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Understanding A.fib (atrial fibrillation)

Updated on December 1, 2013

Atrial Fibrillation or A.Fib

So you're family member is in the hospital, most likely an ICU or telemetry floor, and you hear mention that they are in afib or atrial fibrillation (hereafter called afib). Everybody seems to downplay the importance, except for on occasion when they start a new medicine and seem to care. So, what exactly is afib? I'm glad you asked!

Most peoples hearts beat in a rhythm called sinus rhythm. This is when all the electrical pathways and the natural pacemaker of the heart are following the correct paths and nothing interferes. Afib is a slight variation, but to understand afib, you first have to know just a little about the anatomy of the heart.

The heart has 4 chambers, 2 on the top and 2 on the bottom. The top chambers are called the atria, and the bottom the ventricles. That's about as much as you need to know to understand afib. The natural pacemaker is in the atria. So in a normal heartbeat, the pulse will start in the atrium, then move down to the ventricles. So the atria will beat first, followed by the ventricles. This is what gives the heart that lub-dub sound.

In afib, the atria are... annoyed. Instead of beating all together, the atria just kind of quiver. Now, this isn't the end of the world, but it can cause a few problems. So now, in afib, instead of a good atrial contraction (beat), blood just passively falls into the ventricles.

Complications

The first thing to notice about afib is that, instead of a regular heart beat, it's very irregular. That means you might have 4 very quick beats together, then wait a while for the next. The irregularity comes from the atria quivering. The ventricles are basically receiving constant impulses and can't figure out when they're suppose to beat. This leads to a common complication where the heart beats too fast which is called... wait for it... uncontrolled afib. Very imaginative with names, aren't we?

Uncontrolled afib can be treated multiple ways. They can give multiple different types of drugs to slow down the heart. Or, if the persons blood pressure is falling and they become unstable with it, you can cardiovert (shock) out of it. However, this shock can also present its own challenges.

When a person is in afib, the blood in the atria has a tendency to pool a little bit. When blood sits idle, it likes to form a clot. And if a clot forms in the atria because the blood is pooling, then you have a good atrial beat, the clot gets pushed forward. This is very bad, as it can lead to several different situations that are less than desirable (think stroke). To treat this, your family member will be started on a blood thinner. This will take care of any potential clots prior to attempting to get your family member out of afib. However, if they become unstable, the attempt will still be made to convert them to a normal rhythm.

Treating and Living with Afib

Afib commonly occurs after certain procedures, and especially after heart surgery. If it's new, then your family member will likely be started on a drug called amiodarone. This is the most effective treatment to put somebody back into a normal rhythm.

However, many people live with afib on a day to day basis and do just fine. They may require a daily pill to keep from forming a clot in their heart, and maybe one to slow their heart down some, but otherwise see no symptoms.

So the next time you hear afib around the hospital, hopefully you'll have a better idea what they're talking about!

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