Atrial Arrhythmias - At a Glance

Description
What is the difference between atrial flutter and atrial fibrillation?
A normal, steady heart rhythm typically beats 60-80 times a minute. Atrial flutter and atrial fibrillation rhythms can go at rates over 200 beats per minute (bpm). These types of rhythms are called supra-ventricular (“supra” – above the ventricles) tachycardias, or SVTs. Patients with these rhythms may feel fluttering in the chest and shortness of breath.

Atrial flutter (AFL) is an abnormal heart rhythm with a fast, even heart rate of 200–380 bpm. AFL frequently degenerates into atrial fibrillation (AF).

Atrial fibrillation (AF or AFib) is an abnormally fast heart rhythm where the atrial rate can range from 300-600 bpm. A heart rate of more than 300 bpm means that the atria are just quivering. They can no longer pump efficiently, and some blood may stay in the atria with each heartbeat. The pooled blood could possibly clot, increasing the risk of stroke.

Atrial Fibrillation - Watch the Video [00:07]

The fast atrial heartbeats are trying to follow the electrical pathway to the ventricles and make them contract at the same rate. Luckily, the A-V node cannot send the atrial signals to the ventricles at that fast a rate, so the whole heart usually does not contract at 300 bpm. It may beat at an uneven rate, which may cause symptoms. Like other forms of arrhythmia, AF may prevent the heart from pumping enough blood and oxygen to meet your body's needs.

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Causes and Risk Factors

What are causes and risk factors of atrial arrhythmias?

As you grow older, the risk of atrial arrhythmias seems to increase, especially after age 60. High blood pressure and coronary artery disease are associated with atrial arrhythmias, as are other heart and lung conditions such as chronic lung disease, disease of the heart valves, and heart failure. Otherwise normal hearts influenced by alcohol, stress, caffeine, severe infections, or some drugs may experience atrial arrhythmias. 

Atrial fibrillation not caused by an underlying heart disease is referred to as primary or lone atrial fibrillation.

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Symptoms

What are symptoms of atrial fibrillation?

Symptoms of atrial fibrillation vary, so not everyone feels the same thing during AF. Some people with AF experience palpitations, a sudden fluttering or pounding in the chest. This is caused by the ventricles beating at an uneven rate. Sometimes, because your heart is not pumping efficiently during AF, you may feel dizzy, faint, or short of breath. Some people have no symptoms at all.

"It (the atrial fibrillation) was a runaway train. I was in a constant state of flutter and fibrillation at over 180 beats a minute." Pat Ryan

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Diagnosis
How is atrial fibrillation diagnosed?
To diagnose AF, your doctor will typically use an electrocardiogram (ECG) test. This is a painless test that uses electrode patches on your skin to show how electrical signals travel through your heart. The ECG can be printed out on paper. Your doctor can tell what kind of rhythm you have by looking at the printed pattern of your heartbeat.

An atrial arrhythmia is often labeled by how it starts and stops.

• Paroxysmal – starts suddenly then stops on its own
• Persistent – starts and continues until stopped with treatment
• Permanent or Chronic – a rhythm that prevents a return to a normal heart rate

However, if atrial arrhythmias come and go, a regular ECG test may not show the problem. Your doctor may suggest other types of tests that involve wearing a small monitor over several days in an effort to record an episode. Your doctor will explain what type of testing is best for you.

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Treatment
How is atrial fibrillation treated?
Treatment for AF depends greatly upon you and your symptoms. Generally, your doctor will focus on treatments that help control your heart rate and reduce the risk of blood clots.

Several factors are considered in determining the appropriate method of treatment:

• Your age
• Overall health
• Your personal and family medical history
• Medications you may be taking for other conditions
• Underlying diseases or conditions that may contribute to the arrhythmia
• The nature and severity of the arrhythmia and its symptoms

Possible treatment options include one or a combination of treatments.

Lifestyle Changes
These may help improve or reduce the occurrence of an arrhythmia. They may include eating a more heart-healthy diet, limiting or eliminating the amount of caffeine, exercising regularly, and stopping smoking.

Medication
Blood thinners, such as aspirin or warfarin, are commonly prescribed, to prevent the blood from pooling and causing a blood clot to form.

Two additional types of medications are used to treat arrhythmias: antiarrhythmic medicine, which control the rhythm of the heart, and beta blockers, which control the rate at which the heart beats. They may be used alone or along with other treatments

Cardioversion
Cardioversion uses electrical energy to change an arrhythmia back to a normal rhythm. By delivering a controlled electric shock to the heart, cardioverters "shock" the heart back into a normal heart rhythm. During emergencies, the shock may be delivered through an automatic external defibrillator, or AED. Sometimes, drugs are used to achieve cardioversion.

Cardiac Ablation
In a number of AF patients, medications cannot effectively control the arrhythmia or may cause serious side effects. For these individuals, a procedure called cardiac ablation may be considered.

Some patients may need a pacemaker in conjunction with an ablation procedure.

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