Why AFib Matters

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 artery disease. AFib is also the most common complication after heart surgery.

View an animation of atrialfibrillation.

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 heart quivers. The upper chambers (the atria) of the heart do not produce an effective, regular contraction.
  • 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. Leftover blood remains in the atria 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 (top section 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 of 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 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.

 

Recent Discussions From The Newly Diagnosed Forum
Nightsky avatar

Hello All, Great site! Just read a lot of info that I find very helpful. I have always had the "storm in my chest" feeling as long as I can rememner (I am 61) but never came out to be AFib until today....bittersweet I guess. My Cadio mentioned Elequis and come back in a Month, then he wants to do some sort of "shock" treatment at the Hospital, sounds like I am medicated and then like a defibralator, my heart is shocked "back into sync" and he says this has a pretty good sucess rate. 

I didn't see anything about it here....I mentioned abilation, he said he wanted to do this first. He also gave me a brochure on the "Watchman" from Boston Scientific, which is basically a strainer/fill plug that takes up the space where the blood pools and also has a good sucess rate? Anyone had either of these proceedures done? 

Thanks for your time, look forward to responses. By the way I am a CPAP user (very compliant) and a bit overweight, light coffee drinker (1 a day), non-smoker and no drugs or alcohol, diabetic type 2 with a pump, under control. 

 

Nesshan avatar

Last Wednesday I woke up and was sitting in bed. I felt my heart beating oddly and after that my chest felt uncomfortable, I told my sister how I was feeling and at that point my heart started beating really fast. I thought I was having a heart attack and was about to die. 

Sister took me to the ER where they checked my pulse and put me on an IV I hadn't been told what it was until I was moved to the Hospital, I wasn't allowed to walk and then I was told that I was in AFib. 

Later that night a nurse said I "converted" and all was well. 

The next day I had a ultrasound on my heart done and etc.

The doctors didn't mention anything bad going on and explained that I had AFib probably because of sleep apnea and being overweight. He told me I should work on losing weight and eating better to fix it.

I'm on Eliquis and Diltiazem, I wasn't told how long but was told I shouldn't run out of Eliquis. 

I'm still terrified of havhav that happen again and I have no one else to talk to about this. 

After having AFib and converting, and being on this medication. What are the possobiliposs of having to experience that again ? I'm trying to exercise more but I'm scared of something happening again.

njm5876 avatar

My husband was recently diagnosed with paroxysmal Afib ( March 2019)  He is scheduled for ablation July 15. Husband's normal resting HR is 50-60 --highest with Afib episode was 168.  His symptoms were some chest pressure, heart flip-flopping with fatigue.

  EP doc had him start taking Multaq for 2 weeks, no help at all.  He changed him to Sotalol 6 days ago. His HR is now down in the low 40's possibly lower as the monitor we have at home doesn't register lower than 40.  He has been exhausted since starting Sotalol- he takes 160 mg/day.  It has caused him some stomach related issues - I have noticed some shortness of breath - more fatigued than before.  He actually seems to be feeling worse on the meds than without. He is to go tomorrow to have an EKG -I am hoping he will let them know how he has been feeling the last week.  The husband has been down in the dumps and grumpy since taking Sotalol.  

EP says he also has tachy-brady syndrome..but says we need to tackle the AFib before the bradycardia.  

I think he needs to come off the Sotalol but since I am not a medical pro I may have it wrong.  I just want something to help him to feel better NOT make him worse.

Thanks for listening!! 

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