Managing Atrial Fibrillation

The human heart is a wonder of natural engineering. Its pumping chambers and valves work together to keep blood flowing through to the lungs to be enriched with oxygen, and then continuing outward to the rest of the body. The average adult’s heart beats more than 40 million times a year.

But the heart is much more than just a simple mechanical pump. Its upper and lower chambers must work together so the heart can function at peak efficiency. To accomplish that, the heart has its own electrical control system, with signals flowing from the heart’s internal pacemaker along conductive pathways in the heart muscle. Unfortunately, things can go wrong with the heart’s mechanisms for controlling its speed and rhythm. The result may be an arrhythmia, or abnormal heartbeat, caused by disturbances in the heart’s electrical activity. Arrhythmia can take many forms, but the most common type is atrial fibrillation. It’s a bit of a tongue-twister, so doctors often just say “afib.” If you have afib, the upper chambers of the heart (atria) beat very fast. Instead of beating in a regular pattern, they quiver. This throws them out of sync with the ventricles, the lower chambers of the heart that do most of the work of pumping blood. As a result, the ventricles are not as effective.

Blood also can stagnate in the quivering atria, promoting the formation of blood clots. A clot that breaks free can travel to the brain and cause a stroke.

Common symptoms of atrial fibrillation include a racing heartbeat, “skipped” beats, dizziness, fatigue, shortness of breath, or other unpleasant sensations.

Afib may occur in brief episodes lasting hours to days, or it may go on continually for months or years. Over time, afib can reduce the heart’s ability to pump enough blood to meet your needs.

Estimates of the total number of Americans who have afib range from 2.7 million to 6.1 million. The condition is especially common among older adults. But because afib is so common, doctors have a lot of experience treating it and can offer you many options, including both medications and procedures.

Treatment for afib varies from one person to another. It needs to be customized to your age, your symptoms, and other health conditions you may have. Over time, afib and its symptoms may change, and your treatment may therefore change as well.

This guide will explain what atrial fibrillation is, how to know if you have it, its causes, and the treatments available. Afib can be a complex health condition, so the more you know about it, the better you will be able to work with your doctor. If afib is monitored and treated correctly, you can minimize its symptoms and help to prevent serious complications like stroke and heart damage.

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If you have symptoms of atrial fibrillation, it’s important to get a thorough diagnosis. But what if you are just an older adult worried that you might have afib and not know it? Should you ask your doctor to check?

Preventive testing for undiagnosed health problems is known as screening. Screening for afib remains somewhat controversial. The American Heart Association’s guideline for stroke prevention has stated that afib screening is “potentially useful” for adults 65 and older. Meanwhile, in 2020 the European Society of Cardiology fully endorsed afib screening while also acknowledging the need for better evidence to demonstrate its health benefits.
However, in January 2022, the influential U.S. Preventive Services Task Force, an independent body that evaluates evidence regarding preventive care, concluded that the scientific evidence to date isn’t strong enough to back routine, widespread screening for afib in adults ages 50 or older. (See also “Spotting afib with wearables,” page 5.)

On one hand, early diagnosis and treatment may lead to better long-term results, depending on the condition. But the evidence is crucial, since many people diagnosed with afib after preventive screening would end up taking anticoagulants, which come with the risk of unwanted bleeding. It remains a bit uncertain whether screening potentially millions of older adults would prevent enough strokes to justify its costs and risks.
As technologies evolve, guidelines and the advice your doctor gives you may also change.

Your doctor may suggest an ECG at some point on the chance you may have hidden afib. The decision to screen will depend on your risk factors for the condition, especially older age. Research is under way to establish who can benefit the most from being screened for atrial fibrillation even if they have not noticed symptoms. In the meantime, if you are concerned about afib, ask your doctor for an opinion

• A common, treatable condition
• The heart’s rhythm
• Do you have atrial fibrillation?
• Whos at risk for atrial fibrillation?
• Diagnosing atrial fibrillation
• Preventing stroke
• Treatment: Choosing a long-term strategy
• Treatment: Controlling heart rate
• Treatment: Controlling heart rhythm
• Self-help for afib
• Resources

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