Atrial fibrillation is one of the most common heart rhythm disorders. It affects millions of people around the world, and neglecting its treatment leads to serious complications. In this article, we will discuss the underlying causes of its occurrence, and review the latest diagnostic methods available, in addition to the various treatment options at Al Mousa Specialist Hospital.

What is atrial fibrillation?

It is one of the common types of heart rhythm disturbances, as in the normal state, the heart beats in a regular and organized manner, but in... 

In the case of atrial fibrillation, rapid, irregular electrical disturbances occur in the atria. These chaotic electrical signals cause the atria to quiver ineffectively instead of contracting normally and orderly.

As a result, the heart does not pump blood efficiently from the atria to the ventricles, which leads to several problems such as a rapid and irregular heartbeat, decreased blood pumping efficiency, as well as an increased risk of blood clots. 

Types of atrial fibrillation

Atrial fibrillation is classified based on how long the episode lasts and how the heart returns to its normal rhythm. The main categories include:

• Paroxysmal or intermittent atrial fibrillation: Episodes of fibrillation of the atria in this type occur intermittently and usually stop on their own within 7 days, and in most cases within 48 hours. The attacks last for a few seconds, minutes, hours, or even days, but between these attacks, the heart returns to its normal rhythm, and they may occur unexpectedly and with different frequencies. 
• Persistent atrial fibrillation: An episode of atrial fibrillation in this type lasts for more than 7 days, and the heart does not return to its normal rhythm on its own and requires medical intervention to restore the normal rhythm.
• Long-term persistent atrial fibrillation: This type lasts for more than 12 months, and in this case, it may be difficult to restore and maintain a normal heart rhythm.
• Permanent atrial fibrillation: The normal heart rhythm cannot be successfully restored in this type despite treatment attempts. The doctor and patient decide to accept the presence of fibrillation, and treatment depends on controlling the heart rate, preventing the formation of blood clots, and reducing symptoms.

Classifying the type of fibrillation helps determine the best treatment strategy for the patient. It should be known that fibrillation can develop from one type to another over time. For example, it may begin as paroxysmal atrial fibrillation and then become persistent.

Symptoms of atrial fibrillation

Symptoms of atrial fibrillation vary greatly from one person to another. Some patients may experience clear and bothersome symptoms, while others may not feel any symptoms at all. This is known as silent atrial fibrillation, and they include: 

Common symptoms of atrial fibrillation include:

• Heart palpitations, and the feeling of a fast, strong, irregular, or intermittent heartbeat, and the patient may feel that his heart is fluttering or trembling.
• Shortness of breath, difficulty breathing or a feeling of suffocation, especially during exertion or even at rest. 
• Feeling extremely tired and generally weak, even after getting enough sleep.
• Feeling dizzy, unsteady, or as if the room is spinning.
• In some cases, a person may feel unconscious or be on the verge of fainting.
• Chest pain feels like pressure, but it is an uncommon symptom. 
• Increased urination, which may occur as a result of the secretion of atrial natriuretic peptide hormone in response to arrhythmia.

 Causes of atrial fibrillation

There are many  diseases and factors that can increase the risk of atrial fibrillation, and more than one cause may contribute to the development of the condition. The main causes and factors include the following:

• High blood pressureHigh pressure on the arterial walls causes enlargement of the atria and changes in their electrical structure. 
• Coronary artery disease, narrowing or blockage of the arteries that supply the heart muscle, causes heart damage and increases the risk of atrial fibrillation.
• Congestive heart failure: The heart's poor ability to pump blood efficiently causes the atria to expand and increase pressure on them.
• Heart valve diseases lead to problems with the heart valves, such as stenosis or regurgitation of the mitral or aortic valve, leading to enlarged atria and arrhythmias.
• Myocardial hypertrophy.
• Congenital heart defects.
• Pericarditis and myocarditis affect the heart's electrical system.
• Hyperthyroidism.
• Chronic lung diseases, such as chronic obstructive pulmonary disease and pulmonary fibrosis, as these conditions can lead to a lack of oxygen and increased pressure on the heart.
• Chronic kidney failure.
• Sleep apnea.
• Diabetes, because it is associated with an increased risk of cardiovascular disease.
• السمنة المفرطة.
• Metabolic syndrome.
• Drinking alcohol and excessive smoking.
• Extreme physical and psychological stress.
• Taking some stimulant medications or those that affect the heart rhythm.

Aging, family history of disease and infection increase the risk of atrial fibrillation. 

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How is atrial fibrillation diagnosed?

The diagnosis of atrial fibrillation at Al Mousa Specialist Hospital depends on a set of procedures and examinations that primarily aim to record the electrical activity of the heart and determine its beating pattern. The main methods for diagnosing atrial fibrillation include the following:

• Medical history and physical examination, where the doctor takes a detailed medical history about the patient’s symptoms, his personal and family medical history, and the medications he takes, and then performs a physical examination to listen to the heartbeat and check for any other signs of heart disease or other medical conditions.

• Electrocardiogram, which is the basic and most important test for diagnosing atrial fibrillation, records the electrical activity of the heart with small electrodes. In the case of atrial fibrillation, the electrocardiogram shows a characteristic pattern that includes the absence of P waves that represent the normal contraction of the atria, as well as an oscillating baseline.
• Echocardiogram, an ultrasound examination used to create moving images of the heart. This examination does not directly diagnose atrial fibrillation, but it helps evaluate the size, shape, and function of the heart chambers and valves and detects the presence of structural heart disease that may be a cause or risk factor for atrial fibrillation.
• Blood tests, to rule out other medical conditions that can cause similar symptoms or contribute to atrial fibrillation, such as thyroid function tests, kidney function tests, and analysis of certain blood elements such as potassium and magnesium. 
• Holter monitoring, where a small, portable device is used that records the heart's electrical activity continuously for 24 to 48 hours or up to two weeks, is used in the case of intermittent episodes of atrial fibrillation that are not always apparent during a standard ECG.
• A cardiac event monitor is a portable device that records the electrical activity of the heart, but is used for longer periods of time than a Holter monitor, up to weeks or months.
• An implantable heart monitor is a very small device that is implanted under the skin in the chest area to record the electrical activity of the heart continuously for a long period of several years. It is used in cases where atrial fibrillation episodes are very rare or silent and difficult to detect by other methods, as the device can record events automatically or can be activated manually by the patient when he feels symptoms.

Book your consultation now at مركز القلب والأوعية الدموية At Al Mousa Specialist Hospital.

Treatment of atrial fibrillation  

Atrial fibrillation treatment aims to achieve several main goals, such as restoring the normal heart rhythm in some cases, as well as controlling the heart rate if it is not possible to restore the normal rhythm, preventing the formation of blood clots and stroke, and controlling other symptoms such as shortness of breath, fatigue, and dizziness to improve the patient’s quality of life.

The treatment plan for atrial fibrillation depends on several factors, including the type of atrial fibrillation, the severity of symptoms, the presence of other heart diseases, the patient’s age and general health, in addition to the patient’s preferences. Treatment options include the following:

• العلاج بالأدوية
• Medications to control heart rate, such as beta blockers and nonbinary calcium channel blockers.
• Digoxin, often used when other options are not effective enough or in patients with heart failure.
• Rhythm control medications, aimed at restoring and maintaining normal heart rhythm, such as sotalol and propafenone.
• Anticoagulants, to reduce the risk of blood clots and stroke.
• Medical procedures and surgical treatment 
• Electrical arrhythmia depends on sending a controlled electric shock to the heart with the aim of resetting the heart's electrical activity and restoring normal rhythm.
• Catheter ablation, a minimally invasive procedure, in which the doctor uses a thin, flexible catheter tube and inserts it through a blood vessel, usually in the groin, and directs it to the heart, and then uses radiofrequency energy or cooling to destroy small areas in the atria responsible for releasing the chaotic electrical signals that cause atrial fibrillation. This treatment is effective  in cases of intermittent and persistent atrial fibrillation.
• Ablation of the atrioventricular node and installation of a pacemaker. In this surgery, the atrioventricular node is destroyed to prevent rapid electrical signals from the atria from reaching the ventricles. A pacemaker is then implanted to maintain a regular heart rate. The doctor resorts to this procedure when other treatments fail to control the heart rate and symptoms. 
• Maze procedure, a surgical intervention in which a pattern of small scars is created in the atria to disrupt the propagation of chaotic electrical signals and force them to follow an orderly path, is often performed during other heart surgery.
• Closure of the left atrial appendage, which is a small pocket in the left atrium where most blood clots form in patients with atrial fibrillation. It can be closed using a device inserted through a catheter to prevent clot formation and reduce the risk of stroke in some patients who cannot take anticoagulants in the long term.
• تغيير نمط الحياة 

• Control and manage underlying medical conditions such as treating high blood pressure, diabetes, hyperthyroidism, sleep apnea, and other heart conditions.
• Avoid triggers and factors that may trigger atrial fibrillation attacks, such as excessive alcohol, excess caffeine, extreme stress, and quit smoking.
• Follow a healthy diet rich in fruits, vegetables, and whole grains and low in saturated and trans fats and sodium.
• Exercise regularly after consulting a doctor.
• Maintain a healthy weight.
• Follow up with your doctor regularly to monitor the effectiveness of treatment, adjust it as needed, adhere to the doctor’s instructions, and take prescribed medications regularly. 

Frequently asked questions

Can atrial fibrillation be cured?

The definitive answer to this question depends on several factors, including the type of atrial fibrillation, how long it has been present, the underlying causes, the patient's general health, and the response to treatment.

In some cases, a semblance of functional recovery can be achieved, especially in cases of early intervention and treatment of possible causes. Excellent results can be achieved with treatment, and seizures may not return for long periods or even permanently.

While in many other cases, the goal is to control symptoms, reduce the risk of complications, especially stroke, and improve quality of life.

How do I stop atrial fibrillation?

Stopping an atrial fibrillation episode depends on several factors, including the type of fibrillation, the duration of the attack, the severity of your symptoms, your medical history, and your doctor's recommendations.

If the symptoms are severe, you should not try to stop atrial fibrillation on your own without consulting your doctor or getting emergency medical care, as trying to stop the attack incorrectly could be dangerous.

Some of the methods that can be used to stop atrial fibrillation include:

• Immediate medical intervention if symptoms are severe or persistent by calling 911 or going to the nearest emergency department. 
• Electrocardioversion  in a hospital, where a controlled electric shock is sent to your heart via electrodes on your chest to reset electrical activity and restore normal rhythm.
• Take medications prescribed by the doctor to stop the seizure, which are antiarrhythmic medications such as propafenone or flecainide. 

It should be noted that there is no guaranteed way to stop an atrial fibrillation attack on your own safely and effectively at home, so you should  consult your doctor to develop an individual treatment plan that includes specific strategies to stop attacks when they occur and reduce their recurrence in the long term. 

What should I do in case of heart trembling?

If you feel your heart trembling, it is important to take calm and deliberate steps. You can follow these steps:

• Stop what you are doing and sit or lie down.
• Try to relax and reduce stress.
• Evaluate the symptoms carefully, whether they are a rapid heartbeat, fluttering, or irregular pulse. 
• Determine the duration of the trembling, and whether it stopped on its own.
• If there are no severe symptoms, you can hold your breath for a while and then blow out forcefully.
• Cough forcefully to stimulate the vagus nerve.
• Applying cold compresses to the face to stimulate the vagus nerve in some people.
• Avoid putting pressure on the carotid artery in the neck.

If symptoms persist or become more severe, you should go to the doctor immediately. 

In conclusion, atrial fibrillation certainly represents a health challenge that requires careful attention and effective treatment, and early diagnosis and appropriate treatment are not just options, but rather an absolute necessity to reduce complications.

Al Mousa Specialist Hospital stands out as a pioneering medical institution in providing integrated care for atrial fibrillation patients in the region. Through its highly qualified medical staff and modern diagnostic and therapeutic equipment, the hospital is committed to providing the latest and most effective treatment protocols.

You can contact us on our numbers listed on the website for more information, reservations and inquiries. 

Sources and references

Atrial Fibrillation – medlineplus

Atrial Fibrillation – nih