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Atrial Fibrillation – Causes, Symptoms and Treatment

Atrial fibrillation is the most common sustained cardiac arrhythmia. The heart's upper chambers beat chaotically and irregularly, significantly increasing the risk of stroke.

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Things worth knowing about "Atrial Fibrillation"

Atrial fibrillation is the most common sustained cardiac arrhythmia. The heart's upper chambers beat chaotically and irregularly, significantly increasing the risk of stroke.

What is Atrial Fibrillation?

Atrial fibrillation (AFib or AF) is the most common clinically significant heart rhythm disorder (arrhythmia) worldwide. In this condition, the upper chambers of the heart (the atria) are activated in a chaotic and extremely rapid manner – at rates of up to 600 impulses per minute – rather than in an organized, coordinated fashion. As a result, the atria lose their effective pumping function, and the heartbeat becomes irregular. Atrial fibrillation can be temporary (paroxysmal), recurring (persistent), or permanent (long-standing persistent).

Causes and Risk Factors

Atrial fibrillation can be triggered or promoted by a wide range of conditions and risk factors:

High blood pressure (hypertension): the most common cause
Coronary artery disease and heart attack
Heart valve disease, particularly of the mitral valve
Heart failure
Overactive thyroid (hyperthyroidism)
Diabetes mellitus
Sleep apnea
Excessive alcohol consumption
Overweight and obesity
Advanced age (risk increases significantly after age 60)

Symptoms

Atrial fibrillation can manifest very differently from person to person. Some individuals experience no symptoms at all, while others have significant complaints. Common symptoms include:

Rapid or irregular heartbeat (palpitations)
Dizziness and lightheadedness
Shortness of breath, especially during physical activity
Chest pain or pressure
Fatigue and reduced exercise tolerance
In rare cases: fainting (syncope)

Atrial fibrillation is particularly dangerous because blood can pool in the atria and form clots. If these clots travel to the brain, they can cause a stroke. The risk of stroke is approximately five times higher in people with atrial fibrillation compared to those without it.

Diagnosis

The diagnosis is typically established using the following investigations:

Electrocardiogram (ECG): The standard method for detecting atrial fibrillation. The ECG shows absent P-waves and irregularly spaced QRS complexes.
Holter monitor (ambulatory ECG): Continuous ECG recording over 24 to 48 hours or longer, used to detect paroxysmal (intermittent) atrial fibrillation.
Echocardiography: Ultrasound imaging of the heart to assess its structure and function, and to detect blood clots in the atria.
Blood tests: Including thyroid function tests, complete blood count, and electrolytes.

Treatment

Stroke Prevention (Anticoagulation)

Since atrial fibrillation substantially increases the risk of stroke, preventing blood clots is a primary treatment goal. Blood thinners (anticoagulants) are used for this purpose, including direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, or dabigatran, as well as the traditional vitamin K antagonist warfarin.

Rate Control

The aim of rate control is to slow the heart rate to a normal range. Medications used include beta-blockers, calcium channel blockers (e.g., verapamil), and digoxin.

Rhythm Control

This strategy aims to restore and maintain a normal heart rhythm (sinus rhythm). It can be achieved with antiarrhythmic drugs (e.g., flecainide, amiodarone) or through an electrical cardioversion procedure, which delivers a controlled shock to reset the heart rhythm.

Catheter Ablation

Catheter ablation is a minimally invasive procedure in which the abnormal electrical pathways in the heart tissue that trigger atrial fibrillation are destroyed using heat (radiofrequency energy) or cold (cryoablation). This approach is particularly effective in younger patients with symptomatic atrial fibrillation.

Lifestyle Modifications

Alongside medical treatment, lifestyle changes play an important role: weight loss, regular physical activity, limiting alcohol intake, optimal control of blood pressure and blood sugar, and treatment of sleep apnea can all have a positive impact on atrial fibrillation.

References

Hindricks G. et al. - 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal, 2021; 42(5):373-498. (European Society of Cardiology)
World Health Organization (WHO) - Cardiovascular diseases: Atrial Fibrillation. WHO Fact Sheets, 2023.
January C.T. et al. - 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 2019; 74(1):104-132.

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