What is Atrial Fibrillation : The Most Common Arrythmia

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Nilesh Kulkarni, a 65-year-old retired banker from Pune, now residing in faridabad with his son, began experiencing frequent episodes of palpitations, fatigue, and breathlessness. Initially attributing his symptoms to aging, he ignored the warning signs—until one morning, he felt dizzy and fainted in the garden. His family rushed him to the hospital, where an ECG revealed atrial fibrillation (AF)—a condition where the heart beats in an irregular and often rapid rhythm.

What is Atrial Fibrillation?

Atrial fibrillation (AF or AFib) is the most common type of serious arrhythmia, where the atria (upper chambers of the heart) beat irregularly and chaotically, disrupting blood flow. Instead of contracting effectively, the atria quiver, increasing the risk of stroke, heart failure, and other complications.

Prevalence and Risk Factors

AF affects over 60,000 people monthly in India, according to search volume data. Prevalence rises with age:

Age Group	Risk of AF
< 50	Rare
50–65	Moderate
> 65	High

Risk Factors Include:

• High blood pressure

• Coronary artery disease

• Thyroid disorders

• Diabetes

• Obesity

• Excessive alcohol/caffeine intake

• Stress and sleep apnea

Symptoms of Atrial Fibrillation

Symptoms may vary or be absent (silent AF), but common signs include:

• Palpitations (racing or irregular heartbeat)

• Shortness of breath

• Dizziness or light-headedness

• Fatigue

• Chest discomfort

• Fainting spells

Diagnosis: The Role of ECG

Electrocardiogram (ECG) is the most reliable tool to diagnose atrial fibrillation.

Typical ECG Findings in AF:

• Absence of P waves

• Irregularly irregular RR intervals

• Variable ventricular rate

ECG in Atrial Flutter, however, shows:

• Sawtooth pattern (flutter waves)

• Regular rhythm (in typical flutter)

Table: Difference Between Atrial Fibrillation and Flutter

Feature	Atrial Fibrillation	Atrial Flutter
Rhythm	Irregularly irregular	Regular or variable
Atrial Rate	350–600 bpm	~250–350 bpm
ECG pattern	No clear P waves	Sawtooth flutter waves
Cause	Multiple chaotic atrial impulses	Single reentrant circuit
Stroke risk	High	Moderate
Treatment	Rate/rhythm control, anticoagulants	Cardioversion, ablation

Types of Atrial Fibrillation

Type	Description
Paroxysmal AF	Starts suddenly and stops within 7 days
Persistent AF	Lasts more than 7 days, may require intervention
Long-standing Persistent	Lasts >12 months
Permanent AF	Persistent and accepted as permanent
Lone AF	Occurs without underlying heart disease

ICD-10 Code for Paroxysmal AF: I48.0

Complications of Atrial Fibrillation

• Stroke (5x risk): Blood pooling in the atria may form clots.

• Heart failure

• Dementia or cognitive decline

• Fatigue and reduced exercise capacity

Treatment Options for Atrial Fibrillation

1. Rate Control

• Controls heart rate without restoring normal rhythm.

• Drugs: Beta-blockers (metoprolol), calcium channel blockers, digoxin

2. Rhythm Control

• Restores sinus rhythm via drugs or cardioversion.

• Antiarrhythmics: Amiodarone, flecainide

3. Anticoagulation Therapy

• Prevents stroke by reducing clot formation.

• Drugs: Warfarin, apixaban, dabigatran, rivaroxaban

4. Electrical Cardioversion

• Direct current shock to restore normal rhythm.

5. Catheter Ablation

• Destroys abnormal electrical pathways using radiofrequency or cryotherapy.

• Often used in younger patients or drug-refractory cases.

Lifestyle Modifications for Managing AF

Lifestyle Factor	Recommendation
Diet	Low sodium, high potassium, heart-healthy
Exercise	Moderate regular activity, avoid overexertion
Caffeine/Alcohol	Limit or avoid
Sleep	Address sleep apnea, regular sleep schedule
Stress	Yoga, meditation, counseling

Monitoring and Follow-up

• Regular ECG

• INR monitoring (if on warfarin)

• Annual echocardiography

• Blood pressure and diabetes control

• CHA₂DS₂-VASc scoring for stroke risk stratification

Nilesh’s Progress and Outcome

Post diagnosis, Nilesh was started on metoprolol, apixaban, and scheduled for catheter ablation. He adopted daily walks, reduced salt intake, practiced yoga, and quit alcohol. Follow-ups every 6 months with ECG showed better rhythm control.

His story exemplifies that atrial fibrillation is manageable, with the right treatment and lifestyle.

When to Seek Immediate Medical Help

Call emergency services if you experience:

• Chest pain

• Sudden breathlessness

• Fainting

• Sudden onset of rapid palpitations

Conclusion

Atrial fibrillation may sound frightening, but with awareness, timely diagnosis, and personalized treatment, one can lead a full and active life. Like Nilesh Kulkarni, many patients can reduce complications and improve quality of life through modern interventions and healthy habits.