Atrial Fibrillation: Ongoing Concerns

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Ongoing Concerns

Atrial fibrillation with underlying heart disease

Underlying heart disease—including high blood pressure, heart valve disease, and coronary artery disease—is the most common cause of atrial fibrillation. Seen mostly in people older than 65, this type of atrial fibrillation is often the most complicated to manage.

At first, people usually have paroxysmal atrial fibrillation. Paroxysmal episodes go away on their own. They may last anywhere from a few seconds to a few weeks and may not cause symptoms.

Paroxysmal atrial fibrillation episodes may recur for weeks or years, although usually the disease progresses, and atrial fibrillation becomes persistent, meaning that it no longer goes away on its own. Your doctor may try a procedure called cardioversion, using either medication or low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm). The decision to try cardioversion is based upon how bothersome you find the symptoms and how long the episode of atrial fibrillation has persisted.

If the heart cannot be converted to a normal rhythm or does not stay in a normal rhythm, medications are used to control the heart rate and prevent it from becoming dangerously fast. Many people are able to live full and active lives while being treated for atrial fibrillation. Others may need further treatment because they develop shortness of breath, weakness, fainting, or other significant symptoms.

Lone atrial fibrillation

In rare cases, doctors cannot find the underlying cause of atrial fibrillation. These cases are called lone atrial fibrillation. Lone atrial fibrillation occurs more often in people younger than 65. It often stops on its own, or it may need to be treated.

Treatment may be needed if a rapid heartbeat causes discomfort, decreased energy, or other unacceptable symptoms. Adults older than age 75 with lone atrial fibrillation are at risk for stroke and require treatment with the anticoagulant medication warfarin (such as Coumadin).

Stroke risk

Atrial fibrillation increases your chance of having a stroke. When blood does not completely empty out of the rapidly beating atria, a clot can develop in the blood that pools in the atria. The clot may travel from the heart to the brain, causing a stroke.

People with atrial fibrillation and no damage to the heart valves are 6 times more likely to have a stroke than people without atrial fibrillation. The risk of stroke is significantly higher if heart valve damage is present. This risk of stroke also increases with age and with high blood pressure, diabetes, or a previous stroke or transient ischemic attack (TIA).¹⁰ Taking anticoagulant medications greatly reduces your risk of blood clots and stroke.

If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: Are You at Risk for a Stroke if You Have Atrial Fibrillation?

If atrial fibrillation is not treated, it can further damage the heart and cause serious complications, such as a heart attack or heart failure.

You can lower your risk of complications by controlling high blood pressure.

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Last updated:	January 18, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Laurence Epstein, MD - Cardiac Electrophysiologist
Editors:	Kathleen M. Ariss, MS, Pat Truman