Atrial Fibrillation (AFib)

AFib (atrial fibrillation) is an irregular heart rhythm that begins in the upper chambers of your heart. With this common disorder, your heart’s electrical system doesn’t work as it should. Instead of sending electrical signals in a steady pattern, it sends many different signals at the same time.

This causes a fast, chaotic rhythm in your upper chambers (atria). As a result, your atria can’t do a good job of contracting or pumping blood into your lower chambers (ventricles). Your ventricles, which respond to your atria, also contract irregularly. This causes a fast, irregular heartbeat. The heartbeat that you feel comes from your ventricles’ contractions.

You can think of AFib like several conductors directing an orchestra instead of just one. The musicians wouldn’t know who to follow or what to do. The music would lose its rhythm.

Atrial fibrillation can lead to serious complications, like a stroke or heart failure. That’s why it’s important to learn the symptoms and talk with a healthcare provider about your risk factors.

Estimates predict that 12 million people in the U.S. will have AFib by 2030.

Symptoms of AFib

You may not have symptoms. How often you have symptoms depends on whether you have paroxysmal, persistent, long-standing persistent or permanent AFib.

• Paroxysmal AFib: Episodes happen every now and then. Each attack lasts less than one week. Sometimes, it stops on its own without treatment.
• Persistent AFib: The episode lasts more than one week. It may stop on its own, but you may need treatment to stop it.
• Long-standing persistent AFib: You’re constantly in AFib for one year or longer.
• Permanent AFib: Even after medicine and other treatments, AFib doesn’t go away.

Contact your healthcare provider right away if you have AFib symptoms like:

• Heart palpitations, which can feel like a fish flopping in your chest, or a racing or pounding heart
• Extreme fatigue
• Dizziness or lightheadedness

Call 911 or your local emergency number if you:

• Have chest pain
• Have severe shortness of breath
• Faint or feel like you might faint

AFib causes

Changes to your heart’s tissue and electrical system cause atrial fibrillation. Here’s what can cause these changes:

• Other forms of heart and vascular disease: These include coronary artery disease, valve disease and heart failure.
• Other medical conditions: These include high blood pressure, overweight, obesity, hyperthyroidism, chronic kidney disease and obstructive sleep apnea.
• Genetic variants: Certain gene changes are linked with AFib, according to research.
• Heart surgery: It’s possible for AFib to begin after heart surgery you have for another reason. AFib can also happen when you’re recovering from non-cardiac surgery.

Risk factors

Having any of the medical conditions listed above raises your risk for atrial fibrillation. Other risk factors include:

• Increasing age: Your risk for AFib goes up as you get older, and more so after age 65.
• Excessive alcohol use: Drinking more than the suggested limit, including “binge drinking,” raises your risk for AFib.
• Critical illness: Serious illnesses that require a hospital stay (like sepsis or severe COVID-19) raise your risk of getting AFib.
• Lack of physical activity: You’re more likely to get AFib if you don’t get enough movement each day.
• Extreme exercise training: Physical activity helps your heart. But you’re more likely to develop AFib if you do extreme exercise or intense endurance training for at least three hours a day over many years.

How to lower your risk

You can reduce your risk of atrial fibrillation by being physically active, managing related conditions, and avoiding tobacco products and alcohol.

You may also want to avoid triggers like:

• Being stressed
• Not drinking enough fluids
• Not getting enough sleep
• Missing a dose of medicine for AFib

Complications of this condition

Atrial fibrillation increases your risk of having a stroke. When your heart isn’t beating normally, you have a higher risk of dangerous blood clots forming in your heart and going to vital organs. A blood clot that travels to your brain can cause a stroke. AFib can also lead to heart failure or heart disease.

How doctors diagnose this condition

An electrocardiogram (EKG/ECG) diagnoses atrial fibrillation. This test creates a graph of the electrical signals moving through your heart. The results can show if you have AFib or other types of abnormal heart rhythms.

Your provider will also:

• Do a physical exam and review your medical history.
• Request blood tests to check for other conditions, including those that could affect your AFib treatment plan.
• Request an echocardiogram (echo) to assess your heart’s structure and function.
• Possibly ask you to wear a monitor (Holter monitor or cardiac event monitor) to record your heart’s electrical activity over a longer period of time.

AFib stages

Healthcare providers use these stages when diagnosing and treating atrial fibrillation:

1. Stage 1 (at risk for AFib): You have certain risk factors for AFib, including high blood pressure, obesity, diabetes or sleep apnea.
2. Stage 2 (pre-AFib): You have changes to your heart’s electrical activity or structure that further raise your risk for AFib. These include atrial arrhythmias, enlarged atria, heart failure, coronary artery disease, heart valve disease and heart muscle disease.
3. Stage 3 (AFib): An EKG/ECG shows you have atrial fibrillation. You might have symptoms that come and go on their own. Or you might have AFib episodes that stay despite treatment. Symptoms might go away after treatment but return later.
4. Stage 4 (permanent AFib): This means you’re no longer trying to manage AFib with treatments and you’re constantly in AFib.

How is it treated?

AFib may stop after a surgery or a catheter-based procedure. Atrial fibrillation treatment may involve one or more ways to manage your heart rhythm and rate and prevent blood clots.

Lifestyle changes

These are things you can do from day to day to help keep atrial fibrillation from getting worse. Lifestyle changes are important across all the stages of AFib — even before you have any symptoms. Your provider will help you:

• Reach and maintain a weight that’s healthy for you.
• Limit how much alcohol you drink.
• Avoid tobacco use.
• Get enough physical activity.
• Manage any conditions that raise your risk for AFib, like high blood pressure, obesity, sleep apnea and diabetes.

Medication

The medications you need to manage AFib may change over time. Your provider may prescribe medications to control your heart rate and/or heart rhythm. These medications can prevent damage to your heart and help reduce symptoms that make you feel uncomfortable or anxious.

Your provider may also prescribe blood thinners (anticoagulants) that lower your risk of blood clots that could lead to a stroke. Providers typically prescribe direct-acting oral anticoagulants (DOACs). Sometimes, they prescribe warfarin.

Ablation for AFib

Ablation for atrial fibrillation is a broad term for procedures that create scar tissue in your heart. The scars block the abnormal electrical signals to help your heart beat in a normal rhythm.

You might have these procedures for AFib:

• Catheter ablation: This is a minimally invasive procedure. Your healthcare provider guides thin tubes through your blood vessels to your heart. Pulmonary vein isolation (PVI) ablation involves scarring around where the pulmonary veins enter the heart, as this is commonly where AFib signals start in the heart. The technique to scar the heart tissue can involve heat (radiofrequency ablation), cold (cryoablation) or an electric field (pulsed field ablation). Pulsed field ablation is less likely to damage nearby tissue compared to other ablation techniques.
• Hybrid AFib ablation: This minimally invasive approach uses catheter ablation. But a provider delivers it through small openings or incisions they make in your chest to scar the outside of your heart. This is in addition to using a catheter to scar the inside of the heart.
• Maze procedure: This is also called surgical ablation. Your surgeon creates scar tissue to block abnormal signals. Surgical ablation usually takes place during heart surgery done for another reason (like bypass or valve surgery).

Other procedures

Other procedures that treat atrial fibrillation include:

• Cardioversion: Your provider uses a device (cardioverter) or medicine to get your heart rhythm back to normal.
• Left atrial appendage (LAA) closure: If you can’t tolerate blood thinners, a provider might implant a left atrial appendage occlusion device to lower your risk of a stroke. This procedure seals off a sac in your heart where blood clots can easily form.

When should I see my healthcare provider?

There’s no single schedule to follow. It all depends on your symptoms and treatment plan, and whether you need follow-ups after a procedure. So, it’s important to talk with your provider and make a plan together.

Make sure you go to all your scheduled visits. Keep track of the medications you’re taking and bring a list of your prescriptions to every visit. It’s also a good idea to keep the list in your wallet so it’s with you in emergencies.

At each visit, share any new symptoms or problems you’re having, like side effects from medication. Be sure to ask your provider before taking over-the-counter (OTC) medicines, like those for cold and flu, and supplements. Sometimes, these products can affect your heart rate or interact with your prescriptions.

What can I expect if I have this condition?

Atrial fibrillation develops in stages and can get worse over time. Once you have AFib, you have it for life. Your provider will help you manage the condition. Treatment can lower your risk of a stroke and help you have fewer symptoms.

A study published in 2024 found that people with AFib had a shorter life expectancy than those without AFib. The number of years lost from their life expectancy varied by their age at diagnosis. The younger you are at diagnosis, the shorter your life expectancy, and the more years you lose compared to others your age without AFib.

But remember that numbers just tell part of the story. Working closely with your healthcare team to manage atrial fibrillation and any other medical conditions can give you the best chance at a long life. Many people with managed AFib have a normal life expectancy.

Is there anything I can do to feel better?

The same habits that lower your risk of AFib help you feel better when you have it. Eating healthy foods and getting 30 minutes of physical activity five days a week can help your heart. Cutting out tobacco products and alcohol is good for your heart, too.