Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation is an irregular and often rapid heart rhythm. It begins in the two upper chambers of the heart. Most people call it AFib or AF. The upper chambers quiver instead of squeezing in a steady, coordinated way. Blood is still pumped, but less efficiently. The lower chambers respond at an uneven pace. That is why the pulse feels chaotic. AFib may come in short bursts that stop on their own. It may also become the heart's everyday rhythm. Some people feel every episode. Others feel nothing and learn about it during a routine exam. The most important consequence is stroke. Blood can pool while the upper chambers quiver. A clot then forms and travels to the brain. The National Heart, Lung, and Blood Institute identifies AFib as a major stroke risk factor. AFib is also treatable, and treatment lowers that risk substantially.

Symptoms to watch for

AFib feels different from person to person. Roughly a third of patients have no symptoms at all.

Call the office if you notice:

• A fluttering, quivering or galloping heartbeat.
• A pulse that is irregular when you check it at your wrist.
• Shortness of breath with stairs or light activity.
• Fatigue that is new or out of proportion to what you are doing.
• Lightheadedness, or a feeling of pressure in the chest with an episode.

Call 911 right away if you have:

• Chest pain or pressure that lasts more than a few minutes.
• Sudden face drooping, arm weakness or trouble speaking, the stroke warning signs.
• Fainting, or severe shortness of breath at rest.

Stroke symptoms are time critical. Treatment works best in the first hours. Call 911 rather than driving to a hospital.

How Dr. Nanavati diagnoses it

AFib has to be captured on a tracing to be confirmed. Episodes come and go. So the choice of monitor matters as much as the test itself.

• Electrocardiogram (ECG or EKG) confirms AFib in seconds when you are in the rhythm during your visit.
• Holter monitoring records 24 to 48 hours of beats. It suits symptoms that occur most days.
• 7 to 10 day ambulatory rhythm monitoring catches episodes that appear only occasionally. It also measures how much of the time you are in AFib.
• Loop recorder implantation and interrogation provides long term monitoring. It is used after a stroke of unknown cause or for very infrequent episodes.
• Transthoracic echocardiography measures the size of the upper chambers. It also checks the valves and reports pumping strength.
• Transesophageal echocardiography looks directly for clot in the left atrial appendage before cardioversion or ablation.
• Advanced lipid testing plus thyroid and metabolic blood work identifies reversible drivers.
• Treadmill stress testing shows how well your rate is controlled with exertion.

Monitoring and echocardiogram studies are performed in the office at all three sites.

Treatment options

AFib care has two separate jobs. It prevents stroke and manages the rhythm itself. Both are addressed at every visit.

Stroke prevention. Your risk is scored using age, blood pressure, diabetes, heart failure, vascular disease and prior stroke. An anticoagulant is prescribed when the score warrants it. That follows American College of Cardiology guidelines. Some patients cannot take long term blood thinners. For them, left atrial appendage closure seals the pouch where most AFib clots form.

Lifestyle. Weight loss, treating sleep apnea, limiting alcohol and cutting stimulants all reduce how often AFib returns. So does controlling blood pressure. These steps are part of the American Heart Association approach. They are as effective as some medications.

Rate and rhythm medication. Beta blockers and calcium channel blockers slow the heart rate. Antiarrhythmic drugs work to hold normal rhythm.

Procedures. Electrical cardioversion resets the rhythm with a brief, sedated shock. Catheter ablation isolates the tissue triggering AFib. A pacemaker is added when the rate runs too slow. It is checked at follow up by pacemaker interrogation. These procedures take place at affiliated hospitals. Cardiac rehabilitation helps you rebuild activity safely afterward.

What to expect at your visit

Bring every medication bottle or an accurate list. Also bring any tracings from a smart watch or home device. Be ready to describe when episodes start, how long they last and what triggers them. Your appointment includes an exam, a blood pressure and pulse check and an ECG. Echocardiography and monitor placement are typically arranged the same day. You will leave with a clear answer on three points. You will know whether you need a blood thinner and how your rate will be controlled. You will also know the plan if AFib returns. The FAQs page answers common questions about preparing for a first visit.

When to see a cardiologist

Make an appointment if your pulse is irregular. Do the same if a watch or blood pressure cuff has flagged an irregular rhythm. Unexplained palpitations, breathlessness or fatigue are also reasons. AFib often accompanies coronary artery disease and high blood pressure, so a full cardiac assessment is worthwhile. Request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He sees patients at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

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