Ask the Expert: Inside the rhythm—A clear guide to AFib

Khashayar Hematpour, MD | Assistant professor and cardiovascular electrophysiologist, McGovern Medical School at UTHealth Houston and UT Physicians

Welcome to "Ask the Expert," a UTHealth Houston newsroom series where our leading physicians examine pressing health challenges. In this edition, we address atrial fibrillation, what it means, what to look out for, and how to treat it.

Over 10 million adults in the U.S. are estimated to have atrial fibrillation. Atrial fibrillation is a common type of heart arrhythmia where the heart's upper chambers, called atria, quiver rapidly and irregularly. This causes the lower chambers to beat fast and unevenly, leading to chaotic heartbeat that can cause fatigue, dizziness, or a pounding sensation.

The electrical signals in the heart are misfiring — it's like too many cooks in the kitchen giving you mixed advice. People experiencing symptoms of Afib should seek medical help, as the condition can lead to stroke or heart failure. 

What causes Afib?

Afib is caused by changes to the heart tissue and electrical system. The condition is most commonly caused by high blood pressure or cardiovascular diseases including coronary artery disease, valve disease, and heart failure. Genetic variants and gene mutations, heart surgery, and other medical conditions like obesity, hyperthyroidism, chronic kidney disease, and obstructive sleep apnea can also lead to Afib.

Symptoms of Afib

Symptoms of Afib include heart palpitations — which can be described as fish flopping in your chest or butterflies — extreme fatigue, dizziness or lightheadedness, syncope, shortness of breath, and chest pain. 

Risk factors of Afib

People older than 65 are at the highest risk of developing Afib. In addition to critical illnesses like sepsis or COVID-19, lifestyle choices like excessive alcohol use, lack of physical activity, and extreme physical activity can also lead to Afib. Afib is a progressive condition, meaning it can get worse over time. You can avoid Afib by eating a heart-healthy diet, exercising regularly, limiting alcohol and nicotine, avoiding tobacco, getting enough sleep, managing stress, and staying hydrated.

Diagnosis

You might have symptoms that come and go on their own. Or you might have AFib episodes that persist despite treatment. Symptoms might go away after treatment but return down the road.

Doctors use an echocardiogram (ECG/EKG), which shows the electrical signals traveling through your heart, to determine if Afib or an irregular signal is present. The patient's medical history, a physical exam, blood tests, and at-home cardiac event monitoring are also used to diagnose the condition.

After diagnosis, health care providers identify which of the four substages a patient fits into:

• Paroxysmal AFib: Episodes happen every now and then. Each episode lasts less than one week and usually stops on its own without treatment. You might still feel unwell during these short episodes. However, you have a higher risk of stroke than those who don’t have AFib.
• Persistent AFib: Episodes are continuous, meaning they keep coming back. Each episode lasts more than one week. You need treatment to stop an episode.
• Long-standing persistent AFib: Episodes are continuous for one year or longer.
• Successful AFib ablation: AFib stops after a surgery or a catheter-based procedure.

Here at UTHealth Houston, we are finding new and improved ways to treat Afib, including novel treatment methods specific to patients’ needs.

Khashayar Hematpour, MD, is an assistant professor of cardiovascular medicine in the Department Internal Medicine at McGovern Medical School at UTHealth Houston and a cardiac electrophysiologist at UT Physicians. All quotes should be attributed to him.

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