Dr. John Day, Cardiologist

Nobody wants a heart problem.  Fortunately, most heart conditions are very fixable.  In this article, I will answer what is atrial fibrillation and point you on the way to fixing this problem.

What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm condition.  When your heart is in atrial fibrillation the upper chambers of the heart are no longer beating and your pulse is usually rapid and irregular.  As a result, you will probably experience symptoms of fatigue, shortness of breath with exertion, or palpitations.

Mary’s Experience

Mary knew something was wrong.  Initially, she thought she just had a cold.  But when her cough never went away despite the antibiotics her doctor had prescribed, Mary knew something was wrong.  However, what ultimately brought her to the emergency room was when she was no longer able to walk up stairs without becoming short of breath.

With one EKG in the emergency room, the diagnosis was obvious.  Mary’s heart was in atrial fibrillation.  Not only that but it was also beating faster than 150 beats per minute at rest. With this diagnosis, it was just a few minutes before I was called to the emergency room to help out.

“What is atrial fibrillation?” Mary asked when I saw her for the first time in the emergency room. As atrial fibrillation is a tough name for people to remember, let alone pronounce, most people just call it “AFib” or “AF.”

“Atrial fibrillation, or AFib, is the most common reason why hearts go out of rhythm,” I said.

“Why haven’t I heard of it before,” she asked.

“I bet you already know many people with this condition. Just ask around,” I said.  I then went on to answer her questions below.  To find out what happened to Mary, continue reading until the end of the article.

What causes atrial fibrillation?

For the vast majority of the atrial fibrillation cases I see every day, atrial fibrillation comes from the gradual wear and tear on the heart over time.  This wear and tear then result in little patches of scarring (fibrosis) throughout the heart.  And the more scarring (fibrosis) that occurs, the more difficult it is to maintain a normal rhythm.

When it comes to the causes of scarring in the upper chambers of the heart (atrial fibrosis), the three leading causes that I see are age, obesity, and high blood pressure.  While there isn’t anything we can do about the age listed on our driver’s license, we can maintain a healthy weight and keep our blood pressure in check thereby slowing the rate at which our hearts age.

How many people are affected by atrial fibrillation?

If you ask around, you will be surprised to learn how many people in your life have atrial fibrillation.  In fact, studies show that one in four U. S. adults will have their hearts go out of rhythm with atrial fibrillation at least one time in their life.

What does atrial fibrillation look like?

Atrial fibrillation represents the complete electrical chaos of the upper chambers of the heart.  In other words, there is no organized rhythm and consequently, the upper chambers of the heart aren’t beating at all.

If you were to three-dimensionally map the electrical signals of atrial fibrillation in the heart, like I do every day when performing catheter ablation procedures, you would see chaotic electrical signals going in every direction. Upon closer inspection, you would notice that these signals often are the most intense and chaotic around patches of scar tissue in the upper chambers of the heart.

What does atrial fibrillation feel like?

While some people report feeling like a fish is flopping around in their chest, many people do not have any sensation at all.  The two main symptoms I see in my patients are fatigue and breathlessness with exertion.

Strangely, many people don’t have any symptoms at all with their atrial fibrillation.  In my experience, those people without symptoms tend to be older or more sedentary.  Indeed, if you are pushing your heart hard every day while exercising, then you will quickly notice the 20% drop off in the cardiac performance that happens when the heart is in atrial fibrillation.

Are the upper chambers of the heart beating with atrial fibrillation?

These chaotic electrical signals then cause the upper chambers of the heart to beat so fast that they just appear just to be quivering. With the two atria of the heart quivering, they are no longer pumping any blood. Thus, people in AFib are living entirely off the two lower two chambers of the heart.  Hence, this is why cardiac output drops by 20% with atrial fibrillation.

Is a heart murmur the same as atrial fibrillation?

All a heart murmur means is that someone heard blood moving through the heart with a stethoscope.  In contrast, atrial fibrillation represents the complete electrical failure of the upper chambers of the heart.

Some murmurs are benign whereas others can represent life-threatening heart valve problems.  The only definitive way to find out if you should worry about a murmur or not is to do an echocardiogram or ultrasound of the heart.

Perhaps the reason why some people think that a heart murmur is the same thing as atrial fibrillation is that an abnormally functioning valve in the heart can both make the sound of a murmur and cause atrial fibrillation.  The reason for this is that blood makes a lot of noise going through a tight or leaky heart valve.  Likewise, a tight or leaky heart valve puts a lot of stress on the heart which may disrupt electrical pathways and cause atrial fibrillation.

What happens if you have atrial fibrillation?

For some of my patients, they know the exact minute, down to the second, that they went out of rhythm.  This is because these people can instantly feel when their hearts stop beating normally.  In other words, they feel the irregularity of their heart, as well as the faster heart rate, that often accompanies atrial fibrillation.

However, it isn’t this way for everyone.  For many of my patients, they don’t know precisely when their heart went out of rhythm.  What they do know is that they just feel tired and their exercise stamina has dropped off.   While symptoms are important with atrial fibrillation, the real goal is to prevent the dangerous things that can happen when your heart is out of rhythm.

What are the dangers of atrial fibrillation?

With the upper heart chambers not pumping at all, blood clots can form from this stagnant blood flow. This blood pooling then increases your stroke risk five-fold.

Not only are you at high risk of a stroke, but you also lose 20% of your overall heart function when you are out of rhythm. This loss of heart function also puts you at risk for heart failure, kidney failure, or even dementia.

How is atrial fibrillation diagnosed?

To diagnose atrial fibrillation, you need to capture it on an EKG.  As with taking your car to a mechanic, atrial fibrillation never seems to happen in the doctor’s office.  It is for this reason that your doctor may prescribe a heart monitor that you wear at home for up to a month to make the diagnosis.

How is atrial fibrillation treated?

The most important thing in treating atrial fibrillation is to prevent a stroke.  Because atrial fibrillation patients have a five-fold increased risk of stroke, blood thinners are necessary when the risk of a stroke outweighs the risk of bleeding.

In addition to preventing strokes, medications may be used to slow the heart or to keep it in rhythm.  The two most common heart slowing drugs are diltiazem (Cardizem or Cartia) and metoprolol (Toprol).  Medications to hold the heart in rhythm are called antiarrhythmics.  When medications alone don’t work, your doctor may recommend a cardioversion.

What is a cardioversion?

If atrial fibrillation is causing symptoms, your doctor will probably recommend a cardioversion.  A cardioversion is a simple outpatient procedure to shock the heart back into normal rhythm.  However, it is critical to know that a cardioversion doesn’t correct the underlying electrical problem in your heart.

A cardioversion is just a temporary fix.  It is like rebooting your computer.

With your new atrial fibrillation diagnosis, your doctor will probably start you on a handful of medications.  Don’t get depressed!  With some simple lifestyle changes, there is a good chance you can get off of these medications.

How do you treat atrial fibrillation naturally?

Studies show that with simple healthy lifestyle changes, including weight loss, you have a 50% chance of making your atrial fibrillation go away without any drugs or procedures.  Indeed, I have seen countless patients over the years successfully reverse their atrial fibrillation with healthy living and you can too!

When medications and healthy lifestyle changes fail to control atrial fibrillation symptoms, the next step is usually a catheter ablation.  With a catheter ablation, your cardiologist/electrophysiologist goes into the heart with a catheter to map out those areas that are electrically misfiring.  Once the rogue sites are mapped, your doctor will then burn or freeze those areas so that the heart beats normally again.

Can a person live with atrial fibrillation?

Absolutely.  In fact, our former president, Herbert Walker Bush, has lived with atrial fibrillation for more than 25 years.  While most people with atrial fibrillation experience at least some degree of fatigue, some people are totally unaware that their heart is out of rhythm.

For those older people who truly cannot feel their atrial fibrillation, you don’t need aggressive treatment.  The focus of your therapy really should be to prevent strokes and ensure your heart doesn’t beat too fast.

For stroke prevention, blood thinners are usually prescribed.  The decision as to whether or not you should take a blood thinner comes down to how many risk factors you have for a stroke. The bottom line is that if the risk of stroke outweighs the risk of bleeding, then you probably need a blood thinner.

The reason why we don’t want the heart to beat too fast with atrial fibrillation is that we don’t want the heart to wear out.  In general, as long as you are feeling okay and your echocardiogram looks good, we try to keep your resting atrial fibrillation heart rate below 110 beats per minute.

What can trigger atrial fibrillation?

While there can be many triggers for atrial fibrillation, like alcohol, surgery, an illness, stress, or sleep deprivation, this usually doesn’t happen in completely normal hearts.  If you were to do a cardiac MRI of anyone with atrial fibrillation, you would probably find some degree of scar tissue in the upper chambers.

This scar tissue, or fibrosis, can gradually build up over a lifetime.  The top three causes of atrial fibrosis that I see every day come from the aging process, being overweight, or having high blood pressure.

One of the key strategies for treating atrial fibrillation is to avoid your triggers.  If you can learn which situations, food, etc. trigger an atrial fibrillation attack, you can be better prepared to prevent it in the first place.

What doctors treat atrial fibrillation?

As with any medical condition, you want to make sure you go to the right doctor. As you probably wouldn’t want a general handyman to do the complicated electrical work in your house, the same logic holds true with atrial fibrillation.

When it comes to atrial fibrillation, you want the best doctor with the most experience in treating this condition. Thus, my recommendation would be to schedule an appointment with a cardiologist who specializes in arrhythmias as soon as possible.

Cardiologists who specialize in arrhythmia treatment are called electrophysiologists or “EP’s” for short. To find an electrophysiologist near you, please click on this link:

http://www.hrsonline.org/Find-a-Specialist

Mary’s Transesophageal Echocardiogram and Cardioversion

As we had no way of knowing how long Mary had been in atrial fibrillation, we transferred her to our cardioversion unit.  First, we put her to sleep and performed a transesophageal echocardiogram to make sure there were no blood clots in her heart from the atrial fibrillation.

A transesophageal echocardiogram, or TEE, is an ultrasound probe that you swallow.  It is like a big piece of spaghetti.  With the TEE probe in the esophagus, your cardiologist gets a front row seat to see what is happening in the heart.

Fortunately, Mary didn’t develop a blood clot from her atrial fibrillation.  Knowing that there were no atrial fibrillation clots, we then shocked her heart back into rhythm and put her on a blood thinner for a month.

Mary was lucky.  Not only did she not develop an atrial fibrillation blood clot, but her heart looked strong.  All too often when people come into the emergency room with a rapid heart rate from atrial fibrillation we see some degree of heart failure.  The reason for the heart failure is that if the heart beats too fast for too long, it can start to wear out.

Mary’s Atrial Fibrillation Outcome

After further investigation, I suspect that Mary did indeed initially develop bronchitis.  A bronchitis diagnosis would then explain why her doctor prescribed antibiotics without any further examination.  As what often happens from respiratory illnesses, this respiratory illness then triggered an atrial fibrillation attack.

After following her in my clinic for more than five years, she has had no further episodes of atrial fibrillation.  She also hasn’t had any more respiratory illnesses.  I suspect that the reason why she has been so healthy for the last five years is that her “heart scare,” gave her the strength to quit sugar, all types of flour, and processed foods.

Besides feeling ten years younger without the sugar, flour, or processed foods, her weight naturally dropped 40 pounds without even dieting.  Never before in her life had she been able to eat as much as she wanted and still lose weight.  Simply put, Mary was able to put her heart, and her metabolism, back into rhythm.

Practical Tips

Atrial fibrillation is definitely something that no one wants. The key is to get treated immediately before something terrible happens.

For most people, there is a short window of time where healthy lifestyle changes, and possibly even a procedure, may cure you of this condition. Make sure a cardiologist, who specializes in arrhythmias, sees you as quickly as possible.