having AFib mean I cannot travel? What should I do if I have an episode of AFib when I travel?
- How does AFib affect my risk of having a stroke? Is there anything I can do to decrease my risk of having a stroke?
- What sorts of medications are used to treat AFib, and what are their side effects?
- Are there any blood thinners beside warfarin that I can take to reduce my risk of stroke related to AFib?
- Are there other options to reduce my risk of having a stroke besides taking blood thinners?
- What should I do if I have an accident or need emergent surgery while taking blood thinners?
- What should I do if I notice bruises or start bleeding after taking blood thinners?
- Is there a cure for AFib?
- How can I achieve better control of my AFib?
- What is the treatment for AFib?
- How does catheter ablation treat AFib?
- What are the advantages of catheter ablation over taking medications for AFib?
- What are the chances that my AFib will return after I have catheter ablation?
- Do you have other information I can take home to learn more about AFib, such as a handout, brochure, or booklet?
- Back to Patient Education
- What Is Atrial Fibrillation (AFib)?
- AFib and Stroke
- AFib and Heart Failure
- AFib and Sleep Apnea
- AFib and Influenza (Flu)
- Risk Factors and Triggers of AFib
- Symptoms of AFib
- Types of AFib
- What Is Your Risk for AFib?
- Do You Have AFib?
- AFib Risk Evaluation and Diagnosis
- AFib Treatment
- Modification of Risk Factors
- Reduction of Stroke Risk
- Heart Rate Control
- Maintaining Normal Sinus Rhythm
- Living with Atrial Fibrillation
- What Should I Ask My Doctor If I Have AFib?