The ABCs of atrial fibrillation

If you sometimes notice a fluttering, quivering sensation in your chest, you might have atrial fibrillation. About one in 11 men ages 65 and older has this heart rhythm disorder, commonly known as afib.

Afib causes an irregular and often faster-than-normal heartbeat. At rest, a normal heart rate is 60 to 100 beats per minute with a steady rhythm: beat… beat… beat. During afib, the heartbeat becomes erratic with an irregular rhythm: beat… beat… beat-beat-beat… beat. Afib can be persistent and chronic, or it can happen intermittently (paroxysmal atrial fibrillation).

People might have no symptoms with either variety, or they might feel lightheadedness, shortness of breath, chest pain, or extreme fatigue. But the biggest worry with afib is a fivefold increased risk of stroke.

“Science still does not fully grasp exactly why afib happens,” says Dr. Paul Zei, director of the Comprehensive Atrial Fibrillation Program at Harvard-affiliated Brigham and Women’s Hospital. “You can’t cure afib, but there are ways to manage the condition.”

Detecting afib

Many people with afib are not aware they have it. It’s discovered when they notice their pulse is erratic or the doctor detects it during an office visit. However, new-onset afib may make the heart beat very fast, 150 or more times a minute. With a fast, irregular pace, the heart does not pump as effectively, and that’s when serious symptoms occur.

While afib can affect people at any age, the risk of developing it increases as we grow older. Other issues that raise a person’s risk include high blood pressure, sleep apnea, obesity, diabetes, moderate to heavy alcohol use, smoking, and heart disease. Early detection of afib is crucial. “The sooner it’s diagnosed, the sooner you can begin treatment and protect against problematic symptoms and help lower your stroke risk,” says Dr. Zei.

Afib can be diagnosed in the doctor’s office with a standard ECG test, which records the heart’s electrical activity. However, people with paroxysmal afib alternate between a regular rhythm and afib, and an office ECG will likely show a normal rhythm. They need an ambulatory ECG test, which requires wearing a monitoring device for a full day, or even up to two weeks, to record the heart’s electrical activity over a longer period.

Rate control

The main therapeutic options for people with persistent afib are rate control and rhythm control. You and your doctor will determine which path you take, depending on your treatment goals, age, health conditions (especially stroke risk), and severity of afib symptoms.

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Rate control involves taking a beta blocker like metoprolol (Lopressor, Toprol XL) to keep the heart rate within the normal range. For most people, it also means taking an anticoagulant (anti-clotting) drug indefinitely. With persistent afib, small blood clots that form in the heart can break away and block arteries in the brain and other parts of the body. Anticoagulant drugs thereby help prevent strokes. Doctors most often prescribe a direct-acting oral anticoagulant (DOAC), such as apixaban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto).

Rhythm control

With rhythm control, the goal is to stop the fibrillation and restore the heartbeat to a regular pattern. The long-term advantages of rhythm control rather than rate control are fewer afib symptoms, lower risk of weakening of heart muscle function, and the possibility of not needing anticoagulation.

If you and your doctor opt for rhythm control, there are several options. One is a procedure called electrical cardioversion. Here, a small electrical shock to the chest can “reset” the heart to a normal rhythm. You will need to take an anticoagulant drug before the cardioversion and for several weeks afterward. “Electrical cardioversion works in most people, but more than half eventually develop afib again,” says Dr. Zei.

Another option is catheter ablation. Here, a doctor guides a thin, flexible tube (catheter) into a large vein and threads it up to the heart. There, it delivers zaps of radiofrequency heat energy to burn away small areas of tissue that may be causing the abnormal heartbeat. The overall success rate for catheter ablation is about 75%. Sometimes, people undergo a second procedure if the first one isn’t effective, which boosts the success rate to nearly 90%.

Cardiologists sometimes try to convert patients back to a normal rhythm just with anti-arrhythmic drugs, such as dofetilide (Tikosyn) or flecainide (Tambocor). But these drugs have potentially serious side effects — including a higher risk of a more dangerous heart rhythm — so taking them could cancel any quality-of-life advantage.

People with paroxysmal afib can help avoid episodes with lifestyle changes, like getting enough sleep, managing stress, moderating caffeine intake, and limiting alcohol use. Otherwise, the treatment approach is similar to that for persistent afib.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.

Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.

Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.

2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.

2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;

2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.

Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,

Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more

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