Atrial Fibrillation

What is Atrial Fibrillation?

Atrial fibrillation (AFib) is an arrhyth­mia, caused when the heart beats in an irregular pattern. AFib is one type of ar­rhythmia occurring when the upper chambers of the heart (the atria) fibrillate, or quiver, which causes this irregular rhythm. The normal heart rate for adults is between 60 and 100 beats every minute. When the heart is in AFib, the atria can beat 300-600 times every minute, and the lower chambers (the ventricles) can beat 120-180 times every minute. Many factors can cause this abnormal electrical rhythm to occur, including medical conditions such as:

  • Uncontrolled high blood pressure
  • Coronary artery disease
  • Heart valve disease

Many of these conditions are more common with age. AFib usually occurs in people older than 60 but younger people also can develop AFib. 

Symptoms of Atrial Fibrillation

AFib symptoms are different for each person. Some people feel it when they go into AFib; others don’t notice symptoms or are not aware they are in AFib. Symptoms vary, depending on heart rate, cause of AFib, and how it affects the pumping of the heart. AFib can negatively affect quality of life. Symptoms include:

  • No energy (most common)
  • Fatigue
  • Faster heart rate or fluctuates between fast and slow
  • Short of breath
  • Heart palpitations, racing, pounding or fluttering
  • Chest pain, pressure, tightness or discomfort
  • Dizzy, lightheaded or fainting
  • Urinating frequently

Do You Have AFib Symptoms?

If you have symptoms, it's important to talk to your doctor or call Bryan Heart for an evaluation.


Causes and Risk Factors for Atrial Fibrillation

  • Older than age 60
  • High blood pressure (hypertension)
  • Coronary artery disease and heart attacks
  • Congestive heart failure
  • Heart valve problems or congenital heart defects
  • Stress due to open heart surgery, pneumonia or other illnesses
  • Atrial flutter left untreated (atrial flutter is another type of abnormal heart rhythm)
  • Diabetes
  • Overactive thyroid gland or other metabolic imbalance
  • Emphysema or other lung diseases
  • Sleep apnea
  • Exposure to stimulants, such as medications, caffeine, tobacco, illegal drugs or alcohol
  • Serious illness or infection
  • Blood clots in the lung
  • Some people who lead healthy lifestyles without other medical problems develop AFib; it may be genetic

Lifestyle Adjustments

People with AFib often have other medical conditions that may add to the severity and frequency of their AFib.

  • High blood pressure - If you have high blood pressure, your provider may prescribe medication to lower your blood pressure. High blood pressure can also put you at risk for heart damage, heart failure, damage to your arteries, stroke, kidney failure and damage to your retina (eyes).
  • High cholesterol - If you have high cholesterol, fat­ty material can build up in your arteries over time and block the flow of your blood. When your arteries are clogged, your heart and other organs may not get the oxygen they need to work effectively. Your doctor may prescribe medication (statins) to stop the buildup of fatty material in your arteries. These medications may also decrease inflammation, which may have a role in AFib.
  • Sleep apnea –Sleep apnea can lead to AFib or can make AFib worse. People with sleep apnea don’t get enough oxygen during sleep and may not be aware of how often they wake up during the night. Restless nights and feeling fatigued are common symptoms. If you have sleep ap­nea, your doctor may prescribe a mask or a treatment, called a continuous positive airway pressure (CPAP) machine, to make sure you get normal amounts of oxygen while you sleep.
  • Diet modifications - Eat more fruits and vegetables. Cut down on fats, especially saturated fats, so you can improve your cholesterol levels. Limit the amount of salt you use so you can lower blood pressure.
  • Regular exercise – Walking around the block or light gardening will make your heart and arteries healthier. Eating better and staying active can help you lose weight, which is good for your overall health. You can reduce your risk of getting other heart conditions that are associated with AFib by changing your diet and exercising.
  • Alcohol and stimulants - Avoid drinking too much alcohol or using recreational drugs (stimu­lants). Overuse of alcohol and stimulants can lead to abnormal heart rhythms, such as AFib, and stroke.

Stroke Risk

The most common risk for people with AFib is the formation of blood clots in the heart. About one-third of people with AFib will have a stroke; one out of every four strokes in the U.S. is due to AFib. People with AFib are twice more likely to die from stroke as people with normal heart rhythms. Because of this, stroke prevention is a primary treatment goal for anyone with AFib.

Treatment Goals

AFib should be treated whether or not you are having any symptoms. Treatment is based on the cause of your AFib, your symptoms, and the type of AFib you have. The goal is to:

  • Prevent blood clots from forming that can cause strokes
  • Control the heart rate (pulse)
  • Maintain a normal rhythm (if possible)
  • Treat the causes of AFib
  • Minimize the risk factors that could contribute to AFib

Treatment Options


It may be necessary to try more than one medicine before finding what works best for you. It is common to be prescribed both rhythm and rate controlling medications.

  • Rhythm control medications (antiarrhythmic drugs) – there are several types of rhythm controlling medications that help by keeping the heart in a normal rhythm and by decreasing the severity of symptoms. Benefits of rhythm control include having a more normal heart rate, and creating proper blood flow from the atria to the ventricles, resulting in the likelihood of fewer symptoms from AFib. You may still experience AFib from time to time while on these medications.
  • Rate control medications – these help by slowing a fast heart rate to a normal range. Rate control medications slow the electrical signals passing through the AV node (the electrical bridge between the upper and lower chambers of the heart). This slows the rate at which the ventricles are pumping which also helps prevent weakening of the heart muscle and decreases the severity of symptoms. You will continue to have AFib with this treatment.
  • Blood thinning medications (anticoagulants) – help to prevent blood clots and reduce the risk of stroke.


Your provider may recommend a cardioversion to restore your heart to a normal rhythm. Electrical cardioversion is performed under IV sedation. An electric shock is sent to the heart through paddles on your chest. There is a split second interruption of the abnormal heart beats, allowing the heart to regain a normal rhythm. 

A transesophageal echocardiogram (TEE) may be required if you haven’t taken a blood thinner and you have been in AFib for longer than 48 hours. This is done just before the cardioversion to make sure there are no blood clots in the atrium. While under IV sedation, a narrow tube with a small ultrasound probe is inserted in your mouth and down your esophagus to get a closer view of your heart. Once it is confirmed there are no clots within your heart, then the cardioversion can be performed.

Catheter Ablation for Atrial Fibrillation

An ablation is a non-surgical procedure that can be performed when AFib is not controlled with medications; if medications are not tolerated; or if you do not want to take medications long-term. The procedure is done with general anesthesia. Thin, flexible wires called catheters are inserted into a vein in your right groin. These catheters are thread through the vein and into the heart using X-rays to guide the way. The doctor will be able to tell where the abnormal electrical signals caus­ing AFib are coming from.

The catheter sends out radio waves that create heat. This heat ablates (destroys) the tissue and blocks the abnormal electrical signals that trigger AFib. Special equipment is used to create a 3D picture of your heart. This helps the doctor know ex­actly where to apply the heat. Another option is to use freezing cold to ablate (destroy) the heart tissue; this is called cryoablation. Radiofrequency ablation is the most common ablation performed by the Bryan Heart electrophysiologists.

AV Nodal Ablation

AV (atrioventricular) node ablation can be considered for eliminating the rapid heartbeats if medications and Afib ablations are not effective in controlling Afib.

The AV node is a nerve that conducts electrical impulses from the top chambers to the bottom chambers of the heart, ultimately controlling the heart rate. When the AV node is not working correctly, the bottom chambers of the heart no longer receive electrical signals, meaning they do not receive communication to squeeze, which is how blood is pumped out of the heart to the rest of your body. The procedure eliminates the need for heart rhythm and heart rate controlling medications; however, you will remain in AFib and will need to continue to take a blood thinner.

You will need to have a pacemaker implanted prior to AV nodal ablation. A pacemaker is a device that sends electrical impulses to the ventricles to keep the ventricles beating. It is important to know that you will now depend on the pacemaker to keep your heart beating.