The ultimate guide to atrial fibrillation

The ultimate guide to atrial fibrillation
Atrial fibrillation is a lifelong disease that increases the risk of stroke. We dive into its causes and management to help you gain back control of your health.
Written by Orchid Team
Medically reviewed by Dr. Omar Issa
  • Dr. Omar Issa, MD, is a board-certified cardiologist who completed his specialty training at Mount Sinai Medical Center, Miami Beach and Massachusetts General Hospital, Harvard Medical School. He is currently in private practice in Coral Gables, Florida. 


What is atrial fibrillation?

Atrial fibrillation (AF) is a type of cardiac arrhythmia where the atria of the heart beats rapidly and irregularly. Atrial fibrillation is the most common form of cardiac arrhythmia; about 3-6 million Americans are believed to be living with the disease, and that figure is predicted to rise to 12 million by 2030 (3% of the population). The normal heart rhythm, which originates in the sinus node (natural pacemaker), results in coordination between the atrium (filling chamber)  and ventricles (pumping chamber) of the heart. Conversely, in people with atrial fibrillation, their heart has an erratic signal, which creates dyssynchrony between the atria and ventricles, resulting in heart dysfunction. 

What are some consequences of atrial fibrillation?

The most important consequence of atrial fibrillation is a fivefold increased risk for stroke. Risk calculators have been developed to estimate someone’s risk of stroke, since many additional factors contribute to this risk in patients with atrial fibrillation.

Figure 1: CHA₂DS₂-VASc Calculator

What are the risk factors for atrial fibrillation?

  • age
  • lifestyle factors
  • heart disease
  • family history
  • genetics

How does age influence atrial fibrillation risk?

Age increases the risk of atrial fibrillation. Data from the Framingham Heart Study found that people aged 60-69 years, 70-79 years, and 80-89 years, had a 5-fold, 7.3-fold, and 9-fold increase in risk of AF, respectively, compared to people aged 50-59. 

How do lifestyle factors influence atrial fibrillation risk?

Modifiable lifestyle factors like smoking, sedentary lifestyle, and obesity also increase the risk of atrial fibrillation. While moderate exercise is associated with lower AF risk, very high levels of physical activity and cardiovascular fitness may increase the risk of AF. Obstructive sleep apnea may also increase risk

How does heart disease influence atrial fibrillation risk?

Various types of heart disease increase the risk of atrial fibrillation. These include valvular heart disease, where heart valves don’t function well, and coronary artery disease (described in our CAD guide). Diabetes and hypertension (elevated blood pressure) may also increase the risk. The exact mechanisms by which they cause atrial fibrillation likely involve disruption of heart tissue, stretching of the heart atrium (especially in valvular heart disease), and inflammation. 

How does family history influence atrial fibrillation risk?

Data from the Framingham Heart Study found that having a parent with AF increased the risk of atrial fibrillation in children, with an adjusted odds ratio of 1.85.

How does genetics influence my risk of atrial fibrillation?

Atrial fibrillation is substantially influenced by genetic factors, and its heritability is estimated to be approximately 60%, based on a study that used data on 120,000 individuals of European ancestry. While there are some monogenic causes of AF, most people with AF do not have a single causative variant. The common genetic variants found so far that predict risk of AF are related to heart cell development, electrical conductivity, and cell structure.

What are some symptoms of atrial fibrillation?

Atrial fibrillation is asymptomatic in 15-30% of people, but may cause weakness, palpitations, chest pain, shortness of breath, or fainting.

Is there anything I can do to reduce my child’s risk of developing atrial fibrillation?

As explained in the atrial fibrillation whitepaper, genetics plays an important role in determining the risk of atrial fibrillation. Using Orchid’s embryo scoring, you can prioritize the embryo with the lowest genetic risk for AF and potentially reduce their risk of atrial fibrillation.

Is there anything I can do to reduce my risk of developing atrial fibrillation?

What lifestyle changes can I make to reduce my risk of atrial fibrillation?

Since alcohol and cigarette intake increase the risk of AF, reducing the use of both is recommended. Moderate exercise and weight loss may also help. 

How is atrial fibrillation treated?

Treatment of atrial fibrillation is complex and depends on a patient’s risk score (CHA2DS2-VASc), which uses patient age and other risk factors to predict risk of stroke, as well as other patient characteristics. Treatments include medications that slow the heart (rate control), prevent the arrhythmia (rhythm control), and prevent stroke complications (anticoagulation); surgical treatment ranges from catheter ablation to pacemakers. In addition, since many patients with AF have risk factors for heart disease and stroke, blood pressure and lipid control are also recommended to reduce their risk for those diseases. 

How is atrial fibrillation diagnosed? 

When a patient is suspected to be in atrial fibrillation, doctors will usually try to record the electrical activity of the heart with an electrocardiogram (ECG/EKG). If the arrhythmia  is only present occasionally, they may have patients wear a portable device (“Holter Monitor”) for a few days or weeks in an attempt to capture the arrhythmia. 

When atrial fibrillation is diagnosed, doctors attempt to find a provokable cause for the arrhythmia. These include medications or drugs, thyroid disease, and many other causes. In some cases, treatment of the underlying condition may resolve the AF.

Takeaways

  1. Atrial fibrillation substantially increases your risk of stroke, but this depends on many other risk factors.
  2. There are medical and surgical interventions that can reduce the risk of complications from AF.
  3. Some lifestyle modifications, like exercise and weight loss, may help with AF as well.

Where can I learn more?

  1. Ninja Nerd video on Atrial Fibrillation

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