atrial fibrillation





A major concern with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. These blood clots forming in the heart may circulate to other organs and lead to blocked blood flow (ischemia).




  • Weakness
  • Reduced ability to exercise
  • Fatigue
  • Lightheadedness
  • Dizziness
  • Shortness of breath
  • Chest pain

Atrial fibrillation may be:

  • Occasional. In this case it's called paroxysmal (par-ok-SIZ-mul) atrial fibrillation. You may have symptoms that come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Your symptoms might go away on their own or you may need treatment.
  • Long-standing persistent. This type of atrial fibrillation is continuous and lasts longer than 12 months.
  • Permanent. In this type of atrial fibrillation, the abnormal heart rhythm can't be restored. You'll have atrial fibrillation permanently, and you'll often require medications to control your heart rate and to prevent blood clots.

When to see a doctor




Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart experience chaotic electrical signals. The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100 beats a minute.


Normally, the signal travels through the two upper heart chambers, and then through a connecting pathway between the upper and lower chambers called the atrioventricular (AV) node. The movement of the signal causes your heart to squeeze (contract), sending blood to your heart and body.

In atrial fibrillation, the signals in the upper chambers of your heart are chaotic. As a result, they quiver. The AV node — the electrical connection between the atria and the ventricles — is bombarded with impulses trying to get through to the ventricles.


Possible causes of atrial fibrillation


  • High blood pressure
  • Heart attack
  • Coronary artery disease
  • Abnormal heart valves
  • Heart defects you're born with (congenital)
  • An overactive thyroid gland or other metabolic imbalance
  • Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
  • Sick sinus syndrome — improper functioning of the heart's natural pacemaker
  • Lung diseases
  • Previous heart surgery
  • Viral infections
  • Stress due to surgery, pneumonia or other illnesses
  • Sleep apnea


Atrial flutter



Risk factors

Certain factors may increase your risk of developing atrial fibrillation.

These include:



Sometimes atrial fibrillation can lead to the following complications:


    The risk of a stroke in atrial fibrillation depends on your age (you have a higher risk as you age) and on whether you have high blood pressure, diabetes, a history of heart failure or a previous stroke, and other factors. Certain medications, such as blood thinners, can greatly lower your risk of a stroke or the damage to other organs caused by blood clots.




  • Eating a heart-healthy diet
  • Increasing your physical activity
  • Avoiding smoking
  • Maintaining a healthy weight
  • Limiting or avoiding caffeine and alcohol



  • Stress test. Also called exercise testing, stress testing involves running tests on your heart while you're exercising.



  • Reset the rhythm or control the rate



Resetting your heart's rhythm


Cardioversion can be done in two ways:

  • Electrical cardioversion. In this brief procedure, an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart's electrical activity for a short moment. The goal is to reset your heart's normal rhythm.

    You will be given a sedative before the procedure, so you shouldn't feel the electric shock. You may also receive medications to help restore a normal heartbeat (anti-arrhythmics) before the procedure.

  • Cardioversion with drugs. This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Depending on your heart condition, you may receive medications through an IV or by mouth to help return your heart to normal rhythm.


Before cardioversion, you may be given warfarin or another blood-thinning medication for several weeks to reduce the risk of blood clots and strokes. If your episode of atrial fibrillation lasted more than 48 hours, you may need to take this type of medication for at least a month after the procedure to prevent blood clots in the heart.

Maintaining a normal heart rhythm


  • Dofetilide
  • Flecainide
  • Propafenone
  • Amiodarone
  • Sotalol


  • Nausea
  • Dizziness
  • Fatigue

Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart's lower chambers. These medications may be needed indefinitely. Even with medications, there is a chance of another episode of atrial fibrillation.

Heart rate control

You may be prescribed medications to control how fast your heart beats and restore it to a normal rate.

  • Digoxin. This medication may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medications, such as calcium channel blockers or beta blockers.
  • Beta blockers. These medications can help to slow the heart rate at rest and during activity. They may cause side effects such as low blood pressure (hypotension).
  • Calcium channel blockers. These medicines also can control your heart rate, but may need to be avoided if you have heart failure or low blood pressure.

Catheter and surgical procedures


  • Catheter ablation. During this procedure, a doctor inserts long, thin tubes (catheters) into your groin and guides them through blood vessels to your heart. The catheter's tip produces radiofrequency energy, extreme cold (cryotherapy) or heat to destroy areas of heart tissue that are causing rapid and irregular heartbeats. Scar tissue forms, which helps signaling return to normal. Cardiac ablation may correct the arrhythmia without the need for medications or implantable devices.

    Your doctor may recommend this procedure if you have atrial fibrillation and an otherwise normal heart and medication has not improved your symptoms. It may also be helpful for heart failure patients who have an implanted device and cannot take or tolerate anti-arrhythmic medications.

  • Maze procedure. There are several variations of the maze procedure. The doctor may use a scalpel, radiofrequency or extreme cold (cryotherapy) to create a pattern of scar tissue that interferes with stray electrical impulses that cause atrial fibrillation.

    The maze procedures have a high success rate, but atrial fibrillation may come back. If this happens, you may need another cardiac ablation or other heart treatment.

    Because the surgical maze procedure (using a scalpel) requires open-heart surgery, it's generally reserved for people who don't get better with other treatments or when it can be done during a necessary heart surgery, such as coronary artery bypass surgery or heart valve repair.

  • Atrioventricular (AV) node ablation. If medications or other forms of catheter ablation don't work or cause side effects, or if you're not a good candidate for these therapies, AV node ablation may be an option. The procedure involves using a catheter to deliver radiofrequency energy to the pathway (AV node) connecting the upper and lower heart chambers.

    The procedure destroys a small area of heart tissue, preventing abnormal signaling. However, the upper chambers of the heart (atria) will still quiver. You'll need a pacemaker to be implanted to keep the lower chambers (ventricles) beating properly. You'll need to take blood thinners after this procedure to reduce the risk of a stroke due to atrial fibrillation.

Preventing blood clots

Many people with atrial fibrillation or those who are undergoing certain treatments for atrial fibrillation are at especially high risk of blood clots that can lead to a stroke. The risk is even higher if other heart disease is present along with atrial fibrillation.



  • Newer anticoagulants. Several newer blood-thinning medications (anticoagulants) are available to prevent strokes in people with atrial fibrillation. These medications include dabigatran, rivaroxaban, apixaban and edoxaban. They are shorter acting than warfarin and usually don't require regular blood tests or monitoring by your doctor. These medications aren't approved for people who have mechanical heart valves.


Left atrial appendage closure

Your doctor may also consider a procedure called left atrial appendage closure.

In this procedure, doctors insert a catheter through a vein in the leg and eventually guide it to the upper left heart chamber (left atrium). A device called a left atrial appendage closure device is then inserted through the catheter to close a small sac (appendage) in the left atrium.

This may reduce the risk of blood clots in certain people with atrial fibrillation, as many blood clots that occur in atrial fibrillation form in the left atrial appendage. Candidates for this procedure may include those who don't have heart valve problems, who have an increased risk of blood clots and bleeding, and who are aren't able to take anticoagulants. Your doctor will evaluate you and determine if you're a candidate for the procedure.

Lifestyle and home remedies


  • Exercise regularly. Exercise daily and increase your physical activity.
  • Maintain a healthy weight. Being overweight increases your risk of developing heart disease. Healthy weight loss can help to manage symptoms of atrial fibrillation and may improve the results of catheter ablation.
  • Drink alcohol in moderation. Binge drinking (having five drinks in two hours for men or four drinks for women) can increase your chances of atrial fibrillation. In some people, even modest amounts of alcohol can trigger atrial fibrillation.

Preparing for your appointment



What you can do

  • Write down questions to ask your doctor.


  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests will I need?
  • What's the most appropriate treatment?
  • What foods should I eat or avoid?
  • What's an appropriate level of physical activity?
  • Are there any restrictions that I need to follow?
  • Is there a generic alternative to the medicine you're prescribing?


What to expect from your doctor


  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?