Atrial Fibrillation – Dispelling 6 Myths

Knowing the facts can make all the difference

heart questions

Butterflies in the stomach can signal excitement or nervousness. But fluttering in the chest can signal a short circuit in the heart’s natural electrical wiring, or arrhythmia. Atrial fibrillation (A-fib), the most common arrhythmia in the United States, is an off-speed rhythm in the heart’s upper chambers.

A-fib may be linked to conditions such as high blood pressure (hypertension), coronary artery disease, heart valve disease, heart failure, chronic lung disease or a clot in the lung (pulmonary embolism), among others. But in 10 percent of cases, A-fib is not associated with any other disease.

A-fib can cause the following symptoms:

  • Heart palpitations
  • Dizziness
  • Fatigue
  • Chest discomfort
  • Shortness of breath

However, up to 30 percent of A-fib episodes cause no symptoms at all. Below, Walid Saliba, MD, Director of the Electrophysiology Lab and the Center for Atrial Fibrillation in Cleveland Clinic’s Miller Family Heart & Vascular Institute, addresses some common myths about A-fib:

Myth #1: If you have just one or two episodes of atrial fibrillation, it probably won’t come back.

Fact: Atrial fibrillation is almost always a chronic disease. Lifelong treatment is needed to minimize symptoms and to avoid stroke and heart failure. Early on, episodes of A-fib tend to be sporadic. This is called paroxysmal atrial fibrillation. Over time, episodes usually become more frequent and last longer. Up to 30 percent of A-fib episodes cause no symptoms at all, but treatment is still needed to prevent stroke.

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Myth #2: Cardioversion can stop atrial fibrillation for good.

Fact: Electrical cardioversion can “shock” the heart back to normal rhythm, but it does not guarantee that normal rhythm will be maintained. Medication may be needed to maintain normal heart rhythm and prevent stroke. “One to three types of medication are used in combination: those that control heart rate, such as beta blockers; anti-arrhythmic drugs to maintain normal rhythm; and anticoagulants to prevent blood clots,” says Dr. Saliba.

Myth #3: Your medicine isn’t working if you still get episodes of A-fib.

Fact: “Medication will not cure A-fib, but it will relieve symptoms by decreasing the frequency and duration of episodes,” says Dr. Saliba. Reducing a patient’s episodes from frequent to occasional is considered adequate treatment as long as the symptoms don’t trouble the patient. However, medications tend to become less effective over time, he notes. When that happens, catheter ablation is more likely to help.

Myth #4: Catheter ablation won’t help you if it doesn’t ‘take’ the first time.

Fact: Catheter ablation uses radiofrequency energy or cryoenergy (intense cold) to interrupt faulty electrical pathways in the heart. Sometimes more than one catheter ablation procedure is needed to get the best result. The cure rate of 70 to 80 percent after one catheter ablation goes up to 90 percent after a second or third one if there is no underlying heart disease. When A-fib is chronic or when there is underlying heart disease and the heart’s upper filling chambers (atria) are severely enlarged, maze surgery may be recommended.

Myth #5: If ablation works, you can stop taking Coumadin®.

Fact: “The decision to continue or stop Coumadin, an anticoagulant that requires frequent blood tests, depends upon the risk factors for stroke rather than on the success of the ablation,” says Dr. Saliba. Doctors calculate stroke risk in patients with A-fib using a formula called the CHADS2 score, based on the following risk factors:

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  • Congestive heart failure
  • Hypertension
  • Age over 75
  • Diabetes
  • A past stroke

Myth #6: If you take medication for A-fib and no longer have symptoms, you’re cured.

Fact: “A-fib cannot be cured, but ablation or surgery offers the closest possible symptom relief. There is no rush to undergo ablation if you are doing well on medication,” says Dr. Saliba. Ablation is safe even for patients in their 60s and 70s.

Episodes of A-fib can be triggered by stress, exercise, sleep apnea and hot flashes. Talk to your cardiologist about any concerns. Meanwhile, to minimize symptoms of A-fib and to improve heart health, Dr. Saliba advises patients to:

  • Quit smoking
  • Drink in moderation
  • Ask about exercise guidelines
  • Limit caffeine use
  • Read labels on cough and cold medicines to avoid those containing stimulants
  • Seek treatment for sleep apnea

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  • Rebecca Haley

    This wonderful information.

  • Cassie

    Looking forward to the results of the CABANA trial…hopefully will tell us the best treatment for real life, high stroke risk patients.

  • A fib kid

    I know it is not a cure but a healthy plant based diet as the one described by Dr Esselstyn in Prevent and Reverse Heart Disease as well as staying away from caffeine and alcohol can help alleviate many of your a fib symptoms with no side effects.



    • Char Halasyn

      You really need to find a good cardiologist who specializes in the care and treatment of Afib.There are also blood thinners that dont require frequent blood tests and the drug manufacturers often help with the cost if you have no insurance. GOOD LUCK TO YOI.

    • The_Beating_Edge_Team

      Agree with Char – you need to see a cardiologist. We would be happy to see you at Cleveland Clinic – or please see one closer to home – but see a doctor soon. Let us know if you need help finding a cardiologist. Note – if your chest pain is lasting longer than a few minutes, you should go to an emergency room to be evaluated.

  • Anna

    Just exactly what is A-Fib. I have episodes of a racing heart (198) that can last up to 5 hours at a time, at least once a month. Never heard doctor say “A-Fib”.

  • Ewa

    I only had one episode of AF caused by anxiety in August and have been since taking anticoagulant. Do I have to take it forever?

    • The_Beating_Edge_Team

      this is a good question for your doctor – some will depend on your CHADS2 score for risk of stroke for atrial fibrillation. This takes in account several factors related to risk of stroke. For more information – we have some great questions and answers on our chat transcripts about atrial fibrillation at betsyRN

  • Priscilla Morgan-Gonzalez

    How do I know if I am having an afib event when I am on meds? I knew before because my heart rate went to 170-180 and I went to the hospital but the meds control the rate and rhytm (cartia and ritmol) so how do I know if I am having an episode??

    • The_Beating_Edge_Team

      If you are not having any symptoms – you may be in good control – which is good! You may feel your pulse – – and if it is irregular – you may be in atrial fibrillation. The only other way to know if you are in afib is to have an EKG in your doctor’s office with rhythm strip if you are in constant afib – or with intermittent afib – to wear an ambulatory monitor. If you have your symptoms again – then call your doctor. betsyRN

  • Lynne

    I had one Afib episode a few weeks ago but I am only 39. Some of the doctors and nurses said it could be related to taking child/sinus medicine 6 hrs before and other doctors and nurses said the medicine had nothing to do with it….If it was going to happen it would happen. Now I am on Lopressor and lie dosage aspirin but feel like I am too young for this if caused by sinus medicine and only a one time occurrence. Any thoughts?

    • The_Beating_Edge_Team

      Lynn – it is true that afib increases with age, but I actually know someone who was 21 when he had his first episode. You should talk to your doctor about your options for medications including dosage and frequency. See some of our previous web chat transcripts for treatment plans in patients with infrequent atrial fib episodes betsyRN

  • sue

    I have had A-fib for 10 years and take medication for it. I have had a few episodes on the medication but for the most part it works very well. I also take coumadin a blood thinner to prevent blood clots.

    • The_Beating_Edge_Team

      sounds like you are in good control and doing the right thing. Hope you have continued good health. betsyRN

  • Caroline

    I’m a lifelong athlete and I was diagnosed with Afib last year. I also had other heart arrhythmias and had to get a pacemaker. This caused a long period of no activity. I have been trying to get back into shape but, every time I have what I consider to be a good, solid workout, I’m fine during and right after the workout but, for the next few days I’m weak and exhausted. This is the only way I can tell I’m in Afib. Is there a specific type of Afib that’s triggered by exercise? Also, does this mean my dreams of a cross country road bike trip or hiking the PCT are out?

    • The_Beating_Edge_Team

      Caroline – We see a lot of athletes with rhythm problems – it is difficult to provide you with specific information without knowing more about your medical history and pacemaker settings. You may want to get a second opinion with our arrhythmia specialists combined with a visit with our exercise physiologists who work with athletes (both professional and weekend) to get you on the right training. The goal is to help you achieve your goals safely. Let us know if we can help you. betsyRN

  • chrisyowphoto

    I recently scored well on a stress test that was scheduled after I had a few episodes of fluttering, shortness of breath, etc, and my PCP spotted ‘j-hooks’ in my delta waves on an ecg, possibly indicating a genetic condition. Is this article related or a different breed of arrhythmia all together?

    • The_Beating_Edge_Team

      Atrial fibrillation is one of several different types of arrhythmias, or irregular heart rhythms. It does not sound like from the information you provided that your rhythm on your stress test was atrial fibrillation? betsyRN

  • Nate

    I was just diagnosed in a Major university medical center on Sunday after being treated for flu dehydration – 3 bags of IV. Thought it was dehydration and electrolytic imbalance. Was placed on 120 mg diltiazem and 81 mg aspirin on Sunday and released after heart rate reached high 70s, though still in afib. Had an echo this morning and not following up with cardiologist for six days. I’m 44 YOM, otherwise healthy, exercise most every day. Question: should I be pushing for cardio version at this point to get back in rhythm or not? Pulse is still afib but 70-85 depending on activity w/ diltiazem.

    • The_Beating_Edge_Team

      As a nurse, I can not provide medical advice. However, you can learn about atrial fibrillation and its treatments at Cardioversion is a treatment option for atrial fibrillation, however, with any procedure, there are risks and benefits (and there are also risks with ongoing atrial fibrillation)- and you should discuss this with your electrophysiologist. betsyRN

  • cheryl werner

    Cheryl Werner

  • darwin

    a fib caused by hot flashes. that explains it, they started when i started menopause. why have no docs said this? dumb drs!

    • Ribbon

      My God yes!! I had a V-Tach ablation 30 yrs ago then an Afib attack last month out of nowhere. I wondered if losing Potassium by sweating so much (hot flashes) contributed, since I take daily Potassium for my heart. When my Potassium is too low my PVC’s returns, but never Afib.

      I’m now on Sotalol and hate it. Side effects are terrible. Hopefully I can be weened off meds as I never took any antiarrythmics in the past. I really feel this was an isolated incident due to low Potassium and stress (I’m in college taking a very hard class)

      This is good info!

  • darwin

    was scheduled for ablation but stress leading up to it was so great ( blood draws, etc) i canceled. am age 55. dr said i have up to 15 yrs to do it as its best while young.
    i only get a fib when falling asleep in bed.

    • The_Beating_Edge_Team

      Some people are always managed with medications – the decision for afib ablation is based on your medical history, tolerance and success of medications, symptoms and lifestyle. It takes a discussion with you and your doctor to determine what is best for you. See info about atrial fibrillation and its management at betsyRN

  • Brenda

    I had chemo and radiation for breast cancer. Right afterwards started having afib issues. Had a TEE done and was to have an ablation done 2 days later. Crashed in cath lab and now am supposed to reschedule. Scarred to death, how common is a problem during ablation and could the chemo have caused this problem? 56 year old female

    • The_Beating_Edge_Team

      Brenda – I spoke to Dr. Tamarapoo, the director of our Cardio-Oncology Center. Here are a few points he mentioned:

      1. Given your description of “Crashing in the cath lab,” it may be a good idea to be seen by an electrophysiology specialist so the events may be better understood.

      2. The question of what caused your afib is a difficult one. Myocardial dysfunction may result from chemotherapy and radiation and it is conceivable that this may have resulted in Afib or unmasked an already present arrhythmogenic substrate providing ideal conditions for Afib.

      3. The risks surrounding Afib ablation would be best discussed in a meeting with an electrophysiology specialist land I would recommend the patient see someone from this group to answer all these questions.

      Here are a couple links you may be interested in: Cardio-Oncology Center:

      Atrial Fibrillation Center: betsyRN

  • Alene Nemetz Deller

    I drink regular green tea, is that ok if i have chf?

  • Angela Ashley

    I had AFib once. I now know what they mean by the feeling of “impending doom”. My heart rate rose suddenly to almost 190 and I thought I was going to die. Luckily I was already at the ER with my daughter (she went home while I was admitted). The next day the AFib was gone. My doctor could never find a reason. I was on medicine for about 4 months and the doctor said that I no longer needed it. That was three years ago. I hope to never experience that again.

  • helpus

    my mom is 86 years old with afib. she is on cardizem and xarelto. she is doing pt every day and get sob on exertion. the cardiologist said continue meds see in 6 months. i felt he gave up on mom. can they do anything else for her. thank you

  • David Kirk

    Had 45 treatments of radiation and some chemo. My afib was just an occasional flutter until I completed the treatment for stage 4 cancer of the throat which was attributed to agent orange. Subsequent to those treatments over a three months my afib seemed to increase until I have had 4 ablation procedures. Is there any correlation between radiation/chemo and afib???

    • The_Beating_Edge_Team

      David you ask a very good question. The article in JACC (Farmakis, D., et al. (2014).”Insights into onco-cardiology: atrial fibrillation in cancer.” J
      Am Coll Cardiol 63(10): 945-953.) addresses question question. It states, “Atrial fibrillation (AF) has been found to occur with an increased frequency in patients with malignancies, particularly in those undergoing cancer surgery. The occurrence of AF in cancer may be related to comorbid states or a direct tumor effect or may represent a complication of cancer surgical or medical therapy, whereas inflammation may be a common denominator for both conditions”. In addition, Dr. Van Wagoner who is involved with research in atrial fibrillation noted that they believe there is also a mechanistic link between elevated systemic inflammation and proclivity to develop AF – inflammation likely leads to atrial fibrosis, and increases the risk of AF. He sited two articles:
      Chung, M. K., et al. (2001).
      “C-reactive protein elevation in patients with atrial arrhythmias:
      inflammatory mechanisms and persistence of atrial fibrillation.” Circulation
      104: 2886-2891.
      Chung, M. K., et al. (2002).
      “Systemic Inflammation, Atrial Fibrillation, and Cancer.” 106, from

      I hope this helps – he also noted that due to these issues related to atrial fibrillation and cancer therapy, it is important to be treated by a team that is experienced with this condition, and – that treatment is very individualized. I hope this is helpful. Let us know if we can help you in the future. betsyRN

    • Brenda

      Absolutely, in my opinion. I had no trouble until I had my radiation and chemo!