Understanding Your Atrial Fibrillation Diagnosis

Getting diagnosed with atrial fibrillation can feel overwhelming. You probably have many questions about what this means for your health and daily life. As a cardiologist who has cared for thousands of patients with this condition, I want to help you understand the basics and what comes next.

What Just Happened to Your Heart?

Your heart has four chambers - two on top (atria) and two on bottom (ventricles). Normally, your heart beats in a steady rhythm, like a metronome. With atrial fibrillation, the top chambers start beating chaotically and fast, throwing off your heart's normal rhythm.

I often tell my patients to think of it like an orchestra where the violins suddenly start playing at their own tempo instead of following the conductor. Your heart can still pump blood, but not as efficiently as before.

Understanding Your Type of Atrial Fibrillation

When I diagnose atrial fibrillation, I explain that there are different patterns. Some patients have paroxysmal atrial fibrillation, where episodes come and go on their own, usually lasting less than seven days. Others have persistent atrial fibrillation, where the irregular rhythm lasts longer than seven days or requires treatment to stop it.

Understanding your specific pattern helps me tailor your treatment plan and monitoring approach.

Why You Might Have Noticed Something Was Wrong

Many of my patients first notice their heart feels like it's racing, skipping beats, or fluttering. You might have felt:

  • Your heart pounding or beating irregularly

  • Short of breath, especially during normal activities

  • Unusually tired or weak

  • Dizzy or lightheaded

  • Chest discomfort

But here's something I always explain to new patients - some people have no symptoms at all. Their atrial fibrillation gets discovered during a routine check-up or when I order an EKG for another reason.

The Real Concern: Stroke Risk

When I talk to patients about atrial fibrillation, I focus on the most important issue: stroke prevention. While the irregular heartbeat itself might not feel dangerous, atrial fibrillation significantly increases your stroke risk. When your heart's top chambers don't squeeze properly, blood can pool and form clots. If a clot breaks loose and travels to your brain, it causes a stroke.

In my practice, I've seen how devastating these strokes can be. People with atrial fibrillation face about five times higher stroke risk than those with normal heart rhythms, and strokes caused by atrial fibrillation tend to be more severe.

What Might Have Caused This

When treating my patients with newly diagnosed atrial fibrillation, I emphasize that several factors often work together to cause this condition:

  • High blood pressure (the most common cause I see)

  • Being overweight

  • Sleep apnea

  • Diabetes

  • Previous heart problems

  • Thyroid issues

  • Family history

  • Heavy drinking or smoking

Sometimes infections, surgery, or severe illness can trigger an episode. Age plays a role too - I tell patients that about one in three people will develop atrial fibrillation during their lifetime, with risk increasing each year after 65.

My Treatment Approach Focuses on Multiple Goals

Preventing Strokes This is my top priority for every patient. Most people with atrial fibrillation need blood-thinning medication. These aren't the same as aspirin - I typically prescribe medications like apixaban (Eliquis), rivaroxaban (Xarelto), or edoxaban (Savaysa). Yes, they slightly increase bleeding risk, but in my experience, the stroke prevention benefit far outweighs this concern for most patients.

For select patients who can't take blood thinners long-term, I offer an advanced option called the Watchman device. This small implant gets placed in the heart to block the area where most clots form, potentially eliminating the need for lifelong blood thinners.

Managing Heart Rate If your heart rate feels too fast or you're having symptoms, I can prescribe medications to slow things down and make you feel better. In my practice, I commonly use:

  • Beta-blockers like metoprolol, atenolol, or carvedilol

  • Calcium channel blockers such as diltiazem or verapamil

Both types of medications work differently but achieve the same goal - keeping your heart rate at a more comfortable pace.

Controlling Heart Rhythm For select patients who need stronger medicine, I prescribe rhythm control medications that are purpose-built to try and prevent atrial fibrillation recurrence. These include medications like flecainide, propafenone, or amiodarone. These are more potent than rate control drugs and work to keep your heart in normal rhythm, but they require careful monitoring and aren't right for everyone.

Advanced Monitoring and Procedures In some cases, I implant a tiny paper clip-sized device called an insertable loop recorder (ILR) that monitors heart rhythm continuously. This device can pair with a smartphone app to keep me updated about how much atrial fibrillation you're having, even when you don't feel symptoms.

For breakthrough episodes that don't go away on their own, I can perform a cardioversion procedure. This involves giving your heart a controlled electrical shock while you're under brief sedation to restore normal rhythm. It's very effective for stopping persistent episodes.

Addressing Root Causes and Advanced Treatment Options I always work with my patients to treat any underlying conditions contributing to their atrial fibrillation. This might mean better blood pressure control, weight loss, treating sleep apnea, or managing diabetes.

For patients who continue having symptoms despite medication, I offer advanced procedures. Pulsed field radiofrequency ablation is a minimally invasive procedure that I perform to significantly reduce the chance of atrial fibrillation returning. This technique targets the specific heart tissue causing the irregular rhythm while protecting surrounding structures.

What I Tell My Patients They Can Do Right Now

Several lifestyle changes can make a real difference, and I've seen dramatic improvements when patients commit to these:

  • Lose weight if needed - Even modest weight loss helps tremendously

  • Exercise regularly - I recommend starting slowly and building up gradually

  • Limit alcohol - Heavy drinking can trigger episodes

  • Quit smoking - This helps your entire cardiovascular system

  • Get sleep apnea treated - Untreated sleep apnea worsens atrial fibrillation

  • Manage stress - Chronic stress can contribute to heart rhythm problems

Looking Ahead

In my years of practice, I've learned that atrial fibrillation is a very manageable condition. Many of my patients live full, active lives with proper treatment. Some key points I share for the journey ahead:

  • Take medications exactly as I prescribe them, especially blood thinners

  • Don't stop medications without talking to me first

  • Keep your regular follow-up appointments with me

  • Learn to check your pulse and report any major changes

  • Know the signs of stroke (sudden face drooping, arm weakness, speech difficulty)

When I Ask My Patients to Call Me

Contact my office if you experience:

  • Chest pain or severe shortness of breath

  • Fainting or near-fainting

  • Signs of stroke

  • Unusual bleeding while on blood thinners

  • New or worsening symptoms

My Final Thoughts

Receiving an atrial fibrillation diagnosis means taking your heart health seriously, but it doesn't mean your life is over or severely limited. With proper treatment and lifestyle adjustments, most of my patients do very well. Modern medicine offers more options than ever before - from different types of rate-controlling medications to rhythm control drugs, advanced monitoring devices, cardioversion procedures, and even alternatives to lifelong blood thinners for the right candidates.

I chose your specific medications and treatment approach based on your individual situation. Trust the process, ask me questions when you have them, and remember that managing atrial fibrillation gets easier as you learn more about living with it. I'm here to guide you every step of the way.

This article was written by Dr. Damian Rasch to help patients understand atrial fibrillation and its management. While comprehensive, it is intended for educational purposes only and does not constitute medical advice. Always discuss your specific situation with your healthcare provider.

Published by damianrasch.com