The heart has an electrical rhythm that causes the heart chambers (atria on the top and ventricles on the bottom) to beat in regular fashion and order. Atrial fibrillation (also known as Afib or AF) occurs when the heart’s electrical impulses – which stimulate the heart to beat in a normal rhythm – do not fire correctly. This causes the heart to beat erratically. The sensation can be alarming and uncomfortable. People who experience Afib often report feeling a sudden change in their heart rhythm, such as a fast heartbeat or a fluttering. Many also report dizziness or weakness following an episode of Afib. Some people do not have any symptoms at all.
Afib is the most common heart irregularity, or cardiac arrhythmia. There are several different types of Afib. The symptoms of the different types of Afib may feel similar but how the condition is treated may be different depending on the type. In general, the types of atrial fibrillation are classified by how long the arrhythmia typically lasts (duration) and the underlying reason for it, which it is why it is essential the medical team should be involved in diagnosis and treatment.
In paroxysmal fibrillation, or PAF, the heart will go in and out of normal rhythm (known as sinus rhythm) on its own. This is why the symptoms come and go – and it is why you may have symptoms at home but not in your doctor's office. This spontaneous return to sinus rhythm does not mean the heart has returned to normal permanently; the problem may come and go periodically, or it may recur frequently, as often as every day or two. Because of the risk of complications related to intermittent Afib, it is important to seek medical help without delay.
“Holiday Heart” Syndrome
One type of paroxysmal Afib is known as “holiday heart syndrome.” It has earned that nickname because it tends to be crop up at times when otherwise healthy, and even young, individuals are under a bit more stress than usual – and celebrating a bit more than usual. For example, during holidays or other celebratory occasions (weddings, graduations, etc.), a person may stay up later than usual, drink more alcohol than normal, and be a bit more stressed out than is typical. The heart, not used to this level of activity and alcohol, may go into Afib. Emergency department physicians will generally keep the patient for observation and will treat him or her with medications to help regulate the heart rhythm. Many cases of so-called “holiday heart” will stabilize within 24 hours, and the patient can be released from medical care.
Sick Sinus Syndrome
Another type of Afib is known as sick sinus syndrome, sinus node disease or sinus node dysfunction. All of these terms describe the type of Afib that occurs when the sinus node of the heart – that part that stimulates the heart to beat in proper rhythm – isn’t working effectively. Sick sinus syndrome is a problem that tends to worsen with age and usually results in the need for a pacemaker to assist in keeping the heart beating in a normal sinus rhythm. More about sick sinus syndrome can be found here.
Persistent (Chronic) Atrial Fibrillation
When atrial fibrillation lasts longer than seven days (in other words, when it does not go away on its own within that period), it is known as persistent Afib or chronic Afib. In these cases, medical intervention can be performed to try to restore the heart to normal sinus rhythm. A doctor may use medications or administer a shock to the heart (electrical cardioversion) to bring the heart back into rhythm. Patients with persistent Afib who are at high risk for stroke may be candidates for procedures that target the source of the irregular heartbeat and may restore normal sinus rhythm.
Permanent Atrial Fibrillation
In some people, Afib lasts indefinitely. An individual with persistent Afib and his or her healthcare team may make a joint decision not to pursue interventions, either with medication or with cardioversion, to restore the heart to its normal rhythm. The main goals then are to control the heart rate from running too fast, usually with medications. In some cases, blood-thinner medications may be used to reduce the risk of stroke. However, as the options for treatment continue to expand and evolve, it is far less common for Afib not to be treated.
You can learn more about how patients work with their healthcare teams to manage atrial fibrillation, including reducing risk factors and selecting treatment options, here on SecondsCount. Click here to visit the Atrial Fibrillation Center.