Atrial fibrillation is a condition characterized by an irregular and rapid beating of the heart's atrial chambers and results when the normal electrical conduction system of the atria is not functioning properly. In atrial fibrillation, there is a storm of electrical activity across both atria causing them to fibrillate (quiver) 300-600 times per minute.

It has been estimated that atrial fibrillation occurs in about 4% of the general adult population and affects approximately 2.2 million people in the United States. About 160,000 new cases of atrial fibrillation are diagnosed each year. Atrial fibrillation occurs about 1.5 times more frequently in males than in females. It is estimated that atrial fibrillation is responsible for over 60,000 strokes each year in the United States.

Atrial fibrillation is recognized as an independent risk factor for stroke and patients with atrial fibrillation are about 5-times more likely to suffer a stroke than people without atrial fibrillation. Other factors that increase the risk of stroke in people with atrial fibrillation include:

• History of previous stroke or "mini-strokes" known as transient ischemic attacks (TIAs)
• Hypertension (high blood pressure)
• Congestive heart failure
• Advancing age (particularly age 75 or older)
• Coronary artery disease
• Diabetes

Some patients with atrial fibrillation may have minimal or no symptoms, whereas others may have severe symptoms especially at the onset of the arrhythmia. At onset, patients may complain of symptoms such as palpitations, shortness of breath, cough, dizziness, fainting, and angina, but as the condition persists, the patient may complain of fatigue, shortness of breath and may show signs of pulmonary edema (fluid in the lungs).

The initial diagnostic evaluation of atrial fibrillation focuses on a careful patient history, physical examination, and specific diagnostic studies such as an electrocardiogram, 24-hour Holter monitor, and transesophageal echocardiography (TEE).

The overall focus of care for patients with atrial fibrillation is the prevention of complications and maintenance of functional ability and quality of life which can be accomplished by achieving the following goals:

• Treating any underlying disorders that may be causing atrial fibrillation
• Restoring the heart back to normal sinus rhythm
• Controlling the ventricular heart rate
• Preventing blood clot formation and stroke

The choice of therapy for patients with atrial fibrillation depends on the individual situation and is based on the degree of disability and symptoms as well as the person's ability to tolerate the various treatments and medications.

Atrial fibrillation can either be managed with rate control or rhythm control. Rate control allows the patient to remain in atrial fibrillation, but controls the heart rate by slowing conduction at the AV node with various medications. The heart rate is considered to be controlled when it is between 60-80 beats per minute at rest and between 90-115 beats per minute during moderate exercise. Rhythm control allows for conversion back to normal rhythm either with medications or by delivering a direct current electrical shock to the heart (electrical cardioversion).

In the event that medications alone are not effective for controlling atrial fibrillation, other treatment options that may be considered include radiofrequency catheter ablation or a type of surgery known as a Maze procedure. The goal of these treatments is to destroy the specific areas of the heart that are the origin of the abnormal elecrical impulses that trigger atrial fibrillation. Select patients may also require an artificial pacemaker or an implantable cardioverter-defibrillator.

A main objective in the management of patients with atrial fibrillation is the prevention of blood clots that can lead to stroke. Studies have established that anticoagulation therapy reduces the risk of stroke in patients with atrial fibrillation. Anticoagulants are "blood thinning" medications that are used to prevent the formation of blood clots that can cause a stroke. Numerous options are available for anticoagulation therapy. In recent years, several newer anticoagulant drugs have been approved for patients with atrial fibrillation. The choice of which agent to use depends on a variety of factors, and it is not uncommon to start patients with one drug and, if necessary, to switch to another.

Symptoms associated with atrial fibrillation such as palpitations, shortness of breath, chest pain, dizziness can be a source of fear and anxiety for patients and also interfere with activities of daily living and overall quality of life. Impairment of quality of life, in turn, can lead to physical and emotional disturbances and can also negatively impact the patient's social well-being. It is, therefore, important for patients and their healthcare providers to aggressively manage atrial fibrillation and bring it under control to the greatest extent possible. Patients who develop anxiety disorder and/or panic attacks associated with atrial fibrillation should be referred to a mental health professional for treatment of the psychiatric disorder.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Atrial Fibrillation

If you or a loved one has been diagnosed with atrial fibrillation, it's critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That's why we created the Medifocus Guidebook on Atrial Fibrillation, a comprehensive 160 page patient Guidebook that contains vital information about atrial fibrillation that you won't find anywhere in any other single source.

The Medifocus Guidebook on Atrial Fibrillation starts out with a detailed overview of the condition and quickly imparts fundamental information about atrial fibrillation, including:

• The underlying causes of atrial fibrillation.
• The different types of atrial fibrillation that are recognized.
• A description of the American College of Cardiology/American Heart Association classification system of atrial fibrillation.
• How atrial fibrillation is diagnosed based on factors such as signs/symptoms, physical examination, and specific diagnostic studies that are used to confirm the presence of the condition.

Understanding the Standard Treatments...and the Treatment Options

The overall objectives of treatment for atrial fibrillation include the prevention of complications, such as stroke, and maintaining the patient's functional ability and quality of life. Because understanding the treatments for atrial fibrillation is critical for achieving these important objectives, the Guidebook focuses on both the standard treatments - and the treatment options - that are used for managing the condition. As you read through the Guidebook you will specifically learn about:

• The two major strategies that doctor's use to manage patient's with atrial fibrillation. These strategies are known as:

  • Rate control - controlling the heart rate
  • Rhythm control - controlling the heart rhythm

• The medications that are commonly used to control the heart rate.

• The options that are available for controlling the heart rhythm by converting the patient from a state of atrial fibrillation back to normal sinus rhythm - a strategy known as cardioversion.

• The options that are available for the management of patients who experience a recurrence of atrial fibrillation despite best efforts to control the heart rate and/or heart rhythm. These options, explained in detail in the Guidebook, include:

  • Radiofrequency catheter ablation
  • Cryoballoon ablation
  • Surgical Maze procedure

• Which patients with atrial fibrillation are candidates for implantation of a permanent pacemaker or an implantable cardioverter-defibrillator.

Stroke Prevention in People with Atrial Fibrillation

People with atrial fibrillation are about 5-times more likely to suffer a stroke than those without atrial fibrillation. In the United States, approximately 60,000 cases of stroke attributed to atrial fibrillation occur each year. Because a primary objective in the management of patient's with atrial fibrillation is the prevention of stroke, the Guidebook covers this important issue in detail and, specifically, includes information about:

• The known risk factors that increase the likelihood of stroke in people with atrial fibrillation.
• The classification system, known as CHADS-2, that doctor's use to estimate the risk of stroke in people with atrial fibrillation.
• Medications, known as anticoagulants ("blood thinners") that are prescribed to reduce and prevent the risk of stroke in atrial fibrillation.
• The risks and benefits associated with anticoagulation therapy in people with atrial fibrillation.
• Newer anticoagulant medications that are currently in development that may prove to be safer as well as more effective for stroke prevention than currently available anticoagulants.

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Updated: January 10, 2023
160 Pages