Atrial Fibrillation or Flutter

Causes

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. Common causes of atrial fibrillation include:

• Alcohol use (especially binge drinking)
• Coronary artery disease
• Heart attack or heart bypass surgery
• Heart failure or an enlarged heart
• Heart valve disease (most often the mitral valve)
• Hypertension
• Medicines
• Overactive thyroid gland (hyperthyroidism)
• Pericarditis
• Sick sinus syndrome

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:

• Pulse that feels rapid, racing, pounding, fluttering, irregular, or too slow
• Sensation of feeling the heart beat (palpitations)
• Confusion
• Dizziness, light-headedness
• Fainting
• Fatigue
• Loss of ability to exercise
• Shortness of breath

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.

• Event monitor
• Holter monitor (24-hour test)
• Implanted loop recorder
• Echocardiogram (ultrasound imaging of the heart)
• Tests to examine the blood supply of the heart muscle
• Tests to study the heart's electrical system

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
• 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 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).
• 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.

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.