Diagnosis and Treatment of AFib

How is AFib diagnosed?

Atrial fibrillation (AFib or AF) is a heart rhythm disorder where your heart beats irregularly and rapidly. To diagnose AFib, your provider will review your medical history and perform a physical exam. They may recommend tests such as:

Electrocardiogram (ECG or EKG): An ECG records your heart’s electrical activity and can spot abnormal patterns.
Holter monitor: A Holter monitor is a portable device you wear for 24 to 48 hours to record your heart’s electrical activity. It may capture AFib episodes that don’t occur during a standard ECG.
Event recorder: Like a Holter monitor, an event recorder is a portable device that you can activate when you notice symptoms so it can track your heart’s electrical activity.
Echocardiogram: An echocardiogram uses sound waves to create images of your heart. It can help spot conditions like valve abnormalities or structural defects that might be linked to AFib.
Stress test: A cardiac stress test shows how well your heart works during physical activity and can check your blood flow.
Blood tests: Blood tests can measure thyroid function, electrolyte levels and cardiac biomarkers (molecules that are signs of a medical condition). Thyroid disorders and electrolyte imbalances can contribute to AFib. High cardiac biomarkers could be signs of heart damage or stress.
Chest X-ray: This imaging study can give providers information about your heart and lungs.
Sleep study: A sleep study can check for sleep apnea.

These tests can help confirm if you have AFib, show how severe it is, identify other heart conditions and guide treatment decisions. You may also need additional tests or consultations with specialists.

What are the types of atrial fibrillation?

AFib falls into four categories based on how long episodes last and how you respond to treatment.

Paroxysmal AFib: Irregular heartbeats start suddenly and stop on their own within seven days. Episodes may vary in how often they happen, so they can be unpredictable. Paroxysmal AFib may clear up on its own, or it may need medical intervention.
Persistent AFib: Irregular heart rhythms that last more than seven days and require medications, electrical cardioversion or other procedures to restore normal heart rhythm. Persistent AFib does not clear up on its own.
Long-standing persistent AFib: Continuous irregular heart rhythms that last for more than one year. In this type of AFib, it may be hard to restore a normal heart rhythm. But treatment and management strategies may control symptoms.
Permanent AFib: When efforts to restore a normal heart rhythm don’t succeed or aren’t appropriate. Irregular heart rhythms are accepted as the long-term rhythm pattern. Treatments focus on controlling symptoms, reducing the risk of complications and improving quality of life rather than restoring a normal heart rhythm.

How is AFib treated?

Lifestyle modifications, medications, procedures or surgeries may help control symptoms, restore normal heart rhythm and reduce the risk of complications.

Lifestyle changes

Diet: A heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins and low-fat dairy may help manage AFib symptoms. It’s also good to limit salt, saturated fats, processed foods and sugary drinks.
Exercise: Regular physical activity, such as walking, swimming or cycling, can improve your heart health, reduce stress and help maintain a healthy weight. If you have AFib, talk to your health care provider before you start or change your exercise routine.
Stress management: Relaxation exercises, deep breathing, meditation and yoga can help reduce how emotional triggers affect AFib symptoms.

Medications

Blood thinners: Prescription medications like warfarin (Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis) may reduce the risk of blood clots and stroke in people with AFib.
Rate control medications: Beta-blockers, calcium channel blockers and digoxin (Lanoxin) may help slow down the heart rate and improve symptoms of AFib.
Rhythm control medications: Medications like amiodarone (Cordarone, Pacerone), flecainide (Tambocor), propafenone (Rythmol) and sotalol (Betapace) may restore and maintain normal heart rhythm by suppressing abnormal electrical signals.

Minimally Invasive Ablation

Catheter ablation: Catheter ablation is a minimally invasive procedure that targets and destroys the abnormal heart tissue that generates irregular electrical signals. It may be an option if medications or lifestyle changes aren’t working.
Pulsed-field ablation: Pulsed-field ablation is a newer technique that uses high-voltage electrical fields to treat AFib. The pulses don’t generate heat, so they are less likely to damage other parts of the heart than other methods.
Stereotaxis genesis: With this specialized system, a provider can guide a small catheter into the heart using magnets and robotic guidance to improve precision and safety.

Learn more about heart ablation.

Other procedures and surgeries

Electrical cardioversion: Electrical cardioversion uses a controlled electric shock to restore normal heart rhythm.
Pacemaker: In cases of AFib with a slow heart rate (bradycardia), a pacemaker may regulate the heart’s electrical impulses and rate.
Surgical ablation: Surgical ablation creates scar tissue on the heart’s surface to block abnormal electrical pathways and restore normal heart rhythm. It may be performed on its own or along with other heart surgeries, such as valve repair or bypass surgery. However, it is a rarely used treatment option.

Your provider will recommend treatment options based on what type of AFib you have, how severe it is, whether you have other health conditions, your overall health and your preferences. By working closely with your provider, you can come up with a treatment plan that addresses your needs and goals.

Tips for living with AFib

These tips can help you control symptoms, reduce the risk of complications and improve your quality of life:

Monitor your symptoms: Pay attention to your body and watch for palpitations, shortness of breath, fatigue or dizziness. Keep track of how often you notice symptoms, how long they last and how severe they are, and report them to your health care provider.
Have regular check-ups: See your provider to monitor your heart health, look for early signs of complications, check how well treatments are working and adjust your plan.
Connect with support: Joining an in-person or online support group for people with AFib can provide emotional support, advice and encouragement from others who understand what you’re going through. Connecting with others can help you feel less isolated and better able to manage your condition.
Educate yourself: Turn to reputable websites, books and informational materials from health care organizations or your provider to learn more about AFib and how to manage it. Education can help you make informed decisions and participate in your care.

Preventing AFib complications

Two of the main complications of AFib are stroke and heart failure. Here’s how you can reduce your risk.

Stroke

With AFib, blood clots may form in the heart, dislodge and travel to the brain, where they can cause a stroke. Your provider may prescribe blood thinners to lower this risk. If you can’t take blood thinners, your provider may recommend the WATCHMAN procedure. It’s a small, implanted device that blocks off a small pouch in the heart where blood clots often form.

You’re at higher risk of stroke with AFib if you are over age 65, are female, have diabetes, have high blood pressure and have or have had heart disease.

Heart failure

To prevent heart failure, you’ll want to manage heart conditions, optimize your heart function and lower your cardiovascular risk factors. It can help to:

Control high blood pressure through lifestyle modifications and medication.
Treat heart conditions like coronary artery disease, valve disorders and structural heart defects.

A heart-healthy lifestyle can also lower your stroke and heart failure risk. It’s important to eat a healthy diet low in saturated fats and sodium, get regular exercise, maintain a healthy weight, reduce stress, manage high blood pressure and cholesterol, avoid smoking and limit alcohol.