A fast, pounding heartbeat could be due to A-fib, a type of heart rhythm problem (arrhythmia). Know the warning signs and when treatment is needed.
Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. A-fib increases the risk of stroke, heart failure and other heart-related complications.
During atrial fibrillation, the heart's upper chambers (the atria) beat chaotically and irregularly — out of sync with the lower chambers (the ventricles) of the heart. For many people, A-fib may have no symptoms. However, A-fib may cause a fast, pounding heartbeat (palpitations), shortness of breath or weakness.
Episodes of atrial fibrillation may come and go, or they may be persistent. Although A-fib itself usually isn't life-threatening, it's a serious medical condition that requires proper treatment to prevent stroke.
Treatment for atrial fibrillation may include medications, therapy to reset the heart rhythm and catheter procedures to block faulty heart signals.
A person with atrial fibrillation may also have a related heart rhythm problem called atrial flutter. Although atrial flutter is a different arrhythmia, the treatment is quite similar to atrial fibrillation.
In a typical heart, a tiny cluster of cells at the sinus node sends out an electrical signal. The signal then travels through the atria to the atrioventricular (AV) node and passes into the ventricles, causing them to contract and pump out blood. In atrial fibrillation, electrical signals fire from multiple locations in the atria (typically pulmonary veins), causing them to beat chaotically. Since the atrioventricular (AV) node doesn't prevent all of these chaotic signals from entering the ventricles, the heart beats faster and irregularly.
Some people with atrial fibrillation (A-fib) don't notice any symptoms. Those who do have atrial fibrillation symptoms may have signs and symptoms such as:
Atrial fibrillation may be:
If you have any signs or symptoms of atrial fibrillation, make an appointment with your doctor.
If you have chest pain, seek immediate medical help. Chest pain could mean that you're having a heart attack.
To understand the causes of A-fib, it may be helpful to know how the heart typically beats.
The typical heart has four chambers — two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of the heart (right atrium) is a group of cells called the sinus node. The sinus node is the heart's natural pacemaker. It produces the signal that starts each heartbeat.
In a regular heart rhythm:
In atrial fibrillation, the signals in the upper chambers of the heart are chaotic. As a result, the upper chambers shake (quiver). The AV node is then bombarded with signals trying to get through to the lower heart chambers (ventricles). This causes 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.
Problems with the heart's structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:
Some people who have atrial fibrillation have no known heart problems or heart damage.
Things that can increase the risk of atrial fibrillation (A-fib) include:
Blood clots are a dangerous complication of atrial fibrillation that can lead to stroke.
In atrial fibrillation, the chaotic heart rhythm can cause blood to collect in the heart's upper chambers (atria) and form clots. If a blood clot in the left upper chamber (left atrium) breaks free from the heart area, it can travel to the brain and cause a stroke.
The risk of stroke from atrial fibrillation increases as you grow older. Other health conditions also may increase your risk of a stroke due to A-fib, including:
Blood thinners are commonly prescribed to prevent blood clots and strokes in people with atrial fibrillation.
Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation. Here are some basic heart-healthy tips:
Some people are unaware that they have atrial fibrillation (A-fib). A-fib may be detected when a doctor is listening to the heart with a stethoscope during a physical exam for other reasons.
A doctor may order several tests to diagnose A-fib or exclude other conditions that can cause similar symptoms. Tests may include:
Treatment for atrial fibrillation depends on how long you've had A-fib, your symptoms and the underlying cause of the heartbeat problem. The goals of treatment are to:
Atrial fibrillation treatment may involve:
Together, you and your doctors will discuss the best treatment option for you. It's important to follow your atrial fibrillation treatment plan. If A-fib isn't well controlled, it may lead to other complications, including strokes and heart failure.
You may be prescribed medications to control how fast your heart beats and restore it to a normal rate. Medications are also prescribed to prevent blood clots, a dangerous complication of A-fib.
Medications used to treat atrial fibrillation include:
If A-fib symptoms are bothersome or if this is the first episode of atrial fibrillation, a doctor may attempt to reset the heart rhythm (sinus rhythm) using a procedure called cardioversion.
Cardioversion can be done in two ways:
Cardioversion is usually done in a hospital as a scheduled procedure, but it may be done in emergency situations. If it's scheduled, warfarin (Jantoven) or another blood thinner may be given a few weeks before it's done to reduce the risk of blood clots and strokes.
After electrical cardioversion, anti-arrhythmic medications may be prescribed indefinitely to help prevent future episodes of atrial fibrillation. Even with medications, there is a chance of another episode of atrial fibrillation.
If A-fib doesn't get better with medications or other therapies, a doctor might recommend a procedure called cardiac ablation. Sometimes ablation is the first treatment for certain patients.
Cardiac ablation uses heat (radiofrequency energy) or extreme cold (cryoablation) to create scars in your heart to block abnormal electrical signals and restore a normal heartbeat. A doctor inserts a flexible tube (catheter) through a blood vessel, usually in your groin, and into your heart. More than one catheter may be used. Sensors on the tip of the catheter apply the cold or heat energy.
Less commonly, ablation is performed using a scalpel during open-heart surgery.
There are different types of cardiac ablation. The type used to treat atrial fibrillation depends on your specific symptoms, overall health and whether you're having another heart surgery.
For example, some of the types of cardiac ablation that may be used to treat atrial fibrillation are:
Maze procedure. A doctor uses heat or cold energy or a scalpel to create a pattern of scar tissue (the maze) in the upper chambers of the heart. Because scar tissue doesn't send electrical signals, the maze interferes with the stray heart signals that cause atrial fibrillation.
If a scalpel is used to create the maze pattern, open-heart surgery is necessary. This is called the surgical maze procedure. It's the preferred method of atrial fibrillation treatment in those who need another heart surgery, such as coronary artery bypass surgery or heart valve repair.
Atrial fibrillation may return after cardiac ablation. If this happens, another cardiac ablation or other heart treatment may be recommended. After cardiac ablation, lifelong blood thinners may be needed to prevent strokes.
If a person with A-fib can't take blood-thinning medications, a doctor may recommend a catheter procedure to seal a small sac (appendage) in the left upper heart chamber, where most A-fib related clots form. This procedure is called left atrial appendage closure. A closure device is gently guided through a catheter to the sac. Once the device is in place, the catheter is removed. The device is left permanently in place. Surgery to close the left atrial appendage is an option for some people already having heart surgery.
In atrioventricular (AV) node ablation, a heart doctor uses radiofrequency energy to destroy the electrical connection between the upper and lower heart chambers (AV node), blocking the heart's electrical impulses. Once the AV node is destroyed, the heart doctor then implants a small medical device to maintain a heart rhythm (pacemaker).
Following a heart-healthy lifestyle can help prevent or treat conditions such as high blood pressure and heart disease. Lifestyle changes often include:
If you have an irregular or pounding heartbeat, make an appointment with your family doctor. If atrial fibrillation is found early, treatment may be easier and more effective. You may be referred to a doctor trained in heart conditions (cardiologist).
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For atrial fibrillation, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may save time to go over any points you want to spend more time on. Your doctor may ask: