JAMA PATIENT PAGE

Atrial Fibrillation
Atrial fibrillation is an irregular and often rapid heart rate.

The heart has 4 chambers through which blood flows before being Normal heart rhythm Atrial fibrillation
sent to the rest of the body to deliver oxygen and vital nutrients. The Electrical signals start in the SA node and Disorganized electrical signals in the atria
travel through the atria. The atria contract transmit chaotic impulses to the AV node,
top 2 chambers are the atria and are important in helping blood reach and blood flows into the ventricles. The producing an irregular heartbeat. Blood
signal reaches the AV node, travels to the may pool in the atria and form clots.
the bottom 2 chambers, the ventricles. The right ventricle squeezes ventricles, and the ventricles contract.
blood into the lungs to pick up oxygen, while the left ventricle dis-
SA node Atria
tributes the blood to the rest of the body. Atrial fibrillation (AF) is a Clot
condition in which the electrical signals in the atria are rapid and dis-
organized, producing an irregular heartbeat. The most serious of pos- AV node AV nodee
sible consequences of AF are stroke and heart failure.
BLOOD
About 1 in 4 adults develop AF during their lifetime. Risk in- FLOW
creases with age. Other risk factors include heart failure, excessive
alcohol consumption, obstructive sleep apnea, obesity, high blood
pressure, chronic kidney disease, heart valve problems, and thy- Right Electrical
ventricle signal
roid disease. Some people have AF that comes and goes, lasting for
minutes to weeks. These episodes can be triggered by alcohol in- Left ventricle

take, stress, or infection and can go away on their own or by ad- Normal rhythm
dressing the underlying trigger. Some people experience AF con-
tinuously and permanently. Atrial fibrillation

Symptoms of AF
Symptoms include palpitations (a sense that the heart is racing, beat-
ing irregularly, or skipping beats); fatigue; lightheadedness, dizzi-
ness, or fainting; shortness of breath; and stroke. Many patients have
no symptoms while experiencing AF, but the risk of stroke and heart
failure are still present.
Diagnosis and Treatment
Atrial fibrillation is diagnosed with an electrocardiogram in an of-
fice or hospital. There are several treatment strategies.
Rate control: Because AF tends to cause fast heart rate, a doc-
tor can prescribe drugs that lower heart rate to improve symptoms
and stabilize heart function, such as β-blockers (eg, metoprolol or
carvedilol), calcium channel blockers (eg, diltiazem), or digoxin.
If medications are not working, placing a pacemaker and perform-
ing an ablation of the conduction system can be considered.
Rhythm control: A medical team may recommend a proce-
dure to help the heart come out of AF and restore a normal rhythm.
• Antiarrhythmia drugs are designed to maintain normal rhythm.
• Electrical cardioversion is a procedure in which a shock is sent to
the heart to restore normal electrical activity. If AF continues to re-
turn and cause symptoms, long-term use of antiarrhythmia drugs
can be prescribed.
FOR MORE INFORMATION
US National Library of Medicine
medlineplus.gov/atrialfibrillation.html
JAMA Patient Pages on atrial fibrillation were published in the
August 7, 2018, July 21, 2015, and March 10, 2015, issues of JAMA.
• Catheter ablation uses catheters inside the heart to eliminate
sources of AF and reduce the number of AF episodes.
Stroke prevention: Because AF increases risk of stroke, pa-
tients at high stroke risk should consider taking anticoagulants
(blood thinners). Aspirin and clopidogrel are not useful for preven-
tion of stroke due to AF.
Many patients use wearable technologies and smartphone-
based devices to monitor heart rate and heart rhythm. Many such
devices are approved by the US Food and Drug Administration for
their intended use. However, the results should be confirmed by a
clinician since these devices, while reasonably accurate, are not
perfect. They sometimes miss AF or incorrectly classify a rhythm
as AF. Because many of these technologies are new, their exact
role in helping the diagnosis and treatment of AF is still evolving.

Authors: Jayson R. Baman, MD; Rod S. Passman, MD, MSCE
Author Affiliations: Division of Cardiology, Northwestern University Feinberg School
of Medicine, Chicago, Illinois.
Conflict of Interest Disclosures: Dr Passman reported serving on advisory boards for
Medtronic and Abbott; receiving research support from the American Heart
Association and Pfizer/Bristol-Myers Squibb; and receiving royalties from UpToDate.
No other disclosures were reported.
Source: January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the
management of patients with atrial fibrillation. J Am Coll Cardiol. 2014;64(21):e1-e76.
doi:10.1016/j.jacc.2014.03.022
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