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Atrial fibrillation or flutter

Auricular fibrillation; A-fib; Afib

Atrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and most often irregular.

Causes

When working well, the 4 chambers of the heart contract (squeeze) in an organized way.

Electrical signals direct your heart to pump the right amount of blood for your body's needs. The signals begin in an area called the sinoatrial node (also called the sinus node or SA node).

In atrial fibrillation, the electrical impulse of the heart is not regular. This is because the sinoatrial node no longer controls the heart rhythm.

  • Parts of the heart cannot contract in an organized pattern.
  • As a result, the heart cannot pump enough blood to meet the body's needs.

In atrial flutter, the ventricles (lower heart chambers) may beat very rapidly, but in a regular pattern.

These problems can affect both men and women. They become more common with increasing age.

Common causes of atrial fibrillation include:

Symptoms

You may not be aware that your heart is not beating in a normal pattern.

Symptoms may start or stop suddenly. This is because atrial fibrillation may stop or start on its own.

Symptoms may include:

Exams and Tests

The health care provider may hear a fast heartbeat while listening to your heart with a stethoscope. Your pulse may feel fast, uneven, or both.

The normal heart rate is 60 to 100 beats per minute. In atrial fibrillation or flutter, the heart rate may be 100 to 175 beats per minute. Blood pressure may be normal or low.

An ECG (a test that records the electrical activity of the heart) may show atrial fibrillation or atrial flutter.

If your abnormal heart rhythm comes and goes, you may need to wear a special monitor to diagnose the problem. The monitor records the heart's rhythms over a period of time.

  • Event monitor (3 to 4 weeks)
  • Holter monitor (24-hour test)
  • Implanted loop recorder (extended monitoring)

Tests to find heart disease may include:

Treatment

Cardioversion treatment is used to get the heart back into a normal rhythm right away. There are two options for treatment:

  • Electric shocks to your heart
  • Drugs given through a vein

These treatments may be done as emergency methods, or planned ahead of time.

Daily medicines taken by mouth are used to:

  • Slow the irregular heartbeat. These drugs may include beta-blockers, calcium channel blockers, and digoxin.
  • Prevent atrial fibrillation from coming back. These drugs work well in many people, but they can have serious side effects. Atrial fibrillation returns in many people, even while they are taking these medicines.

Blood thinners are medicines that are used to reduce the risk of developing a blood clot that travels in the body (and that can cause a stroke, for example). They include heparin, warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa).

These drugs increase the chance of bleeding, so not everyone can use them. Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. Your provider will consider your age and other medical problems when deciding which drugs are best.

A procedure called radiofrequency ablation can be used to scar areas in your heart where the heart rhythm problems are triggered. This can prevent the abnormal electrical signals that cause atrial fibrillation or flutter from moving through the heart. You may need a heart pacemaker after this procedure. All people with atrial fibrillation will need to learn how to manage this condition at home.

Outlook (Prognosis)

Treatment can often control this disorder. Many people with atrial fibrillation do very well.

Atrial fibrillation tends to return and get worse. It may come back, even with treatment.

Clots that break off and travel to the brain can cause a stroke.

When to Contact a Medical Professional

Call your provider if you have symptoms of atrial fibrillation or flutter.

Prevention

Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter. Avoid binge drinking.

References

January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071-2104. PMID: 24682348 www.ncbi.nlm.nih.gov/pubmed/24682348.

Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Morady F, Zipes DP. Atrial fibrillation: clinical features, mechanisms, and management. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 38.

Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 37.

Zimetbaum P. Cardiac arrhythmia with supraventricular origin. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 64.

    • Atrial fibrillation

      Atrial fibrillation

      Animation

    •  

      Atrial fibrillation - Animation

      A lot of things can make your heart beat faster, like kissing the person you love or watching a scary movie. But sometimes, your heart beats not only faster but also out of rhythm. That can be a problem if this continues over a long period of time and isn't treated. Let's talk about a condition called atrial fibrillation. If you can listen to your heart through a stethoscope, your heart beat should sound something like this, or lub dub, lub dub, lub dub. If you have atrial fibrillation, the top two chambers of your heart contract too quickly, and in an irregular pattern. So what you'd hear if you listened through a stethoscope would be more like this. Atrial fibrillation doesn't just sound funny, this irregular beat can prevent your heart from pumping enough blood out to the rest of your body. Age may cause atrial fibrillation. As you get older, it's more common to have an irregular heartbeat. You're also more likely to have atrial fibrillation if you've had another heart problem, like valve disease, coronary artery disease, or heart failure. Some people get atrial fibrillation because they drink too much alcohol or take certain medicines. To find out you may have atrial fibrillation . . . You'll feel your heart race and flutter-and not just once in a while, but often. You may also have trouble breathing and feel tired and dizzy. Your doctor can listen for fluttering while listening to your heart with a stethoscope. You may also need a test that records your heart's rhythms, like an ECG, which you have in your doctor's office, or a Holter monitor that you wear around for a day. Your doctor may also prescribe imaging tests to look at your heart and check whether its electrical system is working properly. If you do have atrial fibrillation, your doctor can give you medicine to slow your racing heart. Often, the next step is to restore the normal heart rhythm with an electric shock, a process called Cardioversion. However, if the atria haven't been contracting well for 48 hours or more, blood clots may have formed there. These patients are usually given anti-coagulant medicines before Cardioversion to prevent the clots from moving to the brain and causing a stroke when normal rhythm is restored. If Cardioversion doesn't solve the problem, a procedure called Cardiac ablation can be done to destroy the bad areas of your heart that are causing your heart to beat abnormally. Usually doctors can treat atrial fibrillation so that it becomes a minor nuisance, instead of a big problem. But, the condition can come back, even after it's been treated. If it continues, atrial fibrillation can lead to heart failure. To avoid complications from atrial fibrillation, call your doctor if you're feeling flutters in your chest, and they don't go away.

    • Atrial fibrillation overview

      Atrial fibrillation overview

      Animation

    •  

      Atrial fibrillation overview - Animation

      Atrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and irregular in this condition.

    • Heart, section through the middle

      Heart, section through the middle - illustration

      The interior of the heart is composed of valves, chambers, and associated vessels.

      Heart, section through the middle

      illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    • Posterior heart arteries

      Posterior heart arteries - illustration

      The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

      Posterior heart arteries

      illustration

    • Anterior heart arteries

      Anterior heart arteries - illustration

      The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

      Anterior heart arteries

      illustration

    • Conduction system of the heart

      Conduction system of the heart - illustration

      The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

      Conduction system of the heart

      illustration

    • Atrial fibrillation

      Animation

    •  

      Atrial fibrillation - Animation

      A lot of things can make your heart beat faster, like kissing the person you love or watching a scary movie. But sometimes, your heart beats not only faster but also out of rhythm. That can be a problem if this continues over a long period of time and isn't treated. Let's talk about a condition called atrial fibrillation. If you can listen to your heart through a stethoscope, your heart beat should sound something like this, or lub dub, lub dub, lub dub. If you have atrial fibrillation, the top two chambers of your heart contract too quickly, and in an irregular pattern. So what you'd hear if you listened through a stethoscope would be more like this. Atrial fibrillation doesn't just sound funny, this irregular beat can prevent your heart from pumping enough blood out to the rest of your body. Age may cause atrial fibrillation. As you get older, it's more common to have an irregular heartbeat. You're also more likely to have atrial fibrillation if you've had another heart problem, like valve disease, coronary artery disease, or heart failure. Some people get atrial fibrillation because they drink too much alcohol or take certain medicines. To find out you may have atrial fibrillation . . . You'll feel your heart race and flutter-and not just once in a while, but often. You may also have trouble breathing and feel tired and dizzy. Your doctor can listen for fluttering while listening to your heart with a stethoscope. You may also need a test that records your heart's rhythms, like an ECG, which you have in your doctor's office, or a Holter monitor that you wear around for a day. Your doctor may also prescribe imaging tests to look at your heart and check whether its electrical system is working properly. If you do have atrial fibrillation, your doctor can give you medicine to slow your racing heart. Often, the next step is to restore the normal heart rhythm with an electric shock, a process called Cardioversion. However, if the atria haven't been contracting well for 48 hours or more, blood clots may have formed there. These patients are usually given anti-coagulant medicines before Cardioversion to prevent the clots from moving to the brain and causing a stroke when normal rhythm is restored. If Cardioversion doesn't solve the problem, a procedure called Cardiac ablation can be done to destroy the bad areas of your heart that are causing your heart to beat abnormally. Usually doctors can treat atrial fibrillation so that it becomes a minor nuisance, instead of a big problem. But, the condition can come back, even after it's been treated. If it continues, atrial fibrillation can lead to heart failure. To avoid complications from atrial fibrillation, call your doctor if you're feeling flutters in your chest, and they don't go away.

    • Atrial fibrillation overview

      Animation

    •  

      Atrial fibrillation overview - Animation

      Atrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and irregular in this condition.

    • Heart, section through the middle

      Heart, section through the middle - illustration

      The interior of the heart is composed of valves, chambers, and associated vessels.

      Heart, section through the middle

      illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    • Posterior heart arteries

      Posterior heart arteries - illustration

      The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

      Posterior heart arteries

      illustration

    • Anterior heart arteries

      Anterior heart arteries - illustration

      The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

      Anterior heart arteries

      illustration

    • Conduction system of the heart

      Conduction system of the heart - illustration

      The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

      Conduction system of the heart

      illustration

    Tests for Atrial fibrillation or flutter

     

    Review Date: 4/20/2015

    Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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