Atrial Fibrillation (AFib) Guide: Symptoms, Causes, and Treatments

What causes AFib?

AFib is more common in people who have other heart and blood vessel issues. For example, high blood pressure may cause as many as 1 in 5 cases of Afib. Other heart conditions that can lead to AFib include:

• Heart failure

• Heart attack

• Heart valve disease

• Congenital heart conditions (present at birth)

There are also several risk factors for AFib that aren’t related to your heart health, including:

• Advanced age

• Family history of AFib

• Thyroid issues

• Lung disease

• Obstructive sleep apnea

• Diabetes mellitus 

• Having a BMI of 30 or more

• Chronic kidney disease

• Infections/viral illnesses

• Certain medications 

Certain behaviors can also put people at risk for AFib:

• Drinking alcohol

• Smoking or vaping

• Consuming too much caffeine 

• Using illegal drugs (especially cocaine and amphetamines)

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AFib symptoms

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

• Palpitations (racing or fluttering heartbeat)

• Shortness of breath

• Chest pain

• Dizziness or lightheadedness

• Fatigue

• Exercise intolerance

There are several types of AFib. The type can influence the pattern of symptoms that 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 it can last up to a week. Treatment depends on how long the 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 doesn’t go away, even with medications or procedures.

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How is AFib diagnosed?

If you have symptoms of AFib, the first step is to see your primary care provider. They may recommend one or more of the following for additional testing:

• Electrocardiogram (EKG): This test 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 you can wear at home for a period of 24 to 48 hours. When you have it on, it can continuously monitor your heart’s rhythm. 

• Event monitor: Similar to a Holter monitor, this device is worn on your chest for 2 to 4 weeks. It gives your primary care provider information about your heart rhythm over a longer period of time. 

• Echocardiogram: An “echo” is an ultrasound scan of your heart. It gives detailed, live images of your heart as it beats.

• Stress test: This test looks at the blood flow to your heart muscle. Your heart is scanned or monitored while you exercise on a treadmill. If exercise isn’t possible, you can get medication that makes your heart react as if you’re exercising.

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Medications for AFib

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

Treatment for AFib aims to:

• Reset your heart rhythm or control 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, rate control medications, or anticoagulants.

Rhythm control medications help restore or maintain your normal heart rhythm (also called normal sinus rhythm). These include:

• Amiodarone

• Dofetilide

• Flecainide 

• Propafenone

• Sotalol

Rate control medications help slow your heart rate when it’s in an atrial fibrillation rhythm. These include:

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

• Calcium channel blockers, such as diltiazem and verapamil

• Digoxin (this one is not commonly used anymore)

Anticoagulants (blood thinners) reduce the risk of blood clots and stroke. These include:

• Warfarin (an older medication that is being used less often now)

• Apixaban (Eliquis)

• Rivaroxaban (Xarelto)

• Pradaxa (Dabigatran)

• Savaysa (Edoxaban)

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How can you prevent AFib?

If you have Afib or are at risk for the condition, there are many things you can do to help prevent future episodes. These include: 

• Cutting back on alcohol

• Reducing caffeine and other stimulants

• Quitting smoking

• Treating diabetes, heart failure, and high blood pressure

• Getting a sleep study to check for sleep apnea

• Maintaining a healthy weight

• Exercising regularly

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What is the life expectancy with AFib?

People with AFib are living much longer than they did several decades ago. This is likely a result of earlier detection and improved treatments for AFib. 

But AFib can still impact how long a person lives. According to one study, the life expectancy of people with AFib was 2 years less on average compared to those without it.