Living with afib long term

A Patient’s Guide to Living With Atrial Fibrillation

Atrial fibrillation1 (AF) is the most common heart rhythm disturbance in the United States, affecting over 2 million individuals. Over 150 000 new cases of AF are diagnosed each year. It is estimated that approximately 4% of the population over 65 years of age are affected. The incidence of AF increases with age, so that approximately 11% of individuals over 80 years of age are affected. AF is typically characterized by chaotic, disorganized electrical activity in the upper chambers of the heart. When AF occurs, the upper chambers of the heart (atria) quiver rapidly and irregularly (fibrillate). This chaotic beating can cause a range of symptoms. Although this heart rhythm disturbance is not life-threatening, there is an increased risk of stroke or heart failure for some patients who have AF.

How Is Atrial Fibrillation Diagnosed?

A healthcare professional can identify an irregular heartbeat by checking your pulse or listening to your heart with a stethoscope, but an electrocardiogram (ECG or EKG) is the most reliable method to detect and confirm the presence of AF. If the AF comes and goes intermittently (commonly called paroxysmal AF), it may be necessary for you to wear a Holter monitor (a portable ECG monitor) or an event recorder to detect it.

Symptoms Associated With Atrial Fibrillation

AF can cause a range of symptoms. Some people are unaware that their hearts are fibrillating, whereas others are immediately aware of the change in their heart’s rhythm. Symptoms can range from mild fatigue to difficultly breathing, shortness of breath, and palpitations. It is unclear why some people experience symptoms while in AF and others do not. In many patients, the symptoms are related to a rapid heart rate. If medications effectively slow the rate, the symptoms disappear. Other patients continue to have symptoms, even if the heart rate is not fast. Occasionally, symptoms are due to a heart rate that is too slow. Potential symptoms associated with AF are listed in the Table.

Table. Potential Symptoms Associated With Atrial Fibrillation

Difficulty breathing

Shortness of breath



Dizziness, shortness of breath, or pain while exercising


Irregular heart beat



Chest pain and/or discomfort

Heart failure

Who Gets Atrial Fibrillation?

The causes of AF are not always clear, and potential causes are still under investigation. In some patients, AF may be due to wandering, disorganized electrical waves that circulate throughout the atria. In others, it may be caused by a single rapidly firing electrical spot that is usually located in one of the pulmonary veins in the left atrium. A number of medical conditions can promote AF, including thyroid disease (typically an overactive thyroid), poorly treated hypertension (high blood pressure), valvular heart disease, coronary artery disease, and congestive heart failure. Some individuals develop AF for no identifiable reason and in the absence of any other heart disease; this is more commonly known as lone fibrillation.


AF increases the risk of development of blood clots in the atria, probably as a result of abnormal patterns of blood flow through the atria. When the atria are fibrillating and not pumping blood effectively, blood may pool in parts of the atria, like a stagnant pond of water. A blood clot that forms and breaks loose could travel to the brain or heart, causing a stroke or heart attack. Young patients with lone atrial fibrillation have a low risk of blood clots, but the risk increases in older patients and in those who have other heart abnormalities, such as heart failure, high blood pressure, and diabetes mellitus.

One way to prevent blood clots from forming is by thinning the blood with a medication that reduces clotting. This is a process called anticoagulation. The medications used include aspirin or warfarin sodium (Coumadin, Bristol-Myers Squibb, Princeton, NJ). Several large-scale clinical trials have demonstrated that anticoagulation with warfarin reduces the risk of stroke in patients with atrial fibrillation.

Warfarin is taken daily by mouth. Unlike most medications, the dose of warfarin is adjusted according to blood test results; therefore, the dose may change over time. The blood test used to monitor the thinness or thickness of the blood is referred to as the INR, or International Normalized Ratio. It is important to monitor the INR (at least once a month for most patients) to ensure that the level of warfarin is in the effective range. If the INR is too low, blood clots will not be prevented, and if the INR is too high, there is an increased risk of bleeding.

Treatment of Atrial Fibrillation

The management of AF can vary among individuals depending on factors such as underlying heart condition, age, stroke risk, and the severity of symptoms associated with AF. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial randomized AF patients into 2 treatment strategies: heart rate control without attempting to maintain normal rhythm versus heart-rhythm control that attempted to maintain normal rhythm through the use of medications. Both groups received warfarin. The study showed that there was no advantage of one approach over the other in terms of survival. Patients treated with heart rhythm medications were hospitalized more often for their treatment and were exposed to possible side effects of antiarrhythmic medications.2 Therefore, the selection of treatment strategy is often guided by symptoms. Anticoagulation should be considered for all patients at increased risk for stroke.

Heart Rate Control

During AF, the atria are beating quickly and irregularly, often times in excess of 350 to 500 times per minute. The impulses are transmitted to the ventricles over an electrical bridge called the atrioventricular (AV) node. Fortunately, the AV node slows the transmission of many of these impulses; however, the ventricular rate can still be quite rapid (more than 100 beats per minutes) and, if left untreated, can result in the development of heart failure. Rate control is very important. Medications such as beta-blockers, calcium channel blockers, and digitalis can be used to help slow conduction of electrical impulses over the AV node to maintain a heart rate less than 80 beats per minute at rest.

Heart Rhythm Control: Maintaining a Normal Rhythm

Restoration of a normal heartbeat is often attempted for those individuals with symptomatic AF. Medications called antiarrhythmic drugs are used to stabilize the electrical activity in the atria in an attempt to prevent episodes of AF. If AF is persistent and does not stop by itself, electrical cardioversion can be performed to restore the normal rhythm. Although cardioversion works immediately, it does not prevent the AF from recurring; medications, ablation, and surgery are potential treatments to try to prevent AF from recurring.

Electrical Cardioversion

Cardioversion3 is a procedure whereby a brief electrical current (shock) is delivered through the chest wall to the heart through special pads or paddles that are applied to the skin of the chest. The purpose of the cardioversion is to interrupt the abnormal electrical circuit(s) in the heart to restore the normal heart beat. The delivered shock activates all the heart cells simultaneously, thereby interrupting and terminating the abnormal electrical beat (typically fibrillation of the atria). This procedure allows the electrical system of the heart to take over, restoring a normal heartbeat.

Catheter Ablation

Catheter ablation4,5 is an invasive procedure that uses special tubes (catheters) with small electrodes. After administration of a local anesthetic to numb the skin over blood vessels (usually in the groin), the catheters are inserted into the blood vessel and guided to the heart. There, they are used to cauterize (burn) or freeze heart cells to modify or destroy the abnormal electrical circuits and triggers causing AF, thereby preventing AF. Another type of catheter ablation can also be performed to control rapid ventricular rates by ablating the AV node (the bridge that allows electrical signals to travel from the atria to the ventricles). This type of ablation is usually reserved for patients who have a rapid heart rate that cannot be controlled with medications. It necessitates implantation of a permanent pacemaker6 to maintain a normal heart rate.

Lifestyle Adjustments in Atrial Fibrillation

Treatment for AF must be individualized. Some people require a series of different treatments before the best management approach is found for them. There are a number of lifestyle considerations that can be helpful.


Diet is an important consideration in the management of AF, particularly if one is taking warfarin. There are many types of foods, such as green leafy vegetables and some vegetable oils, that are high in vitamin K. The liver uses vitamin K to make clotting factors that prevent excessive bleeding. Erratic consumption of foods with Vitamin K can cause the INR levels to fluctuate. This does not mean that these foods need to be avoided altogether, but care should be taken to maintain a balanced intake. There are specialized cookbooks for patients who take warfarin to assist them in preparing a variety of healthy foods while maintaining a steady daily intake of vitamin K.7

  • Alcohol and caffeine are both known triggers of AF and therefore should be avoided in susceptible individuals.

  • Blood pressure and cholesterol should be monitored. Follow a low-sodium and low-fat diet. Salt should be used sparingly particularly by those who have high blood pressure. The use of salt substitutes or fresh herbs is recommended.

  • Stop smoking. Nicotine is a cardiac stimulant and can aggravate AF. Cigarette smoking is also a known risk factor for coronary artery disease.

Specific over-the-counter (OTC) medications, such as nasal sprays and cold remedies, contain substances that can aggravate AF and should therefore be used cautiously and only under the advice of your physician. Similarly some herbal remedies may contain stimulants that may aggravate heart rhythm problems.

Managing Anticoagulation with Warfarin

Various medications, including prescription, OTC, and herbal preparations, can interfere with the metabolism of warfarin, resulting in an INR that is either too high or too low. Patients should always consult their prescribing practitioner, pharmacist, or anticoagulation clinic before starting, changing, or stopping any medication.

  • Most antibiotics will interfere with warfarin metabolism; therefore, the warfarin dosage should be adjusted along with careful monitoring of the INR.

  • Multivitamins can also interfere with warfarin and may require an adjustment of the dosage of warfarin. The multivitamin should be taken on a consistent basis to avoid variations in the INR level.

  • Herbal preparations do not undergo safety testing by the US Food and Drug Administration; therefore, the potency of preparations may vary. Some herbal preparations are purported to have anticoagulant activity, but most have little effect and are unlikely to provide the protection against stroke that is achieved with warfarin.

Exercise and Physical Activity

Regular physical activity is important. Before starting any exercise routine, you should consult your physician or nurse to establish what would be a safe and reasonable level of activity given your specific physical condition and capabilities. Physical activity is important for a number of reasons, including:

  • It helps with maintenance of a positive, upbeat mood.

  • It regulates daily biological rhythms, thus helping you get a good night’s sleep.

  • It is an important component of weight control.

Patients who need medications to slow their heart rate may find that their heart rate does not increase as much as they expect with exercise. This observation usually indicates that the medications are doing a good job of controlling the heart rate and the beneficial effects of exercise will still occur.

Coping with Atrial Fibrillation

The triggers of AF are still being investigated, but stress is likely to play a role for some people. Contemporary research suggests that approximately 54% of patients with intermittent AF cite psychological stress as the most common trigger.8 Nonetheless, AF is known to be a complex medical problem. Stress likely works together with many medical factors to prompt AF. Because many different types of stress are common aspects of life, patients with AF benefit from being aware of stress and taking specific strategies to deal with it.

Below we describe a set of strategies for AF patients to use to reduce the effects of stress.

Know Your Condition

Understanding your condition allows you to communicate your needs to family, friends, and healthcare providers. Being smart about your condition is empowering. If you don’t have the answer, ask your healthcare provider.

Be Mindful of Your Emotional Health

Many AF patients believe that they are the only ones who are experiencing worry or anticipatory fear. However, most AF patients experience at least some periods of fear and depression. Talking with a health professional about these concerns is another part of complete health care.

Plan Some Relaxation

Feelings of depressed mood or anxiety can lead to feelings of lack of control over one’s own life. To break the cycle, you will likely need a deliberate plan to schedule pleasant events. Make and follow a plan, even though you may not want to. It makes sense that when you start doing pleasant, fun or rewarding activities again, you might start feeling a bit more like your usual self.

Additional Resources

The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.




Correspondence to Julie B. Shea, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis St, Boston, MA 02115. E-mail

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Can You Live a Normal Life with Atrial Fibrillation?

No one with atrial fibrillation wants to feel like their life is over. \xC2\xA0They still want to be able to do everything they did in their 30s, 40s, or 50s. With the right treatment plan, you can absolutely live a normal life with atrial fibrillation. The purpose of this article is to open your eyes to just how much is really possible.

Maria’s Experience

Maria was sure her life was over. In her mind, atrial fibrillation meant no more sex, traveling, hot tubs, or rollercoasters. Still, she wanted to believe she could do the same things as everyone else.

Even though she was only 52, she felt like she was still 32. \xC2\xA0Her friends and family members all told her that she needed to be careful with atrial fibrillation. \xC2\xA0Her primary care doctor wanted her to stop exercising for fear of a heart attack.

She didn’t want to be a cardiac cripple for the rest of her life. \xC2\xA0And she definitely didn’t want to live like someone who was old. \xC2\xA0She wanted to know if a normal life with atrial fibrillation was possible.

What holds people back with atrial fibrillation?

In my experience, the main two things that keep people from resuming normal activity with atrial fibrillation is the sometimes rapid heart rate and medication side effects. Indeed, until your atrial fibrillation heart rate is under control, you will probably become very winded and lightheaded with any activity.

The second main thing holding people with atrial fibrillation back from living a normal life is all of the new medications. These medications often turn high-energy people into zombies.

There is no reason why you should be on a medication that makes you tired, dizzy, or causes weight gain. If you don’t feel better on atrial fibrillation medications, then you either need a different drug or a new approach to treating your atrial fibrillation.

And if your cardiologist isn’t open to non-drug alternatives, then you may want to get a second opinion. The thing to remember about atrial fibrillation is that if the drugs don’t work, there is always an option that doesn’t involve medications.

Is sex OK with atrial fibrillation?

Sex, even among the more adventurous in this arena, is generally considered to be a moderate form of exercise. As such, studies show\xC2\xA0that as long as you can sustain a moderate level of \xC2\xA0physical activity without symptoms, and you are in a stable monogamous relationship, then sex with any heart condition should pose little risk.

The reason why a stable monogamous relationship is important when it comes to having sex with a heart condition is that studies show that the vast majority of cardiovascular deaths during sex occur during an extramarital affair. While some may claim this is karma, it may just be that the sexual stress from infidelity may be too great for someone with a heart abnormality.

Can you drive your car in atrial fibrillation?

I know it seems strange, but I can’t tell you how many times I have been asked this question. \xC2\xA0Yes, you can absolutely drive your car in atrial fibrillation. \xC2\xA0Assuming, of course, that you could drive a car before atrial fibrillation…

Unless you are on the brink of passing out or otherwise distracted from the craziness of your atrial fibrillation heart rate, then you are safe to drive a car. \xC2\xA0Believe it or not, my home state of Utah requires me to “sign off” on every one of my atrial fibrillation patients who wants to maintain a driver’s license. \xC2\xA0As long as their arrhythmias have been under control, this has never been a problem.

Can you be active with atrial fibrillation?

Absolutely! The goal with all of my atrial fibrillation patients is to help them be as active as they possibly can. Indeed, studies show that the more physically active you are, the better you feel, the less atrial fibrillation you will have, and the less you will weigh.

Of course, until your atrial fibrillation is under control, your doctor may not want you to be that active. The reason for this is that until things are under control, your heart might go dangerously fast with atrial fibrillation. However, with the right treatment, you should be back to full activity within a few weeks.

Can you travel with atrial fibrillation?

Yes, you can still travel with atrial fibrillation. However, as with physical activity, your physician may want you to hold back until your atrial fibrillation is under control.

Even though airplane cabins are pressurized, at typical cruising altitudes this is the equivalent of being at an elevation of six to eight thousand feet (1,800 to 2,400 m) above sea level. Since higher elevations mean there is less oxygen, an uncontrollably fast atrial fibrillation heart rate could get you into trouble.

One other consideration for traveling is that you don’t want to wind up in the emergency room of some third world country. Once again, close partnership with your cardiologist should allow you a backup plan should an atrial fibrillation problem arise.

Can you ride a rollercoaster with atrial fibrillation?

The thrill of rollercoasters causes a massive adrenalin release. This adrenalin release then causes your blood pressure and heart rate to shoot up.

If your heart is already beating too fast with atrial fibrillation, then this adrenalin rush only makes matters worse. If, however, your atrial fibrillation is adequately treated then you should still be able to enjoy your favorite rollercoaster.

Can atrial fibrillation patients get in a hot tub?

Hot water causes your blood vessels to dilate. As your blood vessels dilate, your blood pressure may drop.

As this is often a dose-related effect, the longer you are in the hot tub, the lower your blood pressure may go. In fact, your blood pressure may go so low that you pass out either in the hot tub or while you are trying to get out of the hot tub.

For people not on medications, this usually isn’t a problem as the body generally compensates. However, if your doctor has you on atrial fibrillation medications that lower your blood pressure, like beta-blockers, diltiazem, or an antiarrhythmic, this could be a problem.

Another theoretical concern is for the person on a blood thinner. If you were to cut yourself somehow getting into the hot tub, the hot water could result in more bleeding.

The bottom line is that if you are on any prescription medications; please speak with your doctor before getting into a hot tub. It is possible that with the right precautions like hydrating first or limiting your time in the hot tub, you may still be able to enjoy this activity.

Can you skydive or scuba dive with atrial fibrillation?

When it comes to skydiving, I put the cardiovascular risk on par with riding a roller coaster. While both activities are not that physically demanding in most cases, the adrenalin release may be massive.

Thus, this adrenalin release could trigger an atrial fibrillation episode. If, however, your heart is already out of rhythm, then the adrenalin spike may cause your heart to beat extremely fast. As with all of the other activities discussed, if your atrial fibrillation is under good control, then skydiving should pose little risk.

Scuba diving, in contrast, may seem like it would be much more gentle on the heart. Indeed, you probably won\xE2\x80\x99t get that same adrenalin rush unless you had a shark coming at you.

However, because of unexpected currents, wind, and water temperature, this sport could quickly tax your cardiovascular system. It is for this reason that I make my atrial fibrillation patients pass a full-exertion stress test before embarking on their scuba diving trip.

Practical Tips

The key to living a normal life with atrial fibrillation is to find an open-minded cardiologist who listens to your needs and can work with you to regain your normal life. For some people, medications allow them to resume full activities. For others, it may require a drug-free solution, like losing weight or a catheter ablation procedure, to get back to their previous life. As everyone\xE2\x80\x99s condition, needs, and desires are different; this will require a tailored approach between you and your cardiologist.

Of course, nothing in this article should be taken as medical advice. \xC2\xA0Make sure you are in close communication with your physician when it comes to engaging in any physical activity with atrial fibrillation. \xC2\xA0Poorly controlled atrial fibrillation is a high risk situation that requires prompt treatment.

She continued her morning routine and drove to the aged care home where she worked as an enrolled nurse. One of her fellow nurses noticed Laura was looking unwell and took her heart rate – it was excessively high at 180 beats per minute+.

A quick visit to her local doctor confirmed atrial fibrillation (AF), a form of irregular heart rhythm. An ambulance was called to take her directly to hospital for monitoring and medication.

Laura said a check-up with her doctor six weeks later showed no sign of AF, but a month later, she had another episode.

“That’s when I realised this was not a one-off thing but a heart condition I would need to learn how to manage and live with,” said Laura.

As a 50-year-old with no diabetes, cholesterol or blood pressure problems and a non-smoker, Laura said she was surprised to learn she had a heart problem.

“The main risk factor I had was too much weight, so after the diagnosis and motivated by the birth of a grandchild, I made a conscious decision to get healthy, walk more and lose the weight that was affecting my health and my heart,” said Laura.

Laura joined her local Heart Foundation Walking group, the Morayfield Walkers and walks five times a week. This regular walking, in addition to her healthy diet, helped Laura to lose over 30 kilograms.

“When you have AF you can still be active, as being active and losing weight can help to reduce AF symptoms. I listen to my body and pace myself.”

The Heart Foundation recommends talking to your doctor about the level of activity that is right for if you have AF.

Laura said it is now over 12 years since her diagnosis and she manages her AF by knowing the symptoms, taking medication and addressing her risk factors through healthy eating and regular exercise.

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How to Improve Your Atrial Fibrillation Prognosis

When doctors use the word “prognosis,” they’re talking about your health outcome. So, your atrial fibrillation prognosis is a prediction of how well you will be able to live with and manage your condition. The answer for most people with atrial fibrillation? You should be able to live an active, normal life. However, there’s a significant risk that can get in the way of that.

The biggest threat to a good prognosis with atrial fibrillation — or Afib — is having a stroke, and Afib increases your stroke risk considerably. Stroke is more likely to occur when you have atrial fibrillation because the upper chambers of the heart are beating very quickly and irregularly, and a clot can form in the upper chambers, break free, and travel to the brain. “The most important issue in atrial fibrillation is to reduce stroke risk,” says John A. Scherschel, MD, assistant professor of medicine at the University of Nebraska Medical Center in Omaha.

Stroke Risk Factors for Atrial Fibrillation

Your atrial fibrillation prognosis depends on many variables, including your age, the type of Afib you have, how you respond to treatment, and other medical conditions you have. The symptoms of atrial fibrillation can last for a few hours, a few days, or be permanent. If you have persistent or permanent Afib, you may need more aggressive treatment.

When it comes to stroke prevention, your doctor will want to know about your stroke risk factors — things that increase your chance of having a stroke with atrial fibrillation. They include:

  • Being older than 75
  • Having congestive heart failure
  • Having high blood pressure
  • Having diabetes
  • Having already had a stroke

The more of these risk factors you have, the greater your risk for stroke. Your doctor may use a scoring system for stroke risk: If you have no risk factors, your score is zero, meaning you have a stroke risk of less than 2 percent; if you have all the risk factors, your stroke risk could be close to 20 percent.

“The common way we reduce the risk of stroke is with anticoagulants, or blood thinners,” says Dr. Scherschel. Depending on your stroke risk factors, your unique treatment plan for stroke reduction may include lifestyle changes, aspirin, anticoagulants, or surgery. Be sure to check in with your doctor regularly to make sure that your treatment plan is working the way that it should to help prevent stroke and improve your atrial fibrillation prognosis.

Lifestyle Changes to Improve Your Afib Prognosis

No matter what treatment plan you and your doctor decide on to reduce your stroke risk and improve your atrial fibrillation prognosis, there are other important steps that you can take:

  • Work with your doctor to manage controllable risk factors like high cholesterol, high blood pressure, and diabetes.
  • Keep all your medical appointments and check in with your doctor if there are any changes in your symptoms.
  • Check with your doctor before taking over-the-counter medications, especially herbal supplements and cold or flu medications that could have cardiovascular side effects.
  • Eat a healthy diet that avoids saturated fat, limits salt, and includes plenty of fruits, vegetables, and whole grains.
  • Maintain a healthy weight.
  • Get exercise on a regular basis.
  • Only drink alcohol in moderation.
  • Don’t smoke.

Atrial fibrillation is the most common abnormal heart rhythm among U.S. residents. But with the right treatment plan for Afib, you can live a long and healthy life. Working with your doctor to reduce stroke risk is the most important thing you can do to make sure you have a good prognosis with atrial fibrillation.

Atrial fibrillation — more commonly known as Afib — is a rapid and irregular heartbeat. This condition can lead to heart failure, blood clots, and strokes. Currently, there are almost three million people in the United States living with Afib. The question is, just how long can you live with the condition?

What is the Life Expectancy for a Person with Afib?

In a long-term scenario, living with Afib can make you feel as if your heart is flip-flopping or skipping beats. Whether or not Afib shortens a person’s lifespan depends on whether or not he or she can get their heart rate and anticoagulation under control.

If controlled, then Afib doesn’t shorten a person’s lifespan. If these two things are not under control then Afib can shorten one’s lifespan. Of course, it is important to keep in mind that Afib is often found in patients that have other heart health issues, so Atrial fibrillation long term prognosis can have more to do with other heart disease and less to do with Afib.

Warning Signs of Afib

There is a myth that only older adults are affected by atrial fibrillation, but that’s actually not the case. It can occur at any age. In adults under the age of 5, every one out of 1,000 people has Afib.

When it comes to warning signs and symptoms, you may not have any at all. For some, you may not even notice anything. That’s due to the fact that if your heart is overall healthy, there is still plenty of blood being pumped through the heart by the lower chamber. (

For others, there are some signs. You may notice some of the following:

  • Heart palpitations
  • Rapid heartbeat
  • Shortness of breath
  • Irregular heartbeat
  • Chest pain
  • Dizziness

You may experience any number of these symptoms or none at all.

In many instances, Afib is detected during a routine physical exam or an EKG. If your doctor thinks there may be an issue, your doctor may have you wear a Holter monitor for one or two days. This monitor will record the electrical activity of your heart.

In addition, your physician may run a stress test, echocardiography, chest x-ray, or blood tests.

Can Afib be Prevented? How is Afib Treated?

No one can ensure that you will never develop Afib or suffer from the effects of the disease, however, your Atrial fibrillation life expectancy can increase if you follow some lifestyle guidelines.

You should avoid caffeine and other types of stimulants as they can trigger Afib symptoms. Salty and rich foods can cause issues for some with Afib and alcohol should be limited or eliminated, as well.

When it comes to how long you can live with Afib, it is a personal journey that depends on your lifestyle, overall heart health, and getting the right diagnoses, but there is information and help out there for you that will assist you in living the longest and most productive life possible.

Do you or someone you love live with Afib? What has been your experience with the condition? What are some of the things you do to manage it and live a healthy, happy life? Let us know in the comments below!

What are the consequences of atrial fibrillation (AFib)?

Although atrial fibrillation can feel weird and frightening, an “attack of AFib” usually doesn’t have harmful consequences by itself. The real danger is the increased risk for stroke. Even when symptoms are not noticeable, AFib can increase a person’s risks for stroke and related heart problems.

What causes atrial fibrillation?

Sometimes the cause of AFib is unknown. Other times, it is the result of damage to the heart’s electrical system from other conditions, such as longstanding, uncontrolled high blood pressure or coronary artery disease. AFib is also the most common complication after heart surgery.

View an animation of atrial fibrillation.

Usually, the most serious risk from AFib is that it can lead to other medical problems, including:

  • Stroke
  • Heart failure
  • Chronic fatigue
  • Additional heart rhythm problems
  • Inconsistent blood supply

Learn about the important connection between atrial fibrillation, high blood pressure and stroke.

How does AFib lead to stroke?

  • The heartbeat seems to quiver (or fibrillate) in an erratic way. The upper chambers (the atria) of the heart do not produce an effective, regular contraction, but contract irregularly.
  • The contraction fails. Imagine wringing out a sponge. Without a good squeeze, water will still be left in the sponge. In the same way, when a heart contraction is either too fast or too uneven, it doesn’t completely squeeze the blood from the atria into the next chamber.
  • Blood pools in the atria. Blood not completely pumped out of the atria can remain and may pool there.
  • Risks of clotting go up. When blood has the opportunity to pool, it also has the opportunity to clot.
  • Clots can travel and cause blockages. If a blood clot forms in the atria, it can be pumped out of the heart to the brain, blocking off the blood supply to an artery in the brain, causing a stroke. This type of stroke is called an embolic stroke or some doctors call it a cardioembolic stroke.

How does AFib lead to heart failure?

Heart failure means the heart isn’t pumping enough blood to meet the body’s needs. AFib can lead to heart failure because the heart is beating so fast that it never properly fills up with blood to pump out to the body.

As a result, when the heart doesn’t efficiently pump the blood forward with strong contractions, symptoms develop because:

  • Blood can “back up” in the pulmonary veins (the vessels that return oxygen-rich blood from the lungs to the heart.) which can cause fluid to back up into the lungs.
  • When AFib causes heart failure, fluid in the lungs can cause fatigue and shortness of breath. Oxygen-rich blood is not being delivered to the body and brain, causing physical and mental fatigue and reduced stamina. Fluid also can build up in the feet, ankles, and legs, causing heart-failure related weight gain.

How does AFib lead to additional heart rhythm problems?

Basic answer: The heart’s electrical system stops working properly, and fails to keep the heart chambers in rhythm.

Thorough answer: Every heartbeat is controlled by the heart’s electrical system. To understand why atrial fibrillation is a problem, it is helpful to understand the normal patterns of the heart’s electrical system.

View an animation of a normal heartbeat.

The heart’s normal electrical pattern:

  • The current travels from top to bottom. The heartbeat starts at the top of the heart and – like an electrical wave – the current travels to the lower parts of the heart, signaling the tissue to contract.
  • The sinoatrial (SA) node starts the contraction in the top of the heart. The right atrium (one of the two types of chambers of the heart) houses a group of cells called the sino-atrial node. In healthy adults, the SA node fires off between 60-100 heartbeats per minute. The electrical wave moves through the atria to “gatekeeper node.”
  • The atrioventricular (AV) node regulates the timing for the lower portion of the heart. The AV node serves as a “gatekeeper” for all of the electrical pulses going through the atria (top sections) to the ventricles (bottom sections).The electrical pulses are delayed at the AV node before they are allowed to move into the ventricles. The delay gives the ventricles extra time to finish filling with blood before contracting.
  • The ventricles contract and pump blood out to the lungs and the body.

Electrical problems in atrial fibrillation:

  • In AFib, the SA node may not start the contraction. Instead, the contraction might start randomly in other areas of the atria or even in the pulmonary veins.
  • In AFib, the electrical current doesn’t flow in an organized top-to-bottom fashion. Instead, contractions are rapid and disorganized.
  • In AFib, the AV node often can’t regulate the chaotic current. It does its best to protect the ventricle from extra electrical impulses, but it can’t stop all of them. As a consequence, the ventricle beats more often than it should – giving rise to the noticeable symptoms of breathlessness and fatigue.
  • When the beat is off, the blood supply can be unpredictable. So, even though the ventricles may be beating faster than normal, they aren’t beating as fast as the atria. Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AFib, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.

The amount of blood pumped out of the ventricles to the body is based on the randomness of the atrial beats.

The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.

Can AFib simply go away?

Yes, rarely “spontaneous remission” does happen; it simply goes away. However, it is still something you and your healthcare provider will want to monitor for because some people live with AFib and do not feel the symptoms. However, the risks are still present.

Overall, most of the risks, symptoms and consequences of AFib are related to how fast the heart is beating and how often rhythm disturbances occur.

AFib may be brief, with symptoms that come and go. It is possible to have an atrial fibrillation episode that resolves on its own. Or, the condition may be persistent and require treatment. Sometimes AFib is permanent, and medicines or other treatments can’t restore a normal heart rhythm.

But for all the reasons listed above, it is important to work with your healthcare provider to determine your treatment needs, and to understand your treatment options. It is also important to maintain a heart-healthy lifestyle and reduce your overall risks as much as possible.

Watch this short video explaining stroke risk:

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