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Heart & Vascular Health | Heart News | Rhythm Disorders
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Atrial Fibrillation – Dispelling 6 Myths

Knowing the facts can make all the difference

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.

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:

  • 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
Tags: abnormal heart beat, arrhythmia, atrial fibrillation, heart, heart disease, heart health, prevention, research
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We welcome your comments. However, we cannot provide a medical opinion without an in-person consultation. To learn about Cleveland Clinic services available to you, please fill out our WebMail form.
  • 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.

  • CONNIE

    I HAVE A FIB & I HAVE CHEST TIGHTNESS, SHORT OF BREATH, DIZZYNESS, EYE SIGHT BLURRED SOMETIME… IM ON BLOOD THINNER & I DONT HAVE A CARDIOLOGY . SO WUTZ MY NEXT MOVE?

    • http://www.facebook.com/char.halasyn 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. http://www.clevelandclinic.org/heartnurse 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 http://my.clevelandclinic.org/heart/webchat/abnormal-rhythms.aspx 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 – http://my.clevelandclinic.org/heart/prevention/exercise/pulse-target-heart-rate.aspx – 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 http://my.clevelandclinic.org/heart/webchat/abnormal-rhythms.aspx 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. http://www.clevelandclinic.org/heartnurse 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 http://my.clevelandclinic.org/heart/atrial_fibrillation/afib.aspx 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