Overview of Atrial Fibrillation

In this overview of Atrial Fibrillation we introduce you to A-Fib concepts, terminology, and treatments options. We’ll address the following topics:

• What Does A-Fib Feel Like?
• A-Fib―The Emerging Epidemic
• How Your Heart Pump Works
• How do you get A-Fib? What causes or triggers it?
• The Types of A-Fib
• How A-Fib Affects Your Heart, Brain and Mental Health
• Treatments for A-Fib
• A-Fib is a Progressive Disease

What Does A-Fib Feel Like?

In Atrial Fibrillation (A-Fib) the upper part of your heart beats (quivers) faster than the rest of your heart. Your pulse is irregular and/or more rapid than normal.

If you could look inside your chest, the top part of your heart would be shaking like Jell-O or beating more rapidly than the lower section of your heart. You feel an uncomfortable flutter in your chest or like your heart is going to jump out of your ribs or that your heart is “flip-flopping around.”

Others have described their A-Fib “…like a motor idling too fast in my chest,” or “like mice running around in my heart” or “like I had a maniacal bass drummer hidden away in my chest.”

A-Fib is different from person to person. You may have one or more of the following symptoms:

• Irregular heartbeat (e.g., fast, slow, or both)
• Heart palpitations (i.e., pounding, fluttering, or flip-flopping)
• Dizzinesses, lightheadedness, or fainting
• Feeling overly tired or having low energy
• shortness of breath
• sweating, chest pain, pressure, tightness, or discomfort
• can’t exercise as you want
• feel unsettled, frightened and anxious
• No symptoms at all

You may feel like your brain isn’t working right, that at work you can’t handle routine tasks any more.

While some people feel a dramatic, racing heart flutter, up to nearly 27% to 30% of patients experience no noticeable symptoms, and were surprised when the doctor said, “You have Atrial Fibrillation”.

A-Fib—an Emerging Epidemic

Atrial Fibrillation is the most common heart arrhythmia and nearly 5% of the general population. It’s estimated at least 5.1 million people in the U.S. have A-Fib. Worldwide, it’s estimated 71–142 million suffer with Atrial Fibrillation with 5 million new A-Fib cases diagnosed each year.

Of those with Atrial Fibrillation, it’s estimated as many at 62% are unaware they have A-Fib before being diagnosed.

In the U.S., people over the age of 40 have a one-in-four lifetime risk of developing A-Fib. In addition to the physical symptoms, A-Fib can deeply affect your state of mind and emotional well-being and reduces one’s quality of life. It’s hard to live with a sick heart.

A-Fib has rightly been called an epidemic.

Medical illustrations of the heart: When picturing your heart, visualize it in your own chest (the left atria and ventricle is next to your left arm) or picture it like it would appear in a mirror.

Four chambers of the heart

How Your Heart Pump Works

The heart is actually two pumps in one muscle. It pumps blood through a continuous, two-step loop using its four chambers.

Right side of heart: Oxygen-poor blood from the body enters the right atrium and pushes the blood into the right ventricle, which squeezes it through the pulmonary artery to the lungs. In the lungs, the blood releases carbon dioxide and picks up fresh oxygen.

Left side of heart: Oxygen-rich blood returns from the lungs and enters the left atrium, the blood flows into the left ventricle, which pumps it out through the aorta to the rest of the body.

A Normal Heartbeat

SA Node and AV Node

Normally, each heartbeat starts at the top of the right atrium where a specialized group of cells called the Sinus Node (sinoatrial node).

The Sinus Node generates an electrical signal that travels down a single electrical road called the AV Node (the natural pacemaker of the heart) that connects the atria to the ventricles below. This electrical signal causes the heart to beat.

First, the atria contract, pumping blood into the ventricles. Then, a fraction of a second later, the ventricles contract sending blood throughout the body. Normally the heart beats at 60-100 times per minute. When a doctor or nurse takes your pulse, he/she is counting contractions of your ventricles.

Your Heart in Atrial Fibrillation

In A-Fib, electrical signals from other parts of the heart disrupt your heart’s normal rhythm and cause the atria to beat or quiver rapidly on their own, 300-600 beats per minute.

Below is a graphic representation of your beating heart: on top is an ECG of a normal heart beat (normal sinus rhythm); notice the regular pattern. Below it is an ECG of a heart in Atrial Fibrillation. Notice the irregular and erratic pattern.

However, only a small number of these atrial beats make it through the AV Node which acts like a gate to the ventricles. This is fortunate, because you couldn’t live with a heartbeat that rapid. But some A-Fib beats do make it through the AV Node and make your whole heart beat irregularly and/or faster than normal.

Animation of the Normal Heart and in Atrial Fibrillation

Below is a link to two animations. The first is a normal beating heart. Then, you can watch the same illustration as a heart in Atrial Fibrillation. (Animation with no audio.) To view, click the image below and a separate browser tab will open at the American Heart Association website. Afterwards, you can close the tab to return to this browser tab.

: Animations of normal beating heart and a heart in atrial fibrillation, from the American Heart Association.
• To see a Normal Beating Heart, Click here, or click on the image above to go to the AMA website;
• To see the Heart in Atrial Fibrillation, look in the lower right for the ‘Select a condition’ drop down menu, then select “Atrial Fibrillation”.

How Do You Get A-Fib? What Causes or Triggers A-Fib?

For many A-Fib patients (around 50%), there is no discernible cause or trigger for their A-Fib (called Lone A-Fib). For the others, your risk of developing A-Fib increases if you have:

• Advanced age (60+)
• High blood pressure
• Obesity
• Moderate to heavy alcohol use
• Cigarette/nicotine use
• European ancestry
• Sleep apnea
• Diabetes
• Heart failure
• Hyperthyroidism
• Chronic kidney disease

A-Fib is associated with aging of the heart. As patients get older, the prevalence of A-Fib increases.

If you’ve had other heart problems, this could lead to diseased heart tissue which generates the extra A-Fib pulses—possibly because they stretch and put pressure on the pulmonary veins where most A-Fib signals originate. Up to 40% of patients get A-Fib after open heart surgery.

Emotional stress, severe infections, severe pain, traumatic injury, and illegal drug use can trigger A-Fib. An imbalance of minerals (electrolytes) such as potassium, magnesium and calcium can trigger A-Fib. Some cases have been reported from antihistamines and bronchial inhalants.

A-Fib does run in families. Research has found that if any blood relative has A-Fib, other family members have a 40% increased risk of also developing A-Fib. If you have A-Fib, you should warn all your immediate family members that they have a good chance of getting it also.

As patients get older, the prevalence of A-Fib increases, roughly doubling with each decade.

For an in-depth discussion of A-Fib causes and triggers, see our pages:

• Causes of A-Fib
• Which Comorbid Risks Do You Have That Make Your A-Fib More Severe?
• Which Lifestyle Choices Make Your A-Fib More Severe? What You Can Do.

Types of Atrial Fibrillation

In casual usage you may hear the three types of A-Fib described as occasional, persistent, and permanent or chronic A-Fib. Your doctor, however, may use one of the following medical terms:

• Paroxysmal: (pronounced par-ok-SIZ-mal) describes episodes that stop on their own, and last anywhere from seconds or minutes, to hours or up to a week
• Persistent: episodes which last more than a week; or episodes lasting less than a week but only stopped by cardioversion
• Long-standing Persistent: a type of Persistent A-Fib that lasts longer than one year; (formerly called Chronic or Permanent)

Note: the terms Paroxysmal and Persistent are not mutually exclusive. You may have several episodes of paroxysmal A-Fib and occasional Persistent A-Fib, or the reverse. Your A-Fib is called by whichever occurs most often.

Atrial Flutter (A-Flutter)

Similar to Atrial Fibrillation, is Atrial Flutter. Like in A-Fib, extra electrical signals are generated in your heart which make the atria contract faster than the ventricles. But in Atrial Flutter, your heart beats in an organized, predictable pattern. (In Atrial Fibrillation the atria beat chaotically and irregularly.) You may consider Atrial Flutter as a more regular, organized variety of A-Fib.

A-Flutter often, but not always, originates in the right atrium. Whereas A-Fib usually comes from the left atrium.

Someone with Flutter often has the potential for A-Fib lurking in the left atrium. For some patients, Atrial Flutter can be a precursor to A-Fib.

A-Fib Affects Your Heart, Brain and Mental Health

Prolonged A-Fib episodes may stretch and weaken the heart muscle. Inefficient atrial pumping puts an added burden on the ventricles. Over time a very fast heart rate can strain the heart and cause a heart attack. Of patients suffering from A-Fib, 20%–50% develop heart failure (congestive heart failure).

A-Fib nearly doubles your chances of death. The mortality rate from atrial fibrillation (as either the primary or an underlying cause of death) has been increasing for more than two decades.

A-Fib often changes or “remodels” your heart. Your left atrium (LA) tends to expand, stretch, dilate and weaken. Your ejection fraction (how well your heart is pumping out blood) tends to decrease. A-Fib produces fibrosis (collagen and scarring in the heart). Fibrotic tissue is scarred, immobile, basically dead tissue with reduced or no blood flow and no transport function. It results in a loss of atrial muscle mass. (For more, see my article: A-Fib Produces Fibrosis.)

Over time Fibrotic tissue makes the heart stiff and leads to other heart problems. Your Left Atrium essentially stops contracting and pumping. Your heart also remodels electrically. A-Fib attacks tend to become longer and occur more often.

The Brain in A-Fib

When you have A-Fib, the upper parts of your heart (the atria) aren’t pumping enough blood into the lower chambers of your heart (the ventricles). It’s estimated that this reduces the amount of blood flowing to your brain and the rest of your body by about 15%-30%.

MRI studies of the brain show that nearly half of A-Fib patients have visible signs of brain damage in the form of brain lesions, even if they’ve never had a stroke. Others often have brain volume loss (brain shrinkage) and small patterns of brain injury called “white matter disease.”

Recent studies indicate that A-Fib reduces mental abilities. Patients with A-Fib are 44% more likely to develop dementia.

Psychological and Emotional Effects

Your first A-Fib attack is a shock. Something has gone terribly wrong with your heart. There’s the constant threat, fear and anxiety of an ever-possible A-Fib attack, the sense of sickness, the feelings of depression and impending doom.

A-Fib can deeply affect your state of mind and emotional well-being.

Research has identified that psychological distress is present in a substantial portion of A-Fib patients and is related to greater A-Fib symptom severity, diminished quality of life, and adverse outcomes. Studies show that patients with paroxysmal A-Fib show signs of depression, sleeping disorders and low levels of physical activity.

Mood swings and the need to cry some times are just some of the effects A-Fib can have on your state of mind. Anxiety by itself can produce physical symptoms and a depressed immune system.

Don’t be scared or ashamed to admit how A-Fib makes you feel (especially if you’re a guy). There’s nothing wrong with seeking counseling and drug therapy for how A-Fib affects your psyche. Your psyche is just as important as your physical heart.

Be aware that your doctor may not be of much help with your emotional distress. Few are trained or often have little effective experience in dealing with the psychological and emotional aspect of A-Fib.

Recognize that A-Fib can have significant consequences on your social interactions, with your family, friends and colleagues. Sit down with them and explain to them what A-Fib is and how it affects you. (You can play one our A-Fib videos to help you, see our library of Instructional A-Fib Videos and Animations.)

Realize, though, that many may never understand the suffering A-Fib causes you. A-Fib isn’t like having a broken leg. To your significant others, you don’t look sick.

You are not alone.

Reading a similar personal A-Fib story can replace fear with hope!

Read how others have dealt with their A-Fib. Search the list of Personal Experiences published on his site. With over 100 stories, you’re sure to find a few patients with similar symptoms as yourself. Knowing others have beaten their A-Fib is a tremendous psychological relief. This helps replace fear with hope!

At A-Fib.com, we will give you an understanding of your A-Fib and hopefully a sense of control. You will learn what A-Fib is and how to fix it. As terrible as A-Fib makes you feel, it’s a heart problem that’s the easiest to fix (unlike most other heart problems). Also, see our article: Eight Ways to Cope With Your A-Fib Fear and Anxiety.

Review of Treatments for Atrial Fibrillation

Diagnostic Testing

Doctors have several technologies and diagnostic tests to aid them in evaluating your A-Fib. Your doctor will likely make use of several from this list.

Blood Tests: Blood tests can check the level of thyroid hormone, the balance of your body’s electrolytes (i.e. potassium, magnesium, calcium, sodium, etc.), look for signs of infection, measure blood oxygen levels and hormone levels, and other possible indicators of an underlying cause of Atrial Fibrillation.

ECG of heart in A-Fib

Electrocardiogram: An ECG or EKG is a simple, painless test that uses up to twelve sensors attached to your body to create a graphical representation of the electrical activity of your heart. The standard ECG records for only a few seconds. It can only detect an A-Fib episode if it happens during the test.

Holter and Event Monitors: Those with occasional A-Fib (Paroxysmal) may not experience an A-Fib episode during their ECG. A Holter or Event Monitor is a small, portable recorder that’s worn during your normal daily activities and records your heart’s electrical activity for a full 24–48 hour period in hopes of capturing data during an A-Fib attack. The leads from the Holter Monitor attach to your body like the sensors of an ECG.

Electrophysiology Study: A special catheterization test to examine the electrical activity inside your heart. An electrophysiologist (EP) inserts several electrode catheters through the veins in your groin. By recording data from strategic locations within the heart, most kinds of cardiac arrhythmias can be fully documented.

Imaging Technologies: An Echocardiograph uses ultrasound waves to create a moving picture of your heart. These images show the size and shape of your heart and how well your heart chambers and valves are working.

Transesophageal Echocardiography (TEE): In this test, a tube with an ultrasound device is passed down through your esophagus to capture images of the heart muscle and other parts of the heart. It is often administered just before an ablation to look for blood clots in your atria. If blood clots are found, anticoagulants are prescribed to dissolve them.

Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) or Chest X-Ray: Various technologies for detailed images of the heart and to make three-dimensional (3D) pictures of your heart and chest.

There are several tests your doctor may use to evaluate your A-Fib. A basic understanding of these tests helps you ask informed questions and discuss test results. For a complete list of tests and a detailed discussion, see Diagnostic Tests for Atrial Fibrillation

Common Treatments for Atrial Fibrillation

The most common treatments for Atrial Fibrillation are:

• Assessing Stroke Risk
• Drug Therapies
• Cardioversion
• Catheter Ablation
• Maze & Mini-Maze Surgeries & Hybrid Surgery/Ablation
• Other Treatments

Assessing Stroke Risk

The biggest danger from A-Fib is stroke because your heart isn’t pumping out properly and blood can pool in your atria. Blood clots can form and travel to the brain causing an “ischemic” stroke.

A-Fib stroke and brain clot.

Untreated, you are five-to-six times more likely to have a stroke than the general population. A-Fib is responsible for up to 25% of all strokes, or 140,000 strokes annually. A-Fib-related strokes are often more severe and disabling than strokes from other causes. Of A-Fib stroke patients, 44% suffer significant neurologic damage.

That’s why after your initial diagnosis of Atrial Fibrillation, the first topic to discuss with your doctor is your increased risk of clots and stroke. For most A-Fib patients, blood thinners (anticoagulants) are recommended.

Anticoagulants make it harder for blood clots to form. A stroke risk assessment tools such as the CHA2DS2-VASc Risk Score is used to access your risk of stroke. Not everyone with A-Fib needs a blood thinner. Your doctor will help you decide if they’re right for you.

Direct Oral Anticoagulants (DOACs) like Xarelto and Eliquis, have simplified oral anticoagulation therapy and replaced vitamin K antagonists like Warfarin for most patients. They are associated with lower risks of major bleeding, including intracranial hemorrhage. Most are now available in generic form, and as such, initial cost barriers have been significantly reduced.

But DOACs may not be suitable for everyone, and can have risks such as kidney function impairment. Anticoagulants are not like taking vitamins that you might take as a precaution against a possible mineral deficiency.

Taking an anticoagulants is often a trade-off for most patients. The danger of having an A-Fib stroke usually outweighs the risk of a bleeding (hemorrhagic) stroke or other side effects due to taking anticoagulants.

Drug Therapies for A-Fib

In general, don’t expect miracles from current medications. To date, the magic pill that will cure your A-Fib doesn’t exist. As heart rhythm specialist, Dr. Dhiraj Gupta says, “Drugs don’t cure A-Fib but merely keep it at bay.”

Medicines, by definition, are almost all unnatural. They need to be taken with caution. Our bodies see most medications as toxins and try to eliminate or clear them. But if one has A-Fib, medications may sometimes offer hope of stopping A-Fib episodes or making them more bearable.

There are two basic approaches to managing Atrial Fibrillation with medications:

• Rate Control drugs
• Rhythm Control drugs

Rate control drugs slow down a fast heart rate by blocking electrical signals through the heart’s AV node. They try to control the heart rate of the ventricles, but generally leave the heart in A-Fib.

Rhythm control drugs try to stop the A-Fib signals in the atria and make your heart beat in normal rhythm.

Drug Therapy Not Very Effective: Today’s anti-arrhythmic drugs only work about 40% of the time, have bad side-effects or don’t work at all. If they do work, they often lose their effectiveness over time. In a study of more than 5,000 A-Fib patients, 54% of those on rate control meds went into permanent “persistent” A-Fib in one year.

For a detailed discussion of all the various prescription medications used for A-Fib, go to our page, Drug Therapies & Medicines: Treatments for Atrial Fibrillation.

Cardioversion

Animation of the electrical cardioversion.

Your doctor may recommend a cardioversion to restore your heart to normal sinus rhythm (NSR). There are two types of cardioversion: chemical through the use of drugs or electrical using a low-voltage, timed electrical shock.

During Electrical Cardioversion you are anesthetized and are unconscious. The cardioversion is performed using a short, controlled electrical shock delivered through pads placed on the chest or both the chest and back. The shock causes the signal producing areas of your heart to discharge all at once. This stops all electrical activity in your heart momentarily, hopefully allowing your normal heart rhythm to take over. Usually only one shock is required to restore normal sinus rhythm.

Electrical Cardioversion is considered a low risk procedure. While this procedure often restores a normal rhythm, it carries specific risks involving blood clots, abnormal heart rhythms, and minor skin injury from the shock pads.

Cardioversion has a very high initial success rate, returning up to 95% of A-Fib patients to normal sinus rhythm (NSR), but recurrence of A-Fib is high too. As few as 23% of patients remain in normal sinus rhythm for more than one year post-procedure. For most, their A-Fib returns within the first five days. For a full description, see Cardioversion for Atrial Fibrillation.

Drug therapy and cardioversion have their roles, but they ‘manage’ your A-Fib. Neither treatment eliminates or ‘cures’ your A-Fib.
But know that Atrial Fibrillation is curable.

Catheter Ablation

Catheter inserted into the heart and through septum wall into Left Atria

The only minimally invasive treatment that offers hope of a cure.

Today catheter ablation is considered a first-line strategy choice in patients with Atrial Fibrillation and is vastly superior to using antiarrhythmic drugs first to treat Atrial Fibrillation symptoms. Worldwide, it’s estimated over 1.4 million cardiac catheter ablation procedures were performed in 2024 with Atrial fibrillation representing the largest and fastest-growing share of these treatments. The number of procedures is growing about 6%–8% a year.

A catheter ablation, and specifically a Pulmonary Vein Ablation (PVA), is currently the best technique available for “curing” A-Fib. It is currently the only minimally invasive treatment for A-Fib which offers hope of a cure.

Pulmonary Vein Ablation techniques are achieving success rates of 70%-85% in making Paroxysmal A-Fib patients A-Fib free. With a second ablation, for Persistent A-Fib, for example, the success rates rise to over 90%.

A catheter ablation is performed by applying concentrated amounts of energy to small, targeted areas of heart tissues to destroy the tissue and create minute amounts of scar tissue known as a lesion. The lesion creates an barrier that stops the irregular electric signal, effectively stopping A-Fib from occurring.

A soft, flexible tube (a catheter) with an electrode at the tip is inserted into a vein in your groin and moved to the inside of your heart. A special type of X-Ray, along with 3D imaging systems are used to locate the A-Fib signals.

The catheter is directed to the precise locations, then using either thermal energy (heat or cold) or electrical energy, these areas are burned off or “isolated”― disrupting the path of the irregular signals.

You are usually under general anesthesia during the catheter ablation which means you don’t feel anything. Catheter ablation is a relatively painless procedure, because there are no nerve endings in the smooth tissue of the heart and veins. Most patients can go home the next day. For a full description, see Treatments/Catheter Ablation.

Maze & Mini-Maze Surgeries

Typical Mini-Maze incisions for surgical ablation of A-Fib

Surgery can also be an effective option to eliminate or isolate A-Fib pulses. The open-heart version is the Cox Maze, but it’s usually only performed concurrently with other heart surgery, such as Mitral Valve replacement.

The more frequently performed surgery is the Mini-Maze which accesses the heart through several small incisions in the chest or diaphragm. The catheters and a tiny camera are inserted to locate, then burn or “isolate” the extra signals. All from outside of the heart. A stay in the hospital is necessary to recuperate. See Treatments/Cox Maze and Mini-Maze operations.

Other Treatments

Ablation of the AV Node and Implanting a Pacemaker: From a patient’s point of view, this is a procedure of last resort. By ablating or eliminating the AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing and improves your Quality of Life. But you must have a permanent pacemaker implanted in your heart for the rest of your life to replace your AV Node functions. And what’s worse, you still have Atrial Fibrillation. For more details, go to Ablation of the AV Node->

Pacemakers & ICDs: Pacemakers may be implanted for pacing support, or in conjunction with Ablation of the AV Node (see above). Implanting a pacemaker seems to be most helpful if you have a slow heart rate or pauses as a result of taking A-Fib medications. But be advised that pacemakers tend to have bad effects over the long term. For more details, go to Pacemakers & ICDs ->

Decisions About Treatment Options

For a more thorough discussion of the various treatments for A-Fib, see our page Treatments for Atrial Fibrillation.

When considering treatments for atrial fibrillation, you may ask, “Which is the best A-Fib treatment option for me?”

Decisions About Treatment Options: To help you, I’ve developed some guidelines. I’ve listed A-Fib conditions as patients might describe them. Just select one (or more) that best describes your A-Fib and read your possible options. Then discuss with your doctor. To learn more, go to Decisions About Treatment Options: Which is Best for Me?

A-Fib is a Progressive Disease

It’s important to be treated as reasonably soon as possible. Research now confirms that the sooner you treat your A-Fib, the better your long term outcome.

A-Fib Begets A-Fib.

Over time, your A-Fib episodes can become more frequent and longer, often leading to continuous Persistent A-Fib. In the famous Framingham Heart Study, 25%-40% of people with A-Fib went on to develop continuous “persistent” A-Fib.

However, some people never progress to more serious A-Fib stages.

Some people decide to simply live with A-Fib (usually while on A-Fib medications) rather than to undergo treatments to make them A-Fib free. If this is your choice, realize that A-Fib is a progressive disease that usually harms your heart over time.

On the other hand, if you have bothersome A-Fib symptoms, if it’s impacting your quality of life, if you are miserable, then pursue treatment options that go beyond drug therapy, i.e., a Catheter Ablation/Pulmonary Vein Ablation.

Start by Finding the Right Doctor for You & Your Treatment Goals. Your next step is to find the best doctor you can afford, who specializes in treating irregular heartbeats (i.e. a cardiac electrophysiologist, a type of cardiologist). For advice in selecting the right doctor, see my page, Finding The Right Doctor.

But don’t delay! Seek your A-Fib cure. Research now confirms that the sooner you treat your A-Fib, the better your long term outcome.

Additional Readings

• Causes of A-Fib
• Find the Right Doctor for You
• Treatments for A-Fib
• FAQs: Coping with A-Fib
• Personal A-Fib Stories of Hope
• Resources & Links

Remember: You don’t have to “just take your meds and get used to it.” (A quote from one patient’s doctor.) You don’t have to settle for a life on meds. Seek your Cure!

If you find any errors on this page, email us. Y Last updated: Thursday, September 10, 2026

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