By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Atrial fibrillation, or “a-fib,” is a common and often life-threatening form of arrhythmia—the medical term for irregular heart rhythm. Roughly 2.7 million Americans are living with a-fib.
A-fib can best be described as a miscommunication in the signals that control how the heart beats. Normally, the atria (the two top chambers of the heart) squeeze first, followed by the ventricles (the two bottom chambers). When timed properly, these contractions effectively move blood throughout your body.
However, with atrial fibrillation, the upper and lower chambers of the heart do not work together or communicate properly. The electrical signals that control the process somehow misfire and instead of working together, the atria “do their own thing.” They fibrillate, or start rapidly vibrating, which can cause heart rate to increase up to 250 beats per minute. As a result, the lower chambers do not fill completely or pump enough blood to the lungs and rest of the body. This is problematic for a variety of reasons, which I’ll get into below.
Afib Symptoms and Complications
Afib symptoms can vary from person to person. Some people may feel nothing at all and not even know they have Afib until a doctor discovers it. Other people may feel the fibrillation as quivering or palpitations in the heart. Other Afib symptoms include dizziness, fainting, shortness of breath, weakness or difficulty exercising, fatigue, and chest pain.
Most people can tolerate Afib symptoms for short periods of time. However, episodes that last for several hours or longer place considerable strain on the heart, which can lead to a heart attack or congestive heart failure. But that’s not all…untreated Afib can lead to other dangerous and even life-threatening complications:
- Blood clots. Because the heart isn’t about to pump blood properly with Afib, it can cause blood to pool and form clots. If a clot breaks off, it can travel to the heart (leading to a heart attack), lungs, spleen, kidneys, intestine, brain, etc. Venous thromboembolism—a blood clot that forms in a vein—is also a possibility.
- Stroke. If a clot lodges in an artery that leads to the brain, a stroke can result. Up to 20 percent of people who have a stroke also have Afib. In fact, many don’t even know they have Afib until they suffer a stroke.
- Cognitive impairment. Blockages in the blood vessels leading to the brain can impair cognitive function and even lead to Alzheimer’s disease or vascular dementia.
- Sudden cardiac arrest. People with Afib have an increased risk of their heart suddenly and unexpectedly stopping—which leads to death.
Anyone can develop atrial fibrillation at any age, even those in otherwise excellent health. However, people who have one or more of the following risk factors are more likely to get it:
- Advanced age (those over 60 are highest risk)
- High blood pressure
- Underlying heart issues, including heart disease, structural (valve) or congenital defects, pericardial inflammation, prior heart attacks, and cardiomyopathy
- Prior heart surgery (A-fib is the most common complication after heart surgery)
- Frequent binge drinking
- Family history
- Sleep apnea
- Other chronic conditions, including thyroid disease (particularly hyperthyroidism), diabetes, asthma, and other chronic lung problems
It’s worth mentioning that overexposure to certain man-made electromagnetic frequencies may also cause arrhythmias like atrial fibrillation. I know of two colleagues who developed a-fib after sleeping in close proximity to a cordless phone, and at least one study has linked cordless phone radiation to irregular heartbeats. If you or a loved one develops an arrhythmia like a-fib, try limiting exposure to cell phones, cordless phones, cell towers and WiFi routers. Keep phones off your body, and in a separate room while you sleep, and sleep grounded to help get your body back in harmony with the earth’s natural rhythms (more on grounding here).
Sometimes Afib goes away on its own. In this case, it’s called paroxysmal atrial fibrillation. Symptoms come and go, lasting for a few minutes or hours—and eventually they subside.
For some people, though, atrial fibrillation is an ongoing problem. Over time, it happens more often and episodes last longer. These cases are labeled “persistent Afib,” or the more serious “permanent Afib.” Both require treatment.
Treatment restores normal heart rhythms, helps control symptoms, and prevents complications like blood clots. A-fib treatments range from lifestyle changes to pharmaceutical drugs and medical procedures.
With all cases of A-fib—occasional, persistent, and permanent—lifestyle changes should be the cornerstone of treatment. Sometimes, addressing underlying causes and risk factors is all that needs to be done to eliminate these arrhythmias.
In fact, research confirms that making lifestyle changes and eliminating risk factors can be extraordinarily powerful. In a study of nearly 15,000 participants, researchers determined that, overall, 56.5 percent of A-fib cases could be attributed to having the following risk factors—high blood pressure, diabetes, obesity, smoking, and prior cardiac disease, with high blood pressure being the most important to eliminate. The researchers concluded that “as with other forms of cardiovascular disease, more than half of the A-fib burden is potentially avoidable through the optimization of cardiovascular risk factor levels.”1
In addition to a heart-healthy diet (such as the Pan-Asian Modified Mediterranean, or PAMM, diet), moderate exercise and stress reduction help with weight loss. Additionally, these lifestyle changes decrease stress on the heart and restore its structure and function.
And it should go without saying: Weight loss should be a priority as well. In a study conducted with 1,415 patients, those who lost 10 percent of their body weight were six times more likely to be free of Afib after four years, compared to those who did not lose weight. The researchers wrote that “long-term sustained weight loss is associated with significant reduction of Afib burden…”2
At least half of patients with Afib have sleep apnea, which can easily be addressed (and sometimes through weight loss alone). Other conditions—thyroid, asthma, diabetes—may require more care and direction from a doctor, but they, too, can be controlled.
Targeted heart supplements may not cure Afib, but they can definitely help improve overall heart health. Top of list is CoQ10. In one study of 102 patients with Afib and heart failure, those taking CoQ10 had significant reductions in malondialdehyde (a marker of oxidation) compared to controls. After 12 months of treatment, just three patients in the CoQ10 group (compared to 12 in the control group) had Afib episodes.3
Other heart-supportive nutrients include L-carnitine, magnesium, vitamins D and E, and D-ribose.
Medications and Procedures
When lifestyle changes and supplements aren’t enough, pharmaceuticals and other procedures may be warranted.
For patients who are especially high risk or who have long-term persistent or permanent A-fib, blood thinners like Coumadin can be lifesavers. They prevent the clotting that so commonly occurs with A-fib, and therefore reduce risk of heart attack and stroke. Blood thinners come with their own set of risks, and it’s important to be carefully monitored while taking them. Despite this, I usually recommend blood thinners for people with recurring A-fib (more than one or two episodes) and who show signs of arterial disease – for these people, the benefits outweigh the risks of not taking blood thinners.
Beta-blockers and calcium channel blockers may also be prescribed to slow heart rate, and antiarrhythmic drugs like amiodarone may be given to control heart rhythm.
Antiarrhythmics are serious drugs with even more serious side effects, ranging from dizziness and nausea to pulmonary toxicity and sudden death. In fact, one study showed that up to 70 percent of patients taking amiodarone experienced side effects severe and bothersome enough to discontinue the drug.4 Therefore, antiarrhythmics should be used judiciously, as a last resort, and under the care of a knowledgeable cardiologist.
Procedures like cardioversion and ablation are also options. Cardioversion normalizes rhythm by sending a jolt of electricity into the atria. It provides relief—usually temporary—for most people. So it’s not a cure, but it’s a decent treatment that’s far safer than long-term use of antiarrhythmics.
With ablation, a catheter is inserted through a vein that leads into the atrium. The areas that trigger abnormal signals are zapped into regularity. Ablation can fully eliminate the need for drugs—but it’s only successful in 20 to 40 percent of patients who get it done. Some patients may need to have the ablation done a second time for it to work.
Bottom line, A-fib is a condition that can’t be ignored. Make sure you find a cardiologist you can trust and who engages in open, honest dialogue with you and your treatment options. While A-fib needs to be monitored and treated, you can absolutely still live a productive and happy life with it.
1.Huxley RR, et al. Absolute and Attributable Risks of Atrial Fibrillation in Relation to Optimal and Borderline Risk Factors: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2011 Apr 12;123(14):1501-8. Last accessed Aug. 15, 2019.
2. Pathak RK, et al. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002. Last accessed Aug. 15, 2019.
3. Zhao Q, et al. Effect of Coenzyme Q10 on the Incidence of Atrial Fibrillation in Patients with Heart Failure. J Investig Med. 2015 Jun;63(5):735-9. Last accessed Aug. 15, 2019.
4. Park HS and Kim YN. Adverse Effects of Long-Term Amiodarone Therapy. Korean J Intern Med. 2014 Sep;29(5):571-3. Last accessed Aug. 15, 2019.
© Stephen Sinatra, M.D. All rights reserved.