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You expect to feel your heart “pound” during a hard workout or a sudden fright, but it can be troubling when you experience an abnormal heart rhythm at other times. Heart palpitations — which can feel like pounding, racing or fluttering — are common and often benign. But an abnormal heart rhythm can also be a sign of atrial fibrillation, commonly known as AFib.
Dr. Leal on WPR
Dr. Miguel Leal was recently a guest on Wisconsin Public Radio's Larry Meiller Show discussing the latest research on atrial fibrillation.
“Atrial fibrillation is one of most important and common cardiac arrhythmias,” says Miguel Leal, MD, director of UW Health’s Electrophysiology and Arrhythmia Service. “During episodes of AFib, you have so many extra beats happening in the top chambers of the heart – the atria – that they no longer have the ability to squeeze; they just start quivering, almost like the fluttering of butterfly wings. The atria (top cardiac chambers) can go as fast as 400 to 600 beats a minute and the bottom chambers (ventricles) end up going at a fast and irregular pace, causing your pulse rate to be as fast as 100-150 beats per minute or more.”
Anyone can develop atrial fibrillation, but the prevalence increases after age 40. By age 80, more than 10 percent of people either have or previously had the condition. If untreated, AFib can be dangerous.
“It can cause a significant risk of stroke because the top chambers are not really propelling the blood forward anymore, and so the blood stagnates, and you might start accumulating clots inside the atria. If a clot moves from your heart to your brain, it can cause a stroke, and they’re usually more severe than strokes caused by high blood pressure,” Leal notes. “The second risk is heart failure. Normally your heart will go fast enough to meet your needs. With AFib, your heart is going fast all the time — it doesn’t matter if you’re bike riding or sitting on the couch watching television — and eventually that can wear the heart out.”
What to Know About Heart Rhythms and Atrial Fibrillation
Here’s what to know about detecting and treating abnormal heart rhythms and atrial fibrillation:
Pay attention to your body. Awareness of AFib is higher than ever thanks to wearable technologies like Fitbits and smart watches that can alert wearers to the presence of irregular or faster-than-normal heart rates, Leal says. Talk to your doctor if you notice a consistently fast pulse, skipped or irregular heartbeats, the sensation that you might pass out, or chest pain. “A lot of things can cause those symptoms so it's worth checking out,” he notes.
Call 911 if you think you might be experiencing an emergency like a heart attack or a stroke. But if your symptoms are more mild or fleeting, you can start with your primary care doctor, who might have you wear a monitor to track your heartbeat over a few days. If necessary, your doctor may refer you to a cardiologist or cardiac electrophysiologist for further assessment.
You may have an abnormal rhythm and not even know it. “Some patients can’t feel it,” Leal says. “They may be completely unaware for years or even decades. Other times the palpitations are so intense and frequent that patients say they affect their quality of life.”
Not all rhythm problems are the same. There are several different types of cardiac arrhythmias, and many of them may cause an irregular heartbeat. Even AFib can look different in different patients. “This condition is very complex and can present in many different flavors, which is why treatment can’t be the same for everyone,” Leal says. “Treatment has to be personalized.”
Sometimes arrhythmias are temporary. Physical or emotional stress, lack of sleep, excessive use of caffeine, alcohol, some medications and even a woman’s menstrual cycle can all cause a temporary spike in extra heart beats called premature atrial contractions (PACs), which occur in the upper chambers of the heart, and/or premature ventricular contractions (PVCs), which occur in the lower chambers of the heart.
“It’s really hard to assign a cause to palpitations without additional investigation,” Leal says. “A number of things in your heart or other organs can cause changes in the dynamic way the heart works. Anytime there’s an imbalance, it can disrupt this perfect synchronicity designed by nature. It’s fascinating how many connections there are between the heart and other systems in the body.”
You don’t always need to treat abnormal rhythms. If you have AFib, depending on your age and other disease conditions (such as high blood pressure or diabetes), your doctor may prescribe a blood thinner to reduce your risk of stroke, but your doctor may not recommend fixing your abnormal rhythm unless it’s affecting your quality of life or stressing your heart.
Persistent arrhythmias are treatable. Medications can help get an erratic heartbeat back on track by stabilizing normal heart electrical rhythms within the heart cells. If that doesn’t work, your doctor may recommend ablation, a procedure which involves inserting catheters through the neck or groin into the heart to map the area of the heart that’s out of sync, and then applying heating or freezing energy to ablate (destroy) the tissue that’s causing the faulty signals.
“Neither drugs nor ablation are perfect,” Leal says. “We usually try medications first, and drugs have a success rate of 55 to 60 percent at one year. But ablation tools and techniques are certainly getting better, and that has a success rate of 70 to 75 percent. Ablation can be repeated, but we don’t like to do it too many times given the added risk to a given patient.”
You may need a pacemaker. “One of the ironic things about AFib is that with medicine, your heart can go too slow,” Leal explains. “Both extremes can make you pass out and feel bad. There are patients that we have trouble finding a happy medium for, and we might implant them with a pacemaker to prevent their heart from going too slow.”
Treatments continue to advance. If you have a bleeding disorder like an ulcer, blood thinners can be dangerous. A new alternative offered by UW Health is the recently FDA-approved WATCHMAN device. “It’s meant to seal the left atrial appendage, which is a little recess in the heart that can harbor clots. Blood thinners are still the standard of care, but the WATCHMAN device is a potentially useful alternative for some patients,” Leal says. UW Health also offers a state-of-the-art wireless pacemaker that just recently came on the market. “These are procedures you don’t find everywhere, and UW is very proud to offer these cutting-edge treatments,” Leal notes.
AFib is a lifelong disease. Even patients who have undergone successful ablation will likely remain on blood thinners and still face the risk that their heart rhythm may go haywire again. “You should always be seen at least once a year by your regular physician or your cardiologist,” Leal says.
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