Did you know the most common irregular heart rhythm, atrial fibrillation (AFib), can increase your risk of a stroke and impact your quality of life? Sandeep Goyal, M.D., a Piedmont electrophysiologist and medical director of the cardiac electrophysiology labs at Piedmont Heart Institute, explains what causes atrial fibrillation, the most common symptoms and how it’s treated.

What is atrial fibrillation?

Atrial fibrillation is an irregular rhythm of the heart (arrhythmia) that begins in the heart’s upper chambers (the atria). Dr. Goyal says AFib is a fast, chaotic heart rhythm, resulting in stagnated blood flow in the top chamber of the heart and impaired pumping function in the bottom chambers of the heart.

“Atrial fibrillation increases the risk of stroke because it slows blood flow in the top chambers of the heart,” he says. “This can lead to pooling of the blood and clot formation in a part of the top left chamber. These clots can travel to the brain and cause stroke.”

Atrial fibrillation can also lead to congestive heart failure in some people.

The three main types of atrial fibrillation include:

• Paroxysmal atrial fibrillation: An episodic type of atrial fibrillation where episodes stop on their own and last no more than one week at a time.

• Persistent atrial fibrillation: Episodes last longer than one week and sometimes get better on their own or require treatment for a return to normal rhythm.

• Long-standing persistent atrial fibrillation: Continuous atrial fibrillation for more than one year.

What are the symptoms of atrial fibrillation?

Dr. Goyal says some people don’t have symptoms from atrial fibrillation. However, for those who do, the most common signs include:

• Heart palpitations, racing heartbeat or awareness that your heart is beating

• Shortness of breath, especially during physical activity

• Lightheadedness or dizziness

• Being excessively tired or fatigued

• Reduced ability to do physical activity

• Chest pain

Dr. Goyal says many patients get notified of an irregular heart rhythm by their wearable device, like an Apple Watch or Fitbit. While these devices can’t diagnose atrial fibrillation, they can indicate that you need to see your primary care provider (PCP). Your provider can listen to your heart, do an EKG and refer you to a cardiologist if needed. 

“For a formal diagnosis, most patients need an EKG or heart monitor,” he says.

Atrial fibrillation risk factors

The most common atrial fibrillation risk factors include:

• Age (particularly being over 50, though Dr. Goyal has seen an increase in patients between 35 and 50)

• Family history of atrial fibrillation

• High blood pressure (hypertension)

• Diabetes

• Heavy alcohol use

• Sleep apnea

• Obesity

• Heart failure

• Coronary artery disease

Do caffeine and alcohol make atrial fibrillation worse?

“There’s a common misconception that caffeine, particularly coffee, is associated with atrial fibrillation, but studies have shown there’s no negative relationship between coffee consumption and atrial fibrillation,” Dr. Goyal says. “Some studies even show people who drink up to three cups of coffee per day have a lower incidence of atrial fibrillation compared to those who don’t drink caffeine.”

Alcohol, on the other hand, can worsen atrial fibrillation.

“It’s been repeatedly proven that alcohol consumption is associated with an increased risk of atrial fibrillation,” he says. “From a purely medical standpoint, complete abstinence from alcohol is ideal, but at least moderating the amount you drink and not exceeding five drinks per week if you have atrial fibrillation is recommended in my practice.”

Is atrial fibrillation preventable?

“We can delay the onset of atrial fibrillation by managing the risk factors,” Dr. Goyal says. “In patients with atrial fibrillation, better management of risk factors could make the condition disappear for a period of time.”

Atrial fibrillation treatment options

Dr. Goyal says atrial fibrillation treatment options vary based on your diagnosis and risk factors. Treatments can include lifestyle modifications, medications or procedures.

Lifestyle changes include:

• Reducing or eliminating alcohol.

• Maintaining a healthy weight or losing weight if you’re overweight or obese.

• Treating sleep apnea.

• Controlling blood pressure or diabetes.

• Getting adequate sleep (at least six to eight hours per night).

• Incorporating stress management techniques like meditation and yoga, which can help reduce incidences of atrial fibrillation.

“While none of these things will cure or eliminate atrial fibrillation, lifestyle changes can delay atrial fibrillation recurrences,” he says.

Medication options include:

• Blood thinners or anticoagulants to reduce the risk of stroke.

• Drugs to control heart rate and restore normal heart rhythm.

Procedures include:                  

• Atrial fibrillation ablation: A minimally invasive procedure that is particularly helpful for treating paroxysmal and persistent atrial fibrillation.

• Pacemaker implants: While the pacemaker does not treat atrial fibrillation itself, it is used to treat a slow heart rate (bradycardia) that happens in some people who have atrial fibrillation.

“Early treatment of atrial fibrillation is critical,” Dr. Goyal says. “If you’re over 50, see your primary care provider each year for a physical. If your provider detects anything unusual, they can refer you to a cardiologist for more testing.”

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