Atrial Fibrillation (AFib)

What are Atrial Fibrillation?

Atrial fibrillation (AFib for short) is the most common heart rhythm disorder in which the heart beats irregularly and very fast. In atrial fibrillation, the atria do not contract as they should, but vibrate very fast, at 300-600 beats per minute. Without an effective contraction, blood flow in the heart is reduced and the risk of clots increases.

You can learn more about atrial fibrillation by watching the video below.

Atrial fibrillation mechanism
Mechanism of atrial fibrillation

Atrial fibrillation ECG?

An electrocardiogram (ECG) is a diagnostic tool used to record the electrical activity of the heart and can help determine the presence of atrial fibrillation.

An AF ECG typically shows the following features: There is no P wave because there is rapid fibrillation in the atria. In other words, the atrium does not contract regularly. The transition to the ventricle is also irregular. Therefore, the distance between successive R waves varies irregularly. The patient feels this as an irregular heartbeat or pulse.

Atrial Fibrillation ECG Drawing
Atrial Fibrillation ECG Drawing
Atrial fibrillation sample ECG
Atrial fibrillation sample ECG

Atrial fibrillation causes?

There are a number of causes of atrial fibrillation and these causes can increase an individual’s likelihood of developing atrial fibrillation. Some of the causes that affect the occurrence of atrial fibrillation include:

  • Age
  • High blood pressure
  • Male gender
  • Other underlying heart diseases (such as valve diseases, heart failure)
  • Coronary artery disease (stenosis of the heart vessels)
  • Heart failure
  • Obesity
  • Thyroid problems are some of them.

These make it easier for atrial fibrillation to occur. However, atrial fibrillation can sometimes occur without any cause.

Atrial fibrillation symptoms?

In AFib, the atria beat irregularly and chaotically. This irregular rhythm is also reflected in the ventricles. The pulse is irregular. The pulse rate can be very variable. It can be 40-50 per minute or 150-160 or more. The main feature here is that the ventricular rate is very irregular. Atrial fibrillation can cause symptoms such as irregular pulse, palpitations, weakness, fatigue, and decreased walking capacity.

When atrial fibrillation comes in attacks and ends spontaneously, it is called paroxysmal atrial fibrillation or PAF. The most prominent complaint in paroxysmal atrial fibrillation is palpitations.

If atrial fibrillation attacks are stubborn, i.e. they require medication or shock therapy to stop, this is called persistent atrial fibrillation. In persistent atrial fibrillation, patients feel weakness and fatigue rather than palpitations. These symptoms are not usually associated with atrial fibrillation but should be kept in mind.

In fact, there are several methods that we use and that are recommended in medical guidelines to find out whether complaints such as weakness and fatigue are due to AFib. One of them is to normalize the rhythm with shock therapy (cardioversion) and see if the symptoms go away. A significant proportion of patients will notice an improvement in their quality of life once the rhythm is normalized. Atrial fibrillation significantly reduces your quality of life.

Atrial Fibrillation Risks?

The most important risks of atrial fibrillation are stroke or paralysis, heart failure and valvular heart failure. Let’s talk about these for a moment;

Stroke: Atrial fibrillation is a condition in which the atria vibrate very fast and there is almost no contraction. The blood flow rate in the atria slows down and they cannot easily empty the blood inside. This can increase the risk of blood clots. These clots can break away from the heart and join the circulation. This is called an embolism. If they reach the brain, they can cause a stroke. They can also travel to organs other than the brain, disrupting the blood flow to that organ and causing loss of function.

Heart Failure: Heart failure is one of the most feared consequences of atrial fibrillation. In atrial fibrillation, the irregular and rapid functioning of the heart chambers can weaken the heart muscles, causing the heart to be unable to pump blood effectively. This increases the risk of heart failure.

Heart valve insufficiencies: Especially mitral and tricuspid valve insufficiencies.

Life expectancy in patients with atrial fibrillation (if left untreated) is reduced compared to normal people because of these complications. However, there are no statistics to give a clear duration. It is very important that people with atrial fibrillation keep these risks in mind and do not interrupt their treatment.

Atrial Fibrillation Treatments?

The treatment approach varies depending on the severity of the symptoms, the age and general health of the patient, as well as the cause of the atrial fibrillation. Treatment consists of risk factor control, medication, cardioversion (shock therapy) and ablation.

Risk factor control: First, it is investigated whether there is a correctable cause of atrial fibrillation. These include thyroid problems, alcohol abuse, obesity and hypertension. If there are any, these are tried to be controlled.

Drugs: Heart rhythm regulators and, if the risk of stroke is high, blood thinners are used to control the symptoms caused by atrial fibrillation and reduce the risk of complications. Blood thinners help prevent clots from forming, reducing the risk of stroke.

Cardioversion: Shock therapy used to normalize the rhythm of atrial fibrillation.

Electrophysiology – Ablation: This treatment option is the process of burning – freezing the areas causing the rhythm disturbance with hot (RF) or cold (Cryo) ablation methods. It is a highly effective method to normalize or maintain a normal heart rhythm that has been disrupted by atrial fibrillation. For more details, you can read the article on atrial fibrillation ablation.

Atrial fibrillation is sometimes called atrial premature beats. The origin of these premature beats can be guessed from the ECG or Holter recording, if available. In patients in whom ablation is planned, finding and burning the origin of these premature beats is very useful in eliminating the rhythm disturbance.

AFib treatment is individualized depending on the patient’s specific conditions and symptoms. Treatment options and approaches should be evaluated by a cardiologist/electrophysiologist. Starting treatment early increases success. Therefore, treatment of atrial fibrillation should start from the first diagnosis. Risk factors should be controlled immediately and AFib ablation should be considered early in the presence of recurrent episodes.

Can Afib go away?

Atrial fibrillation is usually a progressive disease. Therefore, it can be progressive if it is not intervened or if the causative factors are not controlled. Atrial fibrillation attacks may become more frequent and prolonged, or they may become permanent. By controlling risk factors, the frequency and duration of atrial fibrillation episodes can be reduced.

How Should Lifestyle in Atrial Fibrillation?

Changing lifestyle is very important in atrial fibrillation.

  • Regular exercise
  • Weight loss
  • Reducing/cutting alcohol intake
  • Control of sleep apnea
  • Like blood pressure control

lifestyle changes significantly reduce the frequency of AFib episodes. Therefore, lifestyle modification is an integral part of both treatments, whether drug therapy or ablation therapy is used.

Reference: Atrial Fibrillation

Update: Feb 13, 2024

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Picture of Prof. Dr. Taylan Akgün
Prof. Dr. Taylan Akgün

He is a cardiologist specialised in the diagnosis and treatment of heart rhythm problems (ablation), pacemaker procedures.
He works in Istanbul province.

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