Atrial Fibrillation: Your GoodRx Guide

Causes

AFib is more common in people who have other heart and vascular conditions. Among people who have AFib, 1 in 5 also have hypertension (high blood pressure). Other heart conditions that can lead to AFib include:

• Heart failure

• Heart attack

• Heart valve disease

• Congenital heart conditions

There are also several non-cardiac risk factors for AFib, including:

• Advanced age

• Family history

• Thyroid issues

• Lung disease

• Obstructive sleep apnea

• Diabetes mellitus 

• Obesity

• Chronic kidney disease

• Infections/viral illnesses

• Certain medications 

Our behaviors can also put us at risk for AFib. Lifestyle habits that can lead to AFib include:

• Drinking alcohol

• Smoking and vaping

• Consuming caffeine 

• Doing illegal drugs (especially cocaine and amphetamines)

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Symptoms

Some people with AFib don’t have symptoms. Other people may experience one or more of the following: 

• Palpitations

• Shortness of breath

• Chest pain/discomfort

• Dizziness/lightheadedness

• Fatigue

• Exercise intolerance

There are several types of AFib, which can influence the pattern of symptoms people experience. The different types of AFib are:

• Paroxysmal: This is when AFib comes on and then goes away. The period of AFib usually lasts less than 24 hours, but can last up to a week. Episodes can be occasional or frequent, and people may or may not have symptoms during an episode. Treatment depends on how long episodes last and how often they occur.

• Persistent: This occurs when AFib lasts longer than 7 days. It usually requires treatment.

• Long-standing persistent: This refers to AFib that lasts for more than 12 months. It usually requires treatment to control the heart rate or restore a normal rhythm.

• Permanent: This is when AFib persists despite medications and/or procedures.

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Diagnosis

If you have symptoms of AFib, the first step is to see your healthcare provider. They will ask questions about your symptoms and your health, and do a physical examination. Then, they will probably order additional testing, for example:

• Electrocardiogram (EKG): An EKG is a test that measures the electrical activity of your heart. It gives a very brief picture of your heart rhythm. Since AFib may come and go, the EKG may be normal.   

• Holter monitor: This is an external monitor worn on the chest for a period of 24 to 48 hours that is used to monitor the heart rhythm. 

• Event monitor: This device is similar to a Holter monitor that’s worn on the chest wall for 2 to 4 weeks. It gives your provider information about your heart rhythm over a longer period of time. 

• Echocardiogram: An “echo” is an ultrasound scan of the heart that’s usually done on the front of the chest. It gives detailed images of the heart as it beats.  

Stress test: This test looks at how healthy the blood flow to the heart muscle is. Your heart is scanned or monitored while you exercise on a treadmill, or you may receive a certain medication to stress the heart (if exercise isn’t possible).

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Medications

The best treatment for AFib depends on your individual health circumstances, such as how long you’ve had AFib, your symptoms, and other medical conditions that you may have. 

Treatment for AFib aims to:

• Reset the heart rhythm or steady the heart rate

• Improve symptoms

• Prevent the formation of blood clots that could cause a stroke

Many people with AFib are recommended three main types of medications:

• Rhythm control medications: to help restore or maintain the normal heart rhythm (normal sinus rhythm). These include:

  • Amiodarone

  • Dofetilide

  • Flecainide 

  • Propafenone

  • Sotalol

• Rate control medications: to help slow the heart rate during atrial fibrillation. These include:

  • Beta blockers, such as metoprolol, carvedilol, and atenolol

  • Calcium channel blockers, such as diltiazem and verapamil

  • Digoxin (uncommonly used)

• Anticoagulants: also called “blood thinners,” to make the blood less sticky, and reduce the risk of blood clots and stroke. These include:

  • Warfarin: an older medication that requires frequent blood checks to monitor levels

  • Newer anticoagulants: these don’t require blood tests to check levels:

    • Apixaban (Eliquis)

    • Edoxaban

    • Rivaroxaban

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Treatments

Sometimes medications don’t work well enough to correct or control AFib. If this is the case, a specialized procedure to treat the abnormal heart rhythm may be necessary. 

Nonsurgical procedures

The first-choice procedures to treat AFib are minimally invasive, meaning they don’t involve open heart surgery. These include:

• Electrical cardioversion: Patches are placed on the chest wall to deliver a burst of low-energy electricity to restore the heart to the normal rhythm.

• Catheter ablation: This involves placing catheters in the heart that deliver radiofrequency energy to destroy the parts of the heart tissue that are causing the abnormal heart rhythm. 

• Permanent pacemaker: This involves implanting a small device near the heart to send electrical impulses to maintain a normal heart rate. This may be done in combination with a special catheter ablation called an AV nodal ablation.

• Left atrial appendage (LAA) occlusion: This involves placing a small, umbrella-like device in a sac called the left atrial appendage to prevent the formation of blood clots in that area. This procedure is used in people who may not be able to take blood thinners.

Surgical procedures

When medications and nonsurgical procedures have failed, or in cases where people need heart surgery for other reasons, people with AFib may need surgery. When a surgeon uses a scalpel or laser to destroy the part of the heart’s electrical system that can cause AFib, it’s called a maze procedure. It’s usually performed at the same time as heart surgeries that fix heart valves or other problems. The surgeon may also remove the left atrial appendage to prevent blood clots related to AFib.

Living

A person with AFib can have a normal, active life. Living well with AFib involves staying in close touch with your healthcare providers and making heart-healthy lifestyle changes, such as: 

• Cutting back on alcoholic drinks

• Reducing caffeine and other stimulants

• Quitting smoking

• Taking steps to lower high blood pressure

• Maintaining a healthy weight

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