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Atrial Fibrillation – What Exactly is It?

Atrial fibrillation (AF), or Afib as I like to call it, is the most common heart rhythm disorder and affects about 1% of the population. It becomes even more common with age. It rarely occurs in people under the age of 40, but occurs in up to 5% of people over the age of 80. Favorite age is “my age” late forties to early fifties. I am 52; mine started when I was 51, but it could have been going on for months or even years without me noticing. It should be said that atrial fibrillation is an electrical problem in the heart, not a plumbing problem like a normal heart attack or blockage.

Normal electrical activity of the heart and what goes wrong in atrial fibrillation.

The heart is basically a large muscular pump that drives blood around the body. To do this correctly, the heart’s chambers, of which there are four, must be precisely controlled electrically to work together as a single pumping unit. A normal heartbeat begins in the sinoatrial or sinus node, which is the heart’s natural pacemaker located in the heart’s upper right chamber (right atrium). This electrical pulse spreads to both upper chambers, the atria, causing them to contract. The contraction of the atria moves the blood into the two ventricles, which are the main pumping chambers. A special structure called the atrioventricular (AV) node is delayed for about a tenth of a second, and then rapidly spreads across the ventricles, causing them to contract. This extra filling of the ventricles by the atria is not vital, but it serves the “ventricular pump” and improves the overall function of the heart.

These atria, which contain the heart’s natural pacemaker, the SA node, are the part of the heart that participates in atrial fibrillation. The ventricles, the muscular part of the heart that actually pumps blood, are electrically isolated from the atria, and the only way an electrical signal can reach them is through the AV node.

A normal heart rhythm is called sinus rhythm (no, nothing to do with your nose)

Most people’s resting heart rate is 60-80 beats per minute. In atrial fibrillation, the atrium contracts rapidly and irregularly at 400-600 beats per minute. Like luck (see GOD), the AV node does not send as many signals to the ventricles; only about 1 or 2 out of every 3 atrial beats go into the ventricles. Still, the ventricles beat too fast, 110-180 beats per minute. (Mine was over 170!)

The most common symptoms:

Shortness of breath, moderate, because your heart is beating faster than if you were running a marathon.

Heart palpitations (sudden pounding, fluttering, or pounding feeling in the chest).

Lack of energy; feeling too tired.

Dizziness (feeling dizzy or light-headed).

Chest discomfort (pain, pressure or discomfort in the chest area)

In my case – the inability to sleep lying down

Slow down!

The first thing you want to do is control the runaway heart rate. This is done with medication and even cardioversion. (similar to the crash paddles and electric shock seen on TV) The goal is to get the heart to beat in a uniform, normal way again. This is called normal sinus rhythm and it’s the holy grail that all of us afibbers want to achieve.

I have only covered the simple mechanics of a complex problem. Please read the other articles as we go into detail and try to explain the true “nature of the beast” – atrial fibrillation.

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