Atrial Fibrillation, Explained
Resting heart rate varies from one individual to another, but the healthy range for an adult is 60-100 beats per minute. In some cases, issues with the heart’s electrical signals that trigger a heartbeat can cause an arrhythmia. This means that the heart beats too quickly, too slowly, or irregularly.
Atrial fibrillation, often referred to as Afib, is a rapid heart rate caused by irregularities in the heart’s upper chambers, or atria. It is the most common type of arrhythmia. Though the condition increases the risk of having a stroke, it is treatable with a combination of medications, lifestyle changes, and non-surgical and surgical procedures. Here’s what to know about the causes, symptoms, and treatment of atrial fibrillation.
What is atrial fibrillation?
The heart’s natural pacemaker, the sinus node, is located in the upper right chamber. It triggers the signal that begins each heartbeat. Normally, the signal travels from the sinus node through the two atria and into a pathway between the upper and lower chambers. As it travels, your heart will contract, transporting blood both to and from the heart.
Atrial fibrillation begins in the heart’s upper chambers. The signals in the atria are irregular, which causes the upper chambers to shake. As signals try to enter the lower chambers, a fast and irregular heart rhythm is produced.
There are different types of atrial fibrillation categorized by their duration.
- Paroxysmal Afib lasts for less than a week and typically does not require treatment.
- Persistent Afib is continuous, lasting longer than a week but less than a year. Treatment is required.
- Permanent Afib is continuous and treatment-resistant.
Causes and risk factors
Most cases of atrial fibrillation stem from issues with the structure of the heart. These structural issues may be caused by coronary artery disease, a heart attack, a congenital heart defect, or heart valve disease. However, it is possible to develop the condition without a history of heart health issues.
The following risk factors are often linked to atrial fibrillation.
- High blood pressure
- Thyroid disease
- Other health conditions including diabetes, chronic kidney disease, lung disease, or sleep apnea
- Alcohol and drug use
- A family history of atrial fibrillation
Not all cases of atrial fibrillation have noticeable symptoms. In some cases, one or more of the following symptoms may develop.
- An irregular heartbeat
- Heart palpitations
- Lightheadedness or fatigue
- Shortness of breath
- Chest pain
As many as 1 in 3 people with Afib may not know that they have the condition. It’s important to understand the condition’s risk factors and discuss your individual risk with your healthcare provider.
Due to the potential for blood clots, atrial fibrillation can lead to a greater risk for stroke. The irregular heart rhythm that characterizes Afib can lead to the accumulation of blood and the formation of clots in the upper chambers. If a clot breaks off from the heart, it may travel to the brain, causing a stroke.
The risk of a stroke related to Afib increases as you age. Having other conditions such as high blood pressure, diabetes, or heart failure in addition to Afib may also increase your risk for a stroke. Staying on track with treatment and following your doctor’s recommendations is the best way to manage this risk.
Treatment and prevention
Many types of atrial fibrillation are treatable. Treatment often consists of a combination of medication, lifestyle changes, and, in some cases, non-surgical procedures or surgery. Several types of medications are used to treat Afib.
Antiplatelets and anticoagulants
These medications prevent the formation of blood clots and treat existing clots. Commonly prescribed antiplatelets and anticoagulants include:
- Warfarin (Coumadin®, Jantoven®)
- Direct-acting oral anticoagulants (DOACs) such as apixaban (Eliquis®), dabigatran (Pradaxa®), edoxaban (Savaysa®), and rivaroxaban (Xarelto®)
Heart rate controlling medications
Beta blockers and calcium channel blockers may be used to manage atrial fibrillation by controlling an individual’s heart rate. Commonly used to treat high blood pressure, beta blockers cause the heart to beat more slowly and less forcefully. Examples of beta blockers include:
- Atenolol (Tenormin®)
- Bisoprolol (Zebeta®)
- Metoprolol tartrate (Lopressor®)
- Metoprolol succinate (Toprol-XL®)
- Acebutolol (Sectral®)
- Propranolol (Inderal®)
Calcium channel blockers slow an individual’s heart rate by opening up narrowed blood vessels and increasing blood flow to the heart. They are often prescribed for individuals who have chest pain or high or low blood pressure in addition to Afib. Examples include:
- Amlodipine (Norvasc®)
- Diltiazem (Cardizem®, Tiazac®)
- Nifedipine (Procardia®)
- Verapamil (Calan®, Verelan®)
Digoxin may also be prescribed to slow the flow of electrical currents from the atria to the ventricle.
Heart rhythm controlling medications
Slowing down the heart rate is often the first goal of atrial fibrillation treatment. If this has been accomplished, a common next step is restoring the rhythm to normal.
Sodium channel blockers including flecainide (Tambocor®), propafenone (Rythmol®), and quinidine work on the heart’s electrical impulses, slowing its ability to conduct electricity.
Potassium channel blockers such as amiodarone (Cordarone®, Pacerone®), sotalol (Betapace®), and dofetilide slow the electrical signals responsible for atrial fibrillation.
When taking any medication for atrial fibrillation, it’s important to stay on track with follow-up appointments and inform your doctor of any side effects.
Non-surgical procedures and surgery
If medications aren’t effective, your doctor may recommend a non-surgical procedure or surgery. Two common non-invasive procedures are electrical cardioversion, which resets the heart rhythm with low-energy shocks, and pulmonary vein ablation, which uses heat or cold energy to block electrical irregularities.
While not all cases of atrial fibrillation are preventable, many of the major risk factors are controllable. In general, practicing a heart-healthy lifestyle can lower your risk for the condition. This includes exercising for at least 150 minutes per week, maintaining a healthy weight, limiting your alcohol intake, and refraining from smoking.
Read How to Prevent Heart Disease at Any Age for more on heart-healthy living.
Take charge of your heart health
At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.
Reach out any time through in-app messaging or by phone at 1-800-874-5881.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.