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.
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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
- 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
- Age over 75
- 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: