Atrial fibrillation (AFib) is a common heart rhythm disorder characterized by an irregular and often rapid heartbeat. It occurs when the heart’s upper chambers (atria) beat out of sync with its lower chambers (ventricles), disrupting its rhythm and blood flow.
Normally, the sinoatrial (SA) node serves as the heart’s natural pacemaker, regulating the electrical impulses that coordinate the heartbeat and ensuring the atria contract to push blood into the ventricles before the ventricles pump blood to the rest of the body. In atrial fibrillation, multiple electrical signals fire simultaneously, causing the atria to quiver instead of contracting effectively. This leads to less efficient blood flow into the ventricles and irregular ventricular contractions, resulting in a fast, erratic heartbeat.
AFib is one of the most prevalent cardiac conditions, affecting millions of people worldwide. If left untreated, it can significantly increase the risk of stroke, underscoring the importance of early diagnosis and intervention.
What Are the Types of Atrial Fibrillation?
AFib is classified based on the duration of the irregular heart rhythm (arrhythmia). The main types are:
• Paroxysmal AFib – Episodes occur suddenly and resolve on their own or with treatment within seven days. Symptoms may come and go, sometimes lasting only a few minutes or hours.
• Persistent AFib – The arrhythmia lasts longer than seven days and does not resolve without medical intervention, which may involve medication or electrical cardioversion.
• Long-standing persistent AFib – The chaotic heartbeat persists for more than 12 months and often requires more advanced treatment, such as catheter ablation.
• Permanent AFib – The heart remains in an irregular rhythm despite treatment, and the patient and physician have decided not to pursue further attempts to restore normal rhythm. The primary focus shifts to managing the symptoms rather than attempting to restore normal rhythm.
• Valvular AFib – The arrhythmia is linked to a heart valve problem, such as a narrowing of the mitral valve, which controls blood flow from the left atrium to the left ventricle.
• Nonvalvular AFib – Typically linked to high blood pressure, aging or other cardiovascular risk factors, nonvalvular AFib is not caused by a heart valve issue.
What Causes Atrial Fibrillation and What Are the Risk Factors?
AFib occurs when the heart’s electrical system misfires, leading to an irregular and often rapid heartbeat. In many cases, the cause is unknown.
While atrial fibrillation can affect anyone, certain factors may increase the risk, such as:
• Advanced age – The risk of AFib increases with age, particularly after age 65.
• Certain chronic medical conditions – Diabetes, obesity and kidney disease can all contribute to AFib.
• Congenital heart defect – A structural problem with the heart may be present at birth.
• Excessive alcohol or stimulant use – Heavy consumption of alcoholic beverages, caffeinated beverages or other stimulants may provoke arrhythmias in some individuals.
• Hypertension – High blood pressure can cause structural changes in the heart, making AFib more likely to develop.
• Hyperthyroidism or hypothyroidism – Abnormal thyroid hormone levels can affect heart function.
• Inflammation or infection – Inflammatory conditions such as pericarditis and certain viral infections that affect the heart can trigger AFib.
• Lung disease – Chronic obstructive pulmonary disease (COPD) and other respiratory conditions can contribute to AFib development.
• Obstructive sleep apnea – Repeated pauses in breathing during sleep can disrupt oxygen flow and stress the heart.
• Previous heart surgery – Scar tissue may form in or around the heart, interfering with its electrical signals.
• Sedentary lifestyle – Lack of physical activity can contribute to cardiovascular issues.
• Smoking – Tobacco use can damage blood vessels and increase strain on the heart.
• Stress and poor sleep – Chronic anxiety and insufficient sleep may trigger AFib episodes.
• Underlying heart disease – Coronary artery disease, cardiomyopathy, heart failure and heart valve disorders can disrupt the heart’s normal rhythms.
What Are the Warning Signs and Symptoms of Atrial Fibrillation?
AFib can present with a variety of symptoms ranging from mild to severe. Recognizing the warning signs is important to ensure early detection and treatment, which can reduce the risk of serious complications, such as heart failure and stroke.
Possible symptoms of atrial fibrillation include:
• Chest discomfort – Some individuals experience chest tightness or pain, which requires immediate medical attention.
• Dizziness – AFib can cause poor blood circulation, leading to lightheadedness and fainting.
• Exercise intolerance – An irregular heartbeat may reduce the capacity to engage in physical activity.
• Fatigue and weakness – AFib is often associated with persistent tiredness and lack of energy.
• Palpitations – A fluttering or pounding sensation may be felt in the chest, throat or neck.
• Shortness of breath – Difficulty breathing, especially during physical activity, can be a sign of AFib.
• Swollen legs (edema) – When the heart does not circulate blood effectively, fluid may accumulate in the lower extremities, causing visible swelling in the legs, ankles and feet.
Some people with atrial fibrillation do not experience noticeable symptoms. Instead, the condition is discovered during a routine medical examination or test performed for an unrelated reason. Despite its lack of symptoms, silent AFib can still increase the risk of stroke and other serious complications.
How Is Atrial Fibrillation Diagnosed?
AFib is usually diagnosed through a combination of tests, which may include:
• Medical history review and physical exam – The physician will ask about the patient’s symptoms, lifestyle and any underlying conditions that could contribute to AFib, such as hypertension and heart disease. Using a stethoscope, the physician will listen to the heart’s sounds, check for irregular heart rhythms and assess the patient’s overall cardiovascular health.
• Electrocardiogram (EKG) – The most common test for detecting AFib, an EKG records the heart’s electrical activity and may reveal arrhythmias. However, because AFib often comes and goes, a single EKG may not always capture an episode.
• Holter monitor or event recorder – A Holter monitor is a portable EKG device that can be worn for 24 to 48 hours to detect intermittent episodes of AFib. An event recorder can be worn for a longer period and is activated when symptoms occur, capturing irregular rhythms.
• Echocardiogram – Ultrasound imaging can provide detailed visuals of the heart, which can help the physician evaluate its structure and function and identify potential underlying causes of AFib, such as valve disease and heart enlargement.
• Stress test – While the patient exercises on a treadmill or stationary bicycle (or takes medication to simulate the effects of physical activity), their heart function will be closely monitored, which can help the physician determine if exertion triggers AFib symptoms.
• Blood work – Specialized blood tests can help the physician identify underlying certain conditions that may be contributing to AFib, such as a thyroid disorder or electrolyte imbalance.
• Electrophysiology study (EPS) – In certain cases, an EPS may be performed to map the heart’s electrical activity and help the physician pinpoint abnormal conduction pathways that may be causing AFib.
How Is Atrial Fibrillation Treated?
AFib treatment focuses on restoring the normal heart rhythm, controlling the heart rate, reducing the symptoms and preventing complications, such as stroke. The optimal approach can vary based on the severity of the atrial fibrillation, its underlying cause and the patient’s overall health. In general, a key component of treatment involves making lifestyle changes. As appropriate, the physician can develop an individualized strategy to help the patient manage hypertension, diabetes and any other conditions that may be contributing to AFib. Additionally, the patient should engage in physician-approved physical activity, consume a heart-healthy diet, avoid tobacco use and limit any consumption of alcoholic and caffeinated beverages, which can trigger irregular heart rhythms.
Other treatment options for atrial fibrillation may include:
• Medications – If needed, the physician may prescribe beta-blockers or calcium channel blockers, which can slow the heart rate; antiarrhythmic drugs, which can help maintain a normal heart rhythm; or anticoagulants, which can reduce the risk of blood clots and stroke.
• Pharmacologic or electrical cardioversion – To reset the heart’s rhythm, the physician may prescribe specialized medications or deliver a controlled shock to the heart.
• Catheter ablation – The physician may use a catheter to deliver radiofrequency or cryotherapy energy to disrupt the abnormal electrical signals causing atrial fibrillation. This minimally invasive procedure may be considered for a patient who has frequent, symptomatic AFib episodes that do not improve with medication-based treatment.
• Procedures – Surgical treatment options for AFib may include a Maze procedure, which involves creating a pattern of scar tissue in the heart to block the erratic electrical impulses, or catheter-based left atrial appendage closure (LAAC), which involves sealing off a small sac-like pocket in the heart to reduce the risk of stroke.
• Pacemaker – An implantable device may be considered for a patient with a slow heart rate or for certain patients undergoing AV node ablation.
What Are the Possible Complications and Long-Term Effects of Atrial Fibrillation?
If left untreated or poorly managed, AFib can have serious complications. The irregular heart rhythm can affect how efficiently the heart pumps blood, leading to various long-term health effects, such as:
• Stroke – AFib significantly increases the risk of stroke by allowing blood to pool in the heart’s atria, where clots can form and travel to the brain. A patient with additional risk factors, such as hypertension or diabetes, may require anticoagulant therapy to help prevent clot formation.
• Heart failure – Over time, AFib can weaken the heart, making it less effective at pumping blood throughout the body. Persistent AFib can lead to fluid buildup in the lungs and other tissues, causing symptoms such as shortness of breath, fatigue and leg swelling.
• Chronic fatigue and exercise intolerance – An irregular or rapid heart rate can cause persistent tiredness, making physical activity more difficult. Additionally, poor circulation due to AFib may lead to dizziness, weakness and decreased stamina.
• Cognitive decline – Studies suggest that atrial fibrillation may contribute to cognitive decline, potentially increasing the risk of dementia, including Alzheimer’s disease. Reduced blood flow to the brain, along with increased risk of mini-strokes, may play a role in long-term cognitive impairment.
• Blood clots and other circulatory issues – In addition to increasing stroke risk, AFib can lead to clot formation elsewhere in the body, potentially causing conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Heart damage – Long-term atrial fibrillation can cause changes in the size and function of the heart’s atria, making it harder to restore and maintain a normal rhythm. Structural damage may increase the likelihood of persistent or permanent AFib.
How Can Atrial Fibrillation Be Prevented?
An effective AFib prevention strategy involves adopting and maintaining heart-healthy lifestyle practices and managing any known risk factors. The same cardiovascular wellness regimen recommended for treating atrial fibrillation can also help prevent it.
Living With Atrial Fibrillation
Living with AFib often involves managing episodes of rapid or irregular heart rhythms and the associated symptoms, such as fatigue, dizziness and shortness of breath, which can be challenging and disruptive. To effectively control the condition, it may be necessary to make lifestyle changes, take medication and possibly undergo a medical procedure. Having regular checkups, monitoring triggers and adhering to a heart-conscious routine can reduce the impact of atrial fibrillation and improve the patient’s quality of life.
Benefit From World-Class Care at TGH
Tampa General Hospital is widely recognized for providing advanced, comprehensive care for patients with atrial fibrillation and other cardiac conditions. We are honored to be the only hospital in the Tampa Bay area to be featured in the list of “100 Hospitals and Health Systems with Great Heart Programs” distributed by Becker’s Hospital Review. In addition, we have been recognized as a top hospital in the nation for Heart & Vascular Care by U.S. News & World Report for 2025-26.
If you would like to learn more about AFib, contact TGH at (813) 822-3627to request an appointment with a specialist in our nationally acclaimed Atrial Fibrillation Program within the Heart and Vascular Institute.
