Atrial Fibrillation

Atrial fibrillation is one of the most common arrhythmias (heart rhythm disorders). It tends to affect older people. Usually it is a non-acute condition that can, on the other hand, have some severe complications.


Note: Do not confuse atrial fibrillation with ventricular fibrillation. It sounds similarly but this is rather a life-threatening arrhythmia.


There are numerous causes of atrial fibrillation. It occurs in patients with chronic ischemic heart disease, with heart failure, in patients suffering from cardiomyopathies, valvular heart disease, overactive thyroid gland, etc. The atrial fibrillation often occurs even without any clear underlying cause.


Atrial fibrillation is often asymptomatic and can be diagnose randomly during an ordinary medical examination. Other symptoms depend on heart rate of the fibrillation. Atrial fibrillation with quick heart rate (tachyfibrillation) often causes palpitations and such a quick rhythm can in addition cause symptoms of heart failure (shortness of breath, leg swelling, etc.). Slow fibrillation (bradyfibrillation) is usually followed by inadequate blood supply to tissue and syncope (sudden loss of consciousness). No matter the frequency, there is another problem. The heart atria do not move properly during fibrillation causing local blood stagnation and there is an increased risk of an atrial blood clot development. Such a blood clot located in the left atrium may be ejected from the heart into peripheral arteries, especially brain arteries causing ischemic strokes.


The diagnosis can be made by physical examination when we palpate irregular pulse. The arrhythmia can be confirmed by ECG. A person with a newly diagnosed atrial fibrillation should have done blood tests for evaluation of thyroid hormones and echocardiography.


There are two main approaches in the therapy of atrial fibrillation. We can be either more “invasive” and try to restore the normal rhythm or leave the atrial fibrillation with simultaneous minimizing the risk of its complications.


Removing the atrial fibrillation may be done by medications (beta-blockers, special anti-arrhythmic drugs) or by so-called electrical cardioversion. When the arrhythmia still recurs, we can either follow the conservative approach (see below) or try to perform the so-called radiofrequency ablation.


When we decide to leave the arrhythmia, we must ensure normal heart rate and prevent occurrence of tachycardia by regular administration of drugs slowing the rhythm (usually beta-blockers) and evaluate the risk of the ischemic stroke occurrence (according to patient's age, other diseases, etc.). When the risk is significant, we prescribe some anticoagulation drugs for chronic usage.


When the patient suffers from slow atrial bfivbrillation (bradyfibrillation) we must on the contrary avoid medications further slowing the heart rate and when this condition is not solvable, then implant a pacemaker.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources