A-FIB

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Overview

Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. A-fib increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart's upper chambers (the atria) beat chaotically and irregularly — out of sync with the lower chambers (the ventricles) of the heart. For many people, A-fib may have no symptoms. However, A-fib may cause a fast, pounding heartbeat (palpitations), shortness of breath or weakness.

Episodes of atrial fibrillation may come and go, or they may be persistent. Although A-fib itself usually isn't life-threatening, it's a serious medical condition that requires proper treatment to prevent stroke.

Treatment for atrial fibrillation may include medications, therapy to reset the heart rhythm and catheter procedures to block faulty heart signals.

A person with atrial fibrillation may also have a related heart rhythm problem called atrial flutter. Although atrial flutter is a different arrhythmia, the treatment is quite similar to atrial fibrillation.
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Symptoms

Some people with atrial fibrillation (A-fib) don't notice any symptoms. Those who do have atrial fibrillation symptoms may have signs and symptoms such as:

Sensations of a fast, fluttering or pounding heartbeat (palpitations)
Chest pain
Dizziness
Fatigue
Lightheadedness
Reduced ability to exercise
Shortness of breath
Weakness

Atrial fibrillation may be:

Occasional (paroxysmal atrial fibrillation). A-fib symptoms come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Symptoms might go away on their own. Some people with occasional A-fib need treatment.
Persistent. With this type of atrial fibrillation, the heart rhythm doesn't go back to normal on its own. If a person has A-fib symptoms, cardioversion or treatment with medications may be used to restore and maintain a normal heart rhythm.
Long-standing persistent. This type of atrial fibrillation is continuous and lasts longer than 12 months.
Permanent. In this type of atrial fibrillation, the irregular heart rhythm can't be restored. Medications are needed to control the heart rate and to prevent blood clots.

When to see a doctor

If you have any signs or symptoms of atrial fibrillation, make an appointment with your doctor.

If you have chest pain, seek immediate medical help. Chest pain could mean that you're having a heart attack.
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Causes

To understand the causes of A-fib, it may be helpful to know how the heart typically beats.

The typical heart has four chambers — two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of the heart (right atrium) is a group of cells called the sinus node. The sinus node is the heart's natural pacemaker. It produces the signal that starts each heartbeat.

In a regular heart rhythm:

The signal travels from the sinus node through the two upper heart chambers (atria).
The signal passes through a pathway between the upper and lower chambers called the atrioventricular (AV) node.
The movement of the signal causes your heart to squeeze (contract), sending blood to your heart and body.

In atrial fibrillation, the signals in the upper chambers of the heart are chaotic. As a result, the upper chambers shake (quiver). The AV node is then bombarded with signals trying to get through to the lower heart chambers (ventricles). This causes a fast and irregular heart rhythm.

The heart rate in atrial fibrillation may range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100 beats a minute.
Causes of atrial fibrillation

Problems with the heart's structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:

Coronary artery disease
Heart attack
Heart defect that you're born with (congenital heart defect)
Heart valve problems
High blood pressure
Lung diseases
Physical stress due to surgery, pneumonia or other illnesses
Previous heart surgery
Problem with the heart's natural pacemaker (sick sinus syndrome)
Sleep apnea
Thyroid disease such as an overactive thyroid (hyperthyroidism) and other metabolic imbalances
Use of stimulants, including certain medications, caffeine, tobacco and alcohol
Viral infections

Some people who have atrial fibrillation have no known heart problems or heart damage.
Risk factors

Things that can increase the risk of atrial fibrillation (A-fib) include:

Age. The older a person is, the greater the risk of developing atrial fibrillation.
Heart disease. Anyone with heart disease — such as heart valve problems, congenital heart disease, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery — has an increased risk of atrial fibrillation.
High blood pressure. Having high blood pressure, especially if it's not well controlled with lifestyle changes or medications, can increase the risk of atrial fibrillation.
Thyroid disease. In some people, thyroid problems may trigger heart rhythm problems (arrhythmias), including atrial fibrillation.
Other chronic health conditions. People with certain chronic conditions such as diabetes, metabolic syndrome, chronic kidney disease, lung disease or sleep apnea have an increased risk of atrial fibrillation.
Drinking alcohol. For some people, drinking alcohol can trigger an episode of atrial fibrillation. Binge drinking further increases the risk.
Obesity. People who have obesity are at higher risk of developing atrial fibrillation.
Family history. An increased risk of atrial fibrillation occurs in some families.

Complications

Blood clots are a dangerous complication of atrial fibrillation that can lead to stroke.

In atrial fibrillation, the chaotic heart rhythm can cause blood to collect in the heart's upper chambers (atria) and form clots. If a blood clot in the left upper chamber (left atrium) breaks free from the heart area, it can travel to the brain and cause a stroke.

The risk of stroke from atrial fibrillation increases as you grow older. Other health conditions also may increase your risk of a stroke due to A-fib, including:

High blood pressure
Diabetes
Heart failure
Some valvular heart disease

Blood thinners are commonly prescribed to prevent blood clots and strokes in people with atrial fibrillation.
Prevention

Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation. Here are some basic heart-healthy tips:

Eat a nutritious diet
Get regular exercise and maintain a healthy weight
Don't smoke
Avoid or limit alcohol and caffeine
Manage stress, as intense stress and anger can cause heart rhythm problems

By Mayo Clinic Staff

[Admin]

They tell me I have A-Fib -
An irregular, often rapid heart rate that commonly causes poor blood flow.
The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles).
This condition may have no symptoms, but when symptoms do appear they include palpitations, shortness of breath, and fatigue.
Treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation).

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Heart DiseaseAtrial FibrillationReference

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What Are the Treatments for AFib?
Written by WebMD Editorial Contributors
Medically Reviewed by James Beckerman, MD, FACC on October 21, 2021
Articles On Atrial Fibrillation Treatments

AFib Treatments
AFib Medications
Cardiac Ablation
Pacemaker for AFib
Flying With AFib
Living With AFib

Atrial fibrillation is a problem with your heart's electrical activity. You and your doctor have treatment options if your symptoms become too severe.

With AFib, your heart quivers, beats irregularly, or skips beats. It can't pump blood through its chambers and out to your body as well as it should. Sometimes blood can pool in the heart and form clots, which could lead to a stroke.

Treatments such as medications, nonsurgical procedures, and surgery can slow your heartbeat and bring it back into a normal rhythm. AFib treatments can also prevent clots and help keep your heart healthy.
What Are Some Medications That Treat AFib?

These can prevent clots and strokes, slow your heart rate, and control your heart rhythm.

Blood thinners: These medications thin your blood to lower your chance of having those problems. But they can raise your risk of bleeding, so you might have to cut back on some activities that can lead to injuries. The most common are:

Apixaban (Eliquis)
Aspirin
Dabigatran (Pradaxa)
Enoxaparin (Lovenox)
Heparin
Rivaroxaban (Xarelto)
Warfarin (Coumadin, Jantoven)

Blood thinners can make you more likely to bruise or bleed too much. You'll see your doctor for a blood test every month to make sure the medication is working and you're on the right dose.

Heart rate medicines: The most common way to treat atrial fibrillation is with drugs that control your heartbeat. These slow your rapid heart rate so your heart can pump better.

You may need other drugs. Some are called beta-blockers. They also slow your heart rate. Some examples are:

Atenolol (Tenormin)
Bisoprolol (Zebeta, Ziac),
Carvedilol (Coreg)
Metoprolol (Lopressor, Toprol)
Propranolol (Inderal, Innopran)
Timolol (Betimol, Istalol)

Others are known as calcium channel blockers. They slow your heart rate and tone down contractions. You might get:

Diltiazem (Cardizem, Dilacor)
Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)

Heart rhythm medicines: They slow the electrical signals to bring your heartbeat into what’s called a normal sinus rhythm. These treatments are sometimes called chemical cardioversion:

Sodium channel blockers, which slow your heart's ability to conduct electricity:

Flecainide (Tambocor)
Propafenone (Rythmol)
Quinidine

Potassium channel blockers, which slow the electrical signals that cause AFib:

Amiodarone (Cordarone, Nexterone Pacerone),
Dofetilide (Tikosyn)
Sotalol (Betapace, Sorine, Sotylize)

You might get them in your doctor's office or at a hospital. Your doctor will monitor you to make sure the medicine is working.
What Are Some Procedures to Treat AFib?

If medicines don't work or they cause side effects, you can try one of two procedures called cardioversion or ablation. These treat AFib without surgery.

Electrical cardioversion: The doctor gives your heart a shock to regulate your heartbeat. They’ll use paddles or stick patches called electrodes onto your chest.

First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest, and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.

Most people only need one. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

Your skin may be irritated where the paddles touched it. Your doctor can point you toward a lotion to ease pain or itching.

Cardiac ablation: There are two major options:

Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s a less invasive ablation option. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then they guide it to your heart. When it reaches the area that’s causing the arrhythmia, it sends out electrical signals that destroy those cells. The treated tissue helps get your heartbeat regular again.

There are two main types of catheter ablation:

Radiofrequency ablation: The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that creates circular scars around each vein or group of veins.
Cryoablation: A single catheter sends a balloon tipped with a substance that freezes the tissues to cause a scar.

Surgical ablation involves cutting into your chest:

Maze procedure: This is usually done while you’re having open-heart surgery for another problem, like a bypass or valve replacement. The surgeon makes small cuts in the upper part of your heart. They’re stitched together to form the scar tissue that stops abnormal signals.

Mazechanginge: Most people with AFib don’t need open-heart surgery. That’s where this less invasive option comes in. The doctor makes several small cuts between your ribs and uses a camera to guide catheters for either cryoablation or radiofrequency ablation. Some hospitals offer robot-assisted surgery that uses smaller cuts and allows for greater precision.

Convergent procedure: This pairs catheter ablation with a mazechanging. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.

AV node ablation: You might get this procedure if:

You don’t respond to medications
You can’t take medications because of side effects
You aren’t a good candidate for a procedure that cures you.

Your doctor will insert a catheter into a vein in your groin and slide it up to the AV node, a nerve that conducts electrical impulses between the top and bottom chambers of your heart. They’ll send radiofrequency energy through the catheter to destroy the AV node. This stops the signals from reaching your ventricle. Then the doctor will implant a pacemaker into your chest.

For some people, ablation restores a normal heart rhythm better than medicine. It’s generally safe, but it does have some risks. Some of the things that can go wrong are:

Bleeding around your heart or where the catheter is inserted
Hole in the heart
Stroke
Heart attack
Narrowing of the pulmonary vein
Damage to the esophagus, the tube that carries food from your mouth to your stomach

Also, your AFib can come back in the first few months after you have ablation. In that case, you may need to have the procedure again or take heart rhythm drugs.

Pacemaker

This is a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it's beating too slowly. It’s made up of a small device called a generator that holds a battery and a tiny computer. Very thin wires called leads connect the pacemaker to your heart.

Getting a pacemaker may sound like a big deal, but it's a minor procedure. First, your doctor inserts a needle into a large vein near your shoulder, which guides the leads into your heart. The pacemaker then goes into your chest through a small cut. Once it's in place, your doctor tests it to make sure it works.

There are some risks, such as:

Bleeding or bruising in the area where your doctor places the pacemaker
Infection
Damaged blood vessel
Collapsed lung
If there are problems with the device, you may need another surgery to fix it.

Sometimes the impulses your pacemaker sends to your heart can cause discomfort. You may be dizzy or feel a throbbing in your neck.

Once you have one put in, you might have to keep your distance from objects that give off a strong magnetic field because they could affect the electrical signals from your pacemaker.

Some devices that can interfere with it are:

Metal detectors
Cell phones and MP3 players
Electric generators
Some medical machines such as an MRI

Treating the Causes of AFib

If problems such as high blood pressure, cholesterol, or an overactive thyroid caused your AFib, you'll need to treat the root cause. Your doctor might prescribe medications to get those conditions under control.

Your doctor may also recommend screening and treatment for sleep apnea, a disorder in which breathing starts and stops throughout the night.
Complementary Treatments

We need more research into alternative and complementary treatments for AFib. But a few have shown some promise in early studies. They include:

Yoga
Acupuncture
Biofeedback
Omega-3 fatty acids
Antioxidant vitamins, such as Vitamins C and E
Herbal supplements like berberine, cinchona bark, and shenshongyanxin (a traditional Chinese mixture)

Always check with your doctor before you try a complementary treatment.
Lifestyle Changes

Your doctor also might recommend you take some simple steps to help keep your heart healthy:

Change your diet -- eat heart-healthy, low-salt food. Go for fruits, veggies, and whole grains.
Get more exercise -- more physical activity strengthens your heart

They'll probably suggest that you make other changes to lower your odds of heart disease, as well as conditions like diabetes and lung disease that can contribute to AFib:

Quit smoking
Stay at, or try to reach, a healthy weight
Control your blood pressure
Manage your cholesterol
If you drink alcohol, do it in moderation

Your doctor will likely advise you to avoid stimulants, which can trigger AFib episodes. These include over-the-counter cough medicines that contain pseudoephedrine as well as recreational drugs like cocaine and amphetamines.

Don't overlook your emotional health. Stress may make atrial fibrillation worse, so find ways to manage it. You might try:

Yoga, tai chi, or other mind-body techniques
Meditation
Spending time with family and friends

If you have symptoms of anxiety or depression, like long-lasting sadness or trouble concentrating, ask your doctor to refer you to a mental health specialist.
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further reading

Heart Rhythm Disorders Illustrated Guide
How Well Are You Living With Atrial Fibrillation?
Heart Arrhythmia Quiz
5 Heart Rate Myths Debunked
Antiarrhythmics Drugs to Treat Heart Disease
Arrhythmia Topics

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5 Heart Rate Myths Debunked
Written by Kara Mayer Robinson
Medically Reviewed by James Beckerman, MD, FACC on May 21, 2015

It's normal to wonder if your heart is ticking just right. Sometimes you may think it beats too slowly. Or you might worry it's racing too fast. The truth is, there's a lot you've heard about your pulse that's flat out wrong. It's time to set the record straight.
1. Myth: A normal heart rate is 60-100 beats per minute.

That's the old standard. Many doctors think it should be lower. About 50-70 beats per minute is ideal, says Suzanne Steinbaum, DO, director of women's heart health at Lenox Hill Hospital.

Recent studies suggest a heart rate higher than 76 beats per minute when you're resting may be linked to a higher risk of heart attack.

The better shape you're in, the slower your heart rate will be when you're not moving around. "It might be OK to have a resting heart rate of 80, but it doesn't mean you're healthy," Steinbaum says.
2. Myth: An erratic heart rate means I'm having a heart attack.

When your heart beats in an irregular pattern, you're having what's called palpitations. You may feel as if it skipped a beat or speeds up. Or it may seem like a brief flutter or a pounding in your chest.

"Most of the time these sensations are not life-threatening," says Apoor Patel, MD, a cardiologist at North Shore-LIJ Medical PC in Manhasset, N.Y.

Many things can cause palpitations, like:

Alcohol
Caffeine
Exercise
Stress
Dehydration
Medication
Fever
Thyroid disorders
Smoking
Dietary supplements like goldenseal, oleander, motherwort, or ephedra

"Having an irregular heartbeat doesn't mean you're having a heart attack," Steinbaum says. But if it's a new symptom, or if you have chest pains or problems breathing, call your doctor.
3. Myth: If my pulse is fast, it always means I'm stressed out.

Stress is just one thing that can raise your pulse. Your heart rate may also speed up when you exercise, get excited, or feel anxious or sad.

When you stand up, your pulse may go up for 15 to 20 seconds before it goes back to normal. Even the weather, like high temperatures or humidity, can raise it.

If you take thyroid medication, a fast pulse may be a sign you're taking too much. Talk to your doctor.
4. Myth: If my heart rate is normal, my blood pressure is fine.

Sometimes your heart rate and your blood pressure go hand in hand. For example, when you exercise, or get angry or scared, they both go up.

But they're not always linked. If your heart rate is normal, your blood pressure may not be. It could be too high or too low, and you may not realize it.

Even if your heart rate seems fine, get your blood pressure checked regularly.
5. Myth: If my heart rate is slow, it means I have a weak heart.

Not necessarily. A slow heart rate can be a sign that you're healthy and fit. An athlete's heart muscle is in better shape, so it doesn't have to work as hard to keep up a steady beat.

In general, Patel says, slow rates are only a problem if you also pass out, feel dizzy, are short of breath, or have chest pain. See your doctor if you have any of those symptoms.
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www.hopkinsmedicine.org/health/conditions-and-diseases/atrial-fibrillation-prevention-treatment-and-research

Atrial Fibrillation: Prevention, Treatment and Research

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Overview

Atrial fibrillation (often called “A-fib” or AF) is the most common type of abnormal heartbeat. In a normal heartbeat, the four chambers of the heart work in a steady, rhythmic way. With atrial fibrillation, disorganized electrical signals cause the upper two chambers of the heart (the atria) to quiver, contracting in a very fast (often more than 300 beats per minute) and irregular way (fibrillating)—hence the name. In turn, that rapid and irregular upper chamber beating causes the lower chamber to beat more rapidly than normal, also in an irregular way. In some patients the atrial fibrillation causes the lower chamber to beat faster than 100 to 175 beats per minute (bpm). A normal heartbeat, in contrast, is very regular and beats at about 60 bpm at rest.

“It’s best to consider atrial fibrillation as a medical condition rather than a disease,” says Johns Hopkins cardiologist Hugh Calkins, M.D. “The more patients learn about this condition, the better equipped they are to be active partners in management.”

Atrial fibrillation can be a dangerous condition because it dramatically increases the risk of stroke, by as much as fivefold. Most strokes that are caused by atrial fibrillation result in permanent disability or death.

About 15 percent to 20 percent of all strokes are due to A-fib. What happens is this: Like a sponge that doesn’t get completely wrung out or emptied, the heart of a person with A-fib is unable to move blood fully from chamber to chamber, raising the risk of clotting. A clot can then be pumped to the brain, causing a type of stroke called embolic stroke.

Inefficient pumping can also cause another, but less common, condition called heart failure. In this case, the heart beats inefficiently, causing blood to back up in the heart and resulting in fluid in the lungs, says Calkins.

In addition to heart failure, atrial fibrillation has been linked to dementia. This may be related to multiple small strokes that affect the memory centers of the brain.

About 2.7 million Americans have been diagnosed with atrial fibrillation. Even more have the condition but aren’t aware of symptoms.
Prevention

Not all cases of atrial fibrillation can be prevented. By taking steps to avoid coronary artery disease or high blood pressure, however, you can help avoid developing A-fib due to these causes. The basics include not smoking, following a heart-healthy Mediterranean-style diet (high in plant-based foods, fruits and vegetables, and low in saturated fats), being physically active and keeping to a normal weight (as indicated on a body-mass index chart).
AFib Treatment at Johns Hopkins

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Diagnosis

Atrial fibrillation is a progressive condition that tends to worsen over time. It’s important to know that atrial fibrillation sometimes causes no symptoms at all. The condition may be diagnosed after complaints of symptoms lead to an examination and tests, or it may be discovered during testing for other heart conditions. Your doctor will try to pinpoint what’s causing it.

Tests used to diagnose atrial fibrillation include:

Electrocardiogram (ECG or EKG): This test, which evaluates the heart’s electrical activity, can usually confirm the condition.

Holter monitor : This portable monitor tracks the heart’s electrical activity over 24 to 48 hours. It’s useful because some people are not in atrial fibrillation all the time. While wearing the monitor, you go about your normal activities. Some monitors can be worn for longer (an event monitor is usually work for four weeks) — they start tracking when irregular activity in the heart is detected .

Stress test : A “treadmill test” (so called because it’s typically done using one) checks the heart when it has to pump hard and faster during exercise.

Echocardiogram (transthoracic echocardiogram): This test uses sound waves to create a moving picture of the heart and evaluate the size of the atria and the overall heart function.

Transesophageal echocardiogram : Because it’s easier to see the atria of the heart through the esophagus (the canal that connects the mouth, throat and stomach), this sound wave test is administered through the throat. “It’s useful in detecting if a blood clot has formed in the atrium prior to a cardioversion procedure,” Calkins says.

Chest X-ray : An X-ray is used to see complications of A-fib in the heart and lungs.

Blood tests : The results may be used to evaluate heart markers, like cholesterol, as well as thyroid and electrolyte levels.

Treatment

“With the latest medical options, including new blood-thinning medications and catheter ablation [radiofrequency energy sent to the heart via thin wires guided through blood vessels] of atrial fibrillation, AF patients are getting the best treatments ever,” Calkins says.

How atrial fibrillation is treated depends on the underlying cause, and on the frequency and severity of symptoms. In general, your doctor aims to:

Reduce your risk of stroke. Most people need a type of blood-thinner medication (such as warfarin, apixaban, rivaroxaban or dabigatran) to reduce the risk of clotting. With warfarin, frequent blood checks are needed to monitor effectiveness and dose, but this is not required for the newer blood thinners, says Calkins. Medication decisions are based on assessment of your stroke risk. Most patients with AF who are over age 65 require a blood thinner, Calkins says.

New Treatment Option. If you are unable to take a blood thinner because of risk of bleeding or falls, your doctor may recommend a procedure to occlude your left atrial appendage. Find out more about these options here .

Manage “rate control.” That’s the rate at which the lower chambers of the heart are beating. Medications that do this include beta-blockers.

Restore a normal heart rhythm. If symptoms persist despite having a controlled heart rate, efforts to restore and maintain the heart’s rhythm are often undertaken. One way normal rhythm can be restored is with a procedure called electrical cardioversion. Anti-arrhythmic medications can also be used. If these options are ineffective, catheter ablation can be performed. This procedure is used to eliminate atrial fibrillation by cauterizing certain areas in the heart that cause atrial fibrillation, says Calkins. Your doctor can explain this procedure to you in more detail.

Treat any underlying disorder, such as a thyroid problem or high blood pressure. For heart problems, lifestyle changes that improve weight and blood markers—a heart-healthy diet, being more active and losing weight if needed—can help. Medications may be given to manage certain conditions. In some cases, surgery is needed to repair damaged arteries (if there’s coronary artery disease) or heart valves (if there’s rheumatic heart disease).

Living With Atrial Fibrillation

Having A-fib and not knowing when quivering episodes will start may cause you stress. But by carefully managing your condition, you’ll feel better physically and mentally. Many people with this disorder lead normal, active lives.

“The main concern in patients with AF is stroke,” Calkins says. “It’s important that you meet with your physician and determine if your stroke risk warrants treatment with a blood-thinning medication. This is the single most important aspect of AF management.”

Be sure to follow medication guidelines carefully. When you take a blood-thinner called warfarin, you need to have your blood checked monthly to evaluate effectiveness. Don’t double up on a dose if you miss one—consult your doctor. With all blood thinners, you can bleed more easily, so let your doctor know if you notice any unusual bruising or bleeding. Your doctor may also advise dietary changes when taking blood thinners, such as avoiding intermittent larger servings of dark leafy greens: It is much better to eat a consistent amount of green leafy vegetables on a near daily basis.

Keep a symptom record. In a notebook, write down when you experience quivering episodes and how long they last, as well as any other symptoms. Bring this information to doctor visits. One way to check if you’re having palpitations is putting two fingers on the artery on the underside of your wrist to feel your pulse. You may be able to detect palpitations if the beating is faster or more irregular than usual, such as skipping beats.

Learn your “triggers.” Keeping a record may also help you identify causes that set off an irregular heartbeat. Common triggers for people with A-fib include stress, drinking alcohol or caffeine, doing certain exercises and consuming foods that contain the flavor enhancer monosodium glutamate (MSG). Being aware of these triggers can help you avoid them.

Research

Johns Hopkins researchers have added much to the understanding of what causes atrial fibrillation and how to manage it. Among their accomplishments:

They defined the guidelines indicating which symptoms call for the use of catheter and surgical ablation of atrial fibrillation, based on the type of AF, the patient’s symptoms and the response to anti-arrhythmic drug therapy. These guidelines help doctors deliver the best, most up-to-date treatments. Calkins was the lead author of the Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation, published by the Heart Rhythm Society.

Johns Hopkins clinicians also helped to define the indications, techniques and outcomes of atrial fibrillation ablation, in the above expert consensus statement.

They learned that people with a history of sudden drops in blood pressure are at increased risk for later A-fib. A Johns Hopkins-led study found that those who experience orthostatic hypotension—a sudden drop in blood pressure when going from lying down to standing—have a 40 percent increase in their risk of developing atrial fibrillation over the next two decades, an important possible early warning sign.