What Is Atrial Fibrillation or Afib?
Atrial fibrillation, shortened to Afib, is the most common cardiac arrhythmia or irregularity in the heart’s rhythm. It is estimated to affect over five million Americans, a staggering number for a condition many people don’t know much about.
Afib is a supraventricular tachycardia or SVT, meaning that the electrical malfunction in the heart happens above the ventricles. In this case, it occurs in the heart’s right atrium or upper right chamber. Within this atrium is the SA node, a specific point where all heartbeats are initiated. When the heart malfunctions, the electrical signal may emanate from another area of the atria and consequently cause the heart to beat more often than it should. Those suffering from Afib may have up to almost 200 beats per minute, causing exceptional discomfort and disability and often landing them in the emergency room.
While Afib itself is not inherently dangerous, there are some important considerations regarding the condition.
First, atrial fibrillation causes blood to pool in an outpouching of the heart known as the left atrial appendage. This can lead to a stroke. Patients with atrial fibrillation are at five times higher risk than those who do not suffer from the condition. The risk of heart attack is also up to five times higher in Afib patients. Longer-term, the risk of congestive heart failure rises significantly.
Second, Afib can be uncomfortable or even debilitating in some instances. It is not uncommon for patients to head to the ER having fainted or feeling significant chest palpitations and pain that they mistake for a heart attack. Often, the first they hear about a cardiac arrhythmia or Afib is in that very emergency room.
The Causes of Atrial Fibrillation
There are many causes of Afib and other arrhythmias that can range from lifestyle conditions to genetic predispositions. It is no coincidence that the rise in Afib cases, especially in younger patients, has coincided with an increase in obesity and related diseases such as high blood pressure, high cholesterol, and sleep apnea. These conditions are all risk factors for new or worsened Afib. Ultimately, any risk factor for cardiovascular disease can also increase the risk of arrhythmia.
The effects of age cannot be overstated. While Afib can affect just about anyone at any age, it is undoubtedly more of a concern in the aging population. Patients over 50 are progressively more at risk of atrial fibrillation. Similarly, both men and women can experience Afib, affecting men more often.
There is also a genetic component. For some, close family members suffering from premature heart rhythm irregularities may be at a greater risk of experiencing themselves. Bear in mind that this is not an absolute certainty. Anyone with a family history of cardiovascular disease or cardiac arrhythmias should speak to their cardiologist and electrophysiologist about a screening regimen to catch any potential concerns at the earliest possible opportunity.
Cardiotoxicity or damage to the heart associated with cancer treatment such as chemotherapy and radiation can increase the likelihood of Afib by altering the heart’s function and causing electrical signals to misfire.
Lastly, but certainly not least, is the psychological component of heart rhythm. We all know that our heart rate increases dramatically when we get flustered, anxious, or scared, and these emotions and reactions can worsen an Afib episode. In today’s often frenetic and stressful lifestyle routines, it becomes even more important to manage stress appropriately through breathing exercises, physical exercise, and mindfulness.
Why Is Afib Hard to Diagnose?
For what someone would believe to be a straightforward condition, Afib is surprisingly sneaky, especially in its earliest stages. Most patients experience peroxisomal or occasional Afib early on. The variability in intensity and onset of these episodes is entirely unpredictable. A typical EKG performed at your primary care physician’s office will not pick up a heart irregularity, even if you have complained of heart palpitations in the past.
Further, some patients and physicians have been desensitized to the concern of occasional heart palpitations. With a dramatic increase in anxiety and panic disorders, a general trend that the COVID-19 pandemic has exacerbated, we often think we are simply having a psychological issue, ignoring the possibility of cardiovascular conditions or Afib.
There is also a knowledge gap: many patients do not know Afib exists! Unfortunately, as our population becomes less healthy, the incidence of Afib has increased dramatically. Awareness of Afib must increase for several reasons, not least of which is ensuring that hundreds of thousands, if not millions of people living with untreated Afib, no longer have to suffer from the discomfort and fear of their next episode.
Lastly, not all cases of Afib produce symptoms. This is a concept known as silent Afib, and patients can experience irregular heartbeats for months or even years without ever knowing it or being diagnosed. However, silent Afib remains a significant concern with the same risks as symptomatic Afib.
How We Diagnose Afib
As mentioned above, the traditional diagnostic tool in the form of an EKG is often performed at your annual checkup with your primary care physician or periodically with your general cardiologist. However, the EKG has a significant limitation in diagnosing Afib. It represents only a single snapshot in time and cannot detect occasional or paroxysmal Afib unless it occurs at precisely the right moment. As a result, patients often go undiagnosed for longer than they should.
At an Electrophysiologist’s office, we have advanced longer-term diagnostic tools such as Holter monitors, event monitors, and loop recorders that can record data for days, weeks, or even months, until the arrhythmia presents itself and gives us the opportunity for a proper diagnosis.
Notably, new wearable technology has begun integrating heart monitoring and arrhythmia notifications into its software algorithms. While this can be useful, it is important to remember that this is not a suitable replacement for these sensitive diagnostic tools. Patients should understand that each of our heartbeats is unique and different. What may seem like an arrhythmia to the wearable device may be a natural variation to an electrophysiologist. As such, arrhythmias should be diagnosed by qualified electrophysiologists.
The Treatment Continuum for Afib
As Electrophysiologists, we approach the treatment of Afib in a stepwise manner. First, lifestyle change is integral to managing Afib and reducing its risk. Losing weight and improving exercise regimens is an essential first step. However, as we all know, weight loss and lifestyle change are not as easy as it seems, so patients who cannot make these significant changes will likely require medication therapy.
There are two essential medications that we often prescribe our Afib patients. First is a blood thinner or anticoagulant. This medication aims to reduce the risk of blood clots forming in the heart’s left atrial appendage. Patients may also be prescribed an antiarrhythmic to help normalize the heart rhythm. However, these medical therapies are not effective in all patients; for some, the side effects of the medication can be too much to continue. This is the case in about 50% of patients. It is also worth noting that medication is not curative. Instead, it only improves symptoms for as long as the patient takes them.
In response to the significant patient population that does not respond well to medication, advanced cardiac catheter ablation technology was developed as a solution for many patients with Afib. Cardiac catheter ablation is effective in upwards of 70-80% of qualified patients and represents a safe and minimally invasive option for those that qualify. Cardiac catheter ablation comes in two forms: RF ablation using heat and cryoablation using cold to destroy the heart tissue causing the errant electrical signal, thus minimizing or eliminating Afib recurrence.
Of course, the goal is to prevent Afib, so the first step is to improve your diet and exercise, even if you are not suffering from the condition. Getting healthier not only helps prevent the occurrence of Afib but will enhance your overall cardiovascular health. However, if you are suffering from chest palpitations, it is important to visit your electrophysiologist as soon as possible, as the treatment options early on are far greater and more effective.
We look forward to meeting and assisting new patients who may be suffering from Afib. Our advanced diagnostic and treatment options can often offer a solution, but the first step is an appropriate diagnosis and treatment plan.