When to Worry About an Irregular Heartbeat - Understanding AFib

Atrial fibrillation, also known as AFib (AF), is the most common heart arrhythmia, or irregular heartbeat, in the United States and the world, according to Dr. Amir Lotfi, MD, FRCPC FSCAI, Chief, Cardiology Division Baystate Health, Associate Professor of Medicine, U-Mass School of Medicine. Though in most cases an irregular heartbeat is not life-threatening itself, it can increase the risk of stroke and congestive heart failure.

What is Atrial Fibrillation?

Atrial fibrillation is an irregular heartbeat sometimes described as an “irregular irregular” heartbeat because it can affect both rhythm and rate – it can cause the heart to beat too quickly and with an irregular beat.

Dr. Lotfi explains that the electrical system in the heart controls the heart rate (how many times it beats per minute) and rhythm (how regular the beat). If it is irregular, like in AFib, you have an arrhythmia. Even when a heart is healthy it can go into AFib, but AFib can also be a sign of other heart problems. It can also increase post-heart surgery, after alcohol intake, with hypertension, and with lung disease. It becomes more prevalent in the population as we age - 70% of individuals with AFib are between the age of 65 and 85 years.

What are some of the most common causes of AFib?

Dr. Lotfi says there can be many causes, like problems with the heart’s structure, but also coronary artery disease, heart attack, and aging. “The exact cause is unknown,” he explains. “Sometimes a healthy person, like an athlete, can have it.”

When there are no conditions associated with your AFib, it is known as lone atrial fibrillation.

Risk factors for AFib

• High blood pressure (hypertension)
• Heart valve disease
• Congenital heart disease
• Pericarditis
• Type 2 diabetes

Most common symptoms of AFib

• Tachycardia (rapid heart rate at rest)
• Heart palpitations or feeling like your heart skipped a beat
• Fatigue
• Dizziness and lightheadedness
• Chest pain
• Shortness of breath

What triggers AFib?

• Drinking excessive amounts of alcohol
• Being overweight
• Drinking a lot of caffeine
• Not getting enough sleep
• Strenuous exercise
• Stress

When should you go to the doctor or Emergency Room with AFib or an irregular heartbeat?

“Many people don’t even know they have AFib,” Dr. Lotfi says. “People go to their doctor for a checkup for some other reason and find out they have it.”

But, if you’ve been in AFib or experiencing an irregular heartbeat for 24-to-48 hours with no break, you should call your doctor. If symptoms worsen and you feel lightheaded, dizzy or faint, or your heart rate doesn’t come down, you have chest pain or trouble breathing, you should visit the ER.

How is AFib diagnosed?

Your doctor or the ER medical staff will do an electrocardiogram (ECG) to test the electrical activity of your heart. It takes about 10 minutes. Because AFib can come and go, you might have to wear a device to track your heartbeat for anywhere from 24 hours to one month.

An echocardiogram might also be done to check your heart’s structure including your valves and function. Blood tests will also be done to check for conditions like an overactive thyroid.

How Serious is AFib?

While AFib isn’t necessarily life threatening, it does require medical attention.

“Typically, doctors treat people by putting them on medication,” Dr. Lotfi says. They might go on a medication that reduces their heartrate, a medication that helps bring them back to sinus rhythm (a normal heartbeat), and a blood thinner, or a combination of all three. There are procedures, depending on the severity of the AFib, and those can include cardioversion (a medical procedure that uses quick, low-energy shocks to restore a regular heart rhythm) and ablation (cardiac ablation uses heat or cold energy to create tiny scars in the hearts to block irregular electrical signals and restore a typical heartbeat).

Now, there is an alternative called the WATCHMAN device, which decreases stroke in AFib patients. That means they can come off blood thinners, which reduces the risk of bleeding, and worry less about the risk of stroke.

Preventing Stroke with The Watchman Device

“One of the major concerns for anyone with atrial fibrillation is stroke caused by a blood clot, which increases after being in AFib for 24-48 hours,” Dr. Lotfi says.

The WATCHMAN device, which Baystate Health has been using for the past four years, is a good alternative for some, reducing the risk of stroke. The Federal Drug Administration approved the device in 2015.

How is risk for stroke determined?

A person’s risk factors for stroke are determined by the CHADS2 score or its updated version, the CHAD2DS2VACc (standing for congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex). These are clinical prediction rules for estimating the risk of stroke in people with AFib. It is a point-based system used to determine how much at risk a person is for stroke related to AFib.

How does an AFib-related stroke occur?

The upper chambers (atria) of the heart and the lower chambers (ventricles) typically beat “normally” or in sinus rhythm, working together to pump blood to the rest of the body. During AFib, the atria beat irregularly by “quivering,” so they do not pump all of the blood they should to the ventricles. That causes blood to pool and can potentially form clots. If one breaks loose and travels through the bloodstream to the brain, it can cause a stroke.

Getting the WATCHMAN Device

“When deciding on what treatment a patient will receive, including the WATCHMAN, we look at how the benefits outweigh the risks,” he says.

After a patient sees their primary care provider and they discuss what they think is the best course of treatment. If it is decided to explore the WATCHMAN, the patient meets, either in person or via telehealth, with Dr. Lotfi or someone else on the team.

The procedure is done at Baystate Health in Springfield. The hospital has done about 300 implants since it started four years ago. Dr. Lotfi has done about 100 of those.

“We don’t look at our patients as patients having this procedure done, but as humans who are looking for a better quality of life,” he says. “We make sure it’s right for each of them. We minimize the safety issues and give each person the greatest advantage. Baystate is committed to providing leading-edge technology to our communities.”

For more information on the WATCHMAN device and procedure, you can listen to Dr. Lofti explain it himself – including what makes a good candidate for the procedure, how does the device work, and what to expect after surgery – in our interview with Dr. Lofti.

If you or a loved one have atrial fibrillation or are experiencing an irregular heartbeat, talk to your doctor. While in most cases it is not life-threatening, it does require medical care, and can impact your risk for stroke in the future. If the symptoms last longer than 24 hours, or if you feel lightheaded, dizzy or faint, or your heart rate doesn’t come down, you have chest pain or trouble breathing, you should visit the ER to get medical attention.