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Atrial fibrillation or flutter

Definition

Atrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and irregular in this condition.

Alternative Names

Auricular fibrillation; A-fib

Causes

When working well, the four chambers of the heart contract (squeeze) in an organized way.

The electrical signal that tells your heart to contract begins in an area called the sinoatrial node (also called the sinus node or SA node). These signals help your heart pump the right amount of blood for your body’s needs.

In atrial fibrillation, the electrical impulse of the heart is not regular.

  • Parts of the heart cannot contract in an organized pattern.
  • As a result, the heart cannot pump enough blood to meet the body's needs.

In atrial flutter, the ventricles (lower heart chambers) may beat very rapidly, but in a regular pattern.

These problems can affect both men and women. They become more common with increasing age.

Common causes of atrial fibrillation include:

Symptoms

You may not be aware that your heart is not beating in a normal pattern.

Symptoms may start or stop suddenly. This is because atrial fibrillation may stop or start on its own.

Symptoms may include:

Exams and Tests

The health care provider may hear a fast heartbeat while listening to your heart with a stethoscope. Your pulse may feel fast, uneven, or both.

The normal heart rate is 60 - 100. In atrial fibrillation/flutter the heart rate may be 100 - 175. Blood pressure may be normal or low.

An ECG (a test that records the electrical activity of the heart) may show atrial fibrillation or atrial flutter.

If your abnormal heart rhythm comes and goes, you may need to wear a special monitor to diagnose the problem. The monitor records the heart's rhythms over a period of time.

Tests to find heart disease may include:

Treatment

Cardioversion treatment is used to get the heart back into a normal rhythm right away. There are two options for treatment:

  • Electric shocks to your heart
  • Drugs given through vein

These treatments may be done as an emergency, or planned ahead of time.

Daily medicines taken by mouth are used to:

  • Slow the irregular heartbeat. These drugs may include beta-blockers, calcium channel blockers, and digoxin.
  • Prevent atrial fibrillation from coming back. These drugs work well in many people, but they can have serious side effects. Atrial fibrillation returns in many people even while taking these medicines.

Blood thinners are medicines that are used to reduce the risk of developing a blood clot traveling in the body (such as a stroke). They include heparin, warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa).

These drugs increase the chance of bleeding, so not everyone can use them. Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. Your doctor will consider your age and other medical problems when deciding which drug is best.

A procedure called radiofrequency ablation can be used to destroy areas in your heart where the heart rhythm problems originate. You may need a heart pacemaker after this procedure.

All people with atrial fibrillation will need to learn how to manage this condition at home.

Outlook (Prognosis)

Treatment can often control this disorder. Many people with atrial fibrillation do very well.

Atrial fibrillation tends to return and get worse. It may come back even with treatment.

Clots that break off and travel to the brain can cause a stroke.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of atrial fibrillation or flutter.

Prevention

Talk to your health care provider about steps to treat conditions that cause atrial fibrillation/flutter. Avoid binge drinking.

References

Dobrev D, Nattel S. New antiarrhythmic drugs for treatment of atrial fibrillation. Lancet. 2010;375:1212-1223.

Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2011;57:e101-198.

Morady F, Zipes DP. Atrial fibrillation: clinical featuers, mechanisms, and management. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 40.

Olgin J, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 39.

Zimetbaum P. Cardiac arrhythmia with supraventricular origin. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 64.


Review Date: 5/3/2013
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by the A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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