Atrial Fibrillation (AFib): Causes, Symptoms, and Treatment Options

Atrial fibrillation (AFib) is a common heart rhythm disorder that occurs when the upper chambers of the heart (the atria) quiver or "fibrillate" instead of beating normally. In a healthy heart, the atria and ventricles (lower chambers) work together in a coordinated rhythm to efficiently pump blood throughout the body.

However, in AFib, normal coordination is disrupted due to unusual electrical activity in the upper chambers, leading to an irregular and often rapid heartbeat. This condition can also cause blood pooling and clot formation in the atria, which may exacerbate the risk of stroke.

Types of Atrial Fibrillation

Atrial fibrillation can be classified into various categories based on its severity. These categories include:

• Paroxysmal AFib: This type of AFib is characterised by its brief and intermittent occurrence. It usually stops in less than 24 hours or persists for up to seven days. During these episodes, the heart may revert to its regular rhythm on its own or with intervention.
• Persistent AFib: This occurs when episodes of an abnormal heart rhythm last longer than seven days and do not resolve on their own. It typically requires medical treatment, such as cardioversion, to restore a normal heart rhythm.
• Long-term Persistent AFib: This type of AFib often lasts more than one year and is sometimes difficult to treat. It is frequently linked to structural heart damage or underlying heart disease.
• Permanent AFib: The irregular heart rhythm persists indefinitely, meaning the heart is always in a state of AFIB. In this case, the heart's normal rhythm cannot be restored, and medications may be prescribed to manage symptoms and reduce the risk of complications.

What Causes Atrial Fibrillation?

The exact cause of atrial fibrillation is still unknown, but it is more prevalent with age. Individuals below the age of 50 have a 0.1% chance of developing AFib; this risk increases to 10% for those over the age of 80.

Moreover, AFib is typically associated with cardiovascular diseases. These conditions include:

• Congenital Heart Defect: Some individuals are born with structural abnormalities in their heart, which can interfere with the heart's electrical signals and lead to AFib.
• Hyperthyroidism: This condition occurs when the thyroid gland produces too much thyroid hormone, causing symptoms such as increased heart rate and palpitations that contribute to the onset of AFib.
• Heart Attack: Atrial fibrillation may occur due to a heart attack. This condition causes damage and scarring to the heart muscle, including the atria, which can disrupt the electrical signals that coordinate the heart's contractions.
• Heart Valve Disease: This refers to several conditions that affect the function of one or more of the valves in the heart, which can increase the risk of developing AFib.
• High Blood Pressure (Hypertension): This condition forces the heart to pump harder for blood to flow through narrowed vessels. The increased pressure can make the heart muscle thicker and stiffer, disrupting the heart's electrical impulses and potentially leading to AFib.
• Coronary Artery Disease: Narrowing or blockage of the coronary arteries may prevent oxygen-rich blood from reaching the heart. These blockages can also damage the heart muscle and result in an abnormal heart rhythm.
• Heart Failure: When the heart muscle is unable to pump blood adequately, blood accumulates in the atrial chamber, causing the heart to quiver and skip beats instead of maintaining a regular rhythm.
• Sick Sinus Syndrome: This condition occurs when the sinus nodes, the heart's natural pacemaker, become damaged and cannot generate normal heartbeats, resulting in a very slow or rapid heart rate.

What Risk Factors Can Initiate an Episode of Atrial Fibrillation?

In some cases, several problems that are unrelated to the heart, as well as lifestyle factors, can trigger an episode of atrial fibrillation. These include:

• Excessive alcohol use and smoking
• High levels of stress
• Use of stimulants such as caffeine or certain medications
• Family history of AFib
• Other chronic illnesses, such as diabetes, obesity, sleep apnoea, and chronic lung disease

What Are the Symptoms of Atrial Fibrillation?

Some patients with atrial fibrillation may be asymptomatic and unaware of their condition until detected by a heart specialist, while other patients may experience a range of bothersome symptoms, including:

• Dizziness or light-headedness
• Extreme fatigue and exercise intolerance
• Irregular heartbeat or palpitations
• Chest discomfort or pain
• Shortness of breath

It is important to note that the symptoms of atrial fibrillation may vary from one individual to another. Seek immediate consultation with a cardiologist if you notice any of the aforementioned symptoms.

How Is Atrial Fibrillation Diagnosed?

A heart doctor conducts a thorough physical examination where they listen to your heart using a stethoscope to check for a heart murmur or signs of an irregular heart rate or rhythm.

In addition to a physical examination, the doctor may order additional tests to confirm the atrial fibrillation diagnosis. These tests include:

• Electrocardiogram (EKG or ECG): During this test, the doctor attaches small electrodes to the patient's arms, legs, and chest. These electrodes are connected to an ECG machine to measure and record the electrical activity and rhythm patterns of the heart.
• Echocardiogram: This ultrasound test utilises high-frequency waves from a transducer to generate a computerised image of the heart and its valves. It helps reveal issues with heart muscle contractions or any abnormalities related to AFib.
• Holter Monitor: This is a portable ECG recorder that measures the heart's electrical activity over 24 to 48 hours. Doctors can observe how the heart beats during your daily activities and discern any potential triggers for AFib.
• Blood Tests: A simple blood test may be ordered to check for underlying conditions, such as anaemia, thyroid disorders, or electrolyte imbalances, that may initiate or contribute to AFib episodes.

Remember, early diagnosis and proper management of atrial fibrillation are crucial, as the condition can lead to severe complications if left untreated. If you exhibit unusual chest pain or other symptoms, consult a heart specialist for a detailed evaluation and treatment recommendations.

What Are the Treatment Options for Atrial Fibrillation?

Depending on the diagnosis, treatment options for atrial fibrillation come in several forms, from medication and non-surgical techniques to surgical procedures. These include:

• Medications: A heart specialist may recommend taking regular medications to control AFib and restore rhythm control (antiarrhythmics) or to slow down the heart rate during an episode (beta-blockers, calcium channel blockers, and digoxin). They may also prescribe anticoagulants to prevent blood clot formation and lower stroke risk.
• Electrical Cardioversion: This procedure involves sending electric shocks to the heart through paddles or patches placed on the chest to restore a normal heart rhythm.
• Pulmonary Vein Isolation (PVI): An electrode catheter is inserted into blood vessels in the groin area and guided to the heart. Once in place, it delivers energy – either heat (radiofrequency) or extreme cold (cryoablation) – to target the site of the heart that triggers AFib.
• Permanent Pacemaker: Through a minor surgical procedure, a small device called a pacemaker is implanted beneath the skin in the chest to stimulate electrical impulses in the heart and prevent the heart from beating too slowly.
• Left Atrial Appendage Closure: In this procedure, a closure device is surgically implanted to seal off the left atrial appendage (the pouch-like structure in the heart), preventing blood clots and reducing the risk of stroke in individuals diagnosed with AFib.
• Maze Procedure: This procedure involves creating a series of incisions in the atria to form a “maze” of scar tissue and disrupt the abnormal electrical pathways that cause AFib. The maze procedure is usually done in conjunction with bypass surgery or valve repair.

Can Atrial Fibrillation Go Away Naturally?

In some cases, atrial fibrillation may resolve spontaneously without any intervention. This is more common with paroxysmal AFib, where the episodes come and go. However, AFib can also progress, and the episodes are likely to recur over time if left untreated. This may lead to serious complications such as an increased risk of stroke, heart failure, and other cardiovascular issues.

How Can I Prevent Atrial Fibrillation?

Not all cases of atrial fibrillation are preventable. On the patient’s end, leading a healthy lifestyle can help reduce risk and manage the condition. Some measures include:

• Adopt a heart-healthy diet, exercise regularly, and maintain a healthy weight.
• Avoid common AFib triggers like caffeine, alcohol, and stress.
• Manage any pre-existing conditions, such as hypertension, high cholesterol, and thyroid disorders.
• Quit smoking or refrain from using tobacco products.
• Monitor your heart health through regular doctor visits.

The symptoms of atrial fibrillation can be effectively controlled with personalised medical treatment and regular check-ups by a cardiologist. Ace Cardiology Clinic is a heart clinic in Singapore that provides comprehensive evaluations, management plans, and tailored care to address AFib and other cardiovascular conditions. To schedule an appointment with our heart specialist, please call 9155 2942 today.