Got Rhythm? The Ins and Outs of Afib
Afib, or atrial fibrillation, is an irregular heart rhythm that can increase your chances of a devastating stroke or damage to the heart.
It occurs when the upper and lower chambers of the heart, which pump in synchronization to move blood through the body, get off rhythm. The upper chambers (the atria) will beat at a rapid and irregular pace compared to the bottom chambers (the ventricles). It’s the most common heart rhythm disorder affecting more than 5 million Americans, and that figure is expected to triple by 2050 as our nation ages.
UR Medicine electrophysiologist Dr. Parag Patel explains how it affects our bodies and what can be done to prevent and treat this life-threatening condition.
Health Matters: What causes atrial fibrillation?
Patel: Aging, hypertension, valve disorders, heart failure, diabetes and coronary artery disease contribute to the development of afib—all of which can be prevented or managed, except for aging, of course. Recent studies have shown sleep apnea may also play a role in the rhythm disorder. Sometimes acute illness, such as pneumonia, thyroid disease and pericarditis (inflammation of the heart sac), contributes to atrial fibrillation.
Health Matters: What does it feel like?
Patel: People describe feeling like their heart is racing uncontrollably (palpitations), skipping beats or causing pressure on their chest and throat, mimicking a heart attack. When it’s happening, people often experience chest pain, shortness of breath or dizziness, and some faint.
Those symptoms usually prompt people to contact their physician or go to an urgent care or emergency department for evaluation, resulting in the diagnosis of atrial fibrillation.
Interestingly, some patients have no symptoms at all and the diagnosis may be made incidentally on an EKG. However, even if there are no symptoms, there is still potentially concern for blood clots and stroke.
Health Matters: What can afib do to the heart?
Patel: The heart is a pump that pushes oxygen-rich blood through the body. But when there’s a malfunction like atrial fibrillation, the heart may not pump properly. The upper chambers beat irregularly, with an extremely rapid rate (400 beats per minute or more). When this happens, the upper chambers quiver instead of contracting normally.
In some patients, if the heart rate is rapid and irregular for a long time, the heart muscles work inefficiently and don’t pump blood effectively through the body, potentially leaving other muscles and organs starved for oxygen-rich blood. This can cause a cardiomyopathy, or weakening of the heart.
When the heart doesn’t pump properly, it allows blood to pool and form clots. A clot could move through the body and block blood flow, and if it affects the brain, it can cause a stroke.
Health Matters: What treatments are available?
Patel: Physicians want to reduce their patient’s risk of stroke and typically begin treatment by prescribing anticoagulants if the person is at higher risk of blood clot and stroke. This is determined from factors including age, hypertension and diabetes.
Then the focus turns to managing the afib by lowering the rapid heart rate and restoring a normal rhythm. The most common treatments include cardioversion, antiarrhythmic medications and ablation procedures. Some people also benefit from care by an electrophysiologist, a cardiologist who specializes in heart-rhythm disorders.
Throughout the process, physicians encourage patients to choose a heart-healthy lifestyle, incorporating a low-fat and nutritious diet, exercise and consistent efforts to lower other risk factors.
People with asymptomatic atrial fibrillation can live decades if they work with their doctor to manage their heart rate and stroke risk.
Parag Patel, M.D., is an electrophysiologist with Rochester Cardiopulmonary Group, a part of UR Medicine Heart and Vascular.