Overview
Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by irregular and often rapid beating of the heart's upper chambers (atria). It affects approximately 5% of people over age 65 and 10% of people over age 80.
In AF, blood pools in the atria, leading to clot formation and stroke risk. Stroke risk is 5 times higher in patients with AF.
Symptoms
Some people may not experience symptoms. Common symptoms:
- Palpitations (irregular, rapid heartbeat)
- Shortness of breath
- Weakness, fatigue
- Dizziness, lightheadedness
- Chest pain or discomfort
- Decreased exercise tolerance
- Fainting (rarely)
- Anxiety
Types
- Paroxysmal: Starts and stops on its own (within 7 days)
- Persistent: Lasts more than 7 days, returns with intervention
- Long-standing persistent: More than 1 year
- Permanent: Cannot be returned to normal rhythm
Causes
- High blood pressure
- Coronary artery disease
- Heart valve diseases
- Heart failure
- Congenital heart diseases
- Hyperthyroidism
- Sleep apnea
- Lung diseases
- Excessive alcohol consumption
- Excessive caffeine
- Stress, fatigue
- After surgery
- Some infections
Risk Factors
- Age (over 65)
- High blood pressure
- Diabetes
- Obesity
- Family history
- Heart diseases
- Smoking
- Excessive alcohol
- Sleep apnea
- Hyperthyroidism
Complications
- Stroke (most serious - 5 times increased risk)
- Heart failure
- Dementia
- Decreased quality of life
When to See a Doctor
- Palpitations, irregular heartbeat
- Shortness of breath
- Dizziness, fainting
- Emergency: Severe chest pain, stroke symptoms (facial palsy, speech disorder, arm weakness)
Diagnosis and Treatment
Diagnosis: ECG, Holter, event recorder, echocardiography, blood tests (thyroid, electrolytes).
Treatment:
1. Rate control: Beta blockers, calcium channel blockers, digoxin
2. Rhythm control:
- Antiarrhythmic medications (amiodarone, dronedarone, propafenone)
- Electrical cardioversion
- Catheter ablation
- Surgery (Maze procedure)
3. Stroke prevention (most critical):
- Anticoagulants: apixaban, rivaroxaban, dabigatran, edoxaban (new generation)
- Warfarin
- Left atrial appendage closure (Watchman)
Prevention
- Keep blood pressure, blood sugar, cholesterol under control
- Maintain a healthy weight
- Regular exercise
- Quit smoking
- Limit alcohol
- Treat sleep apnea
- Manage stress
- Get enough sleep