Atrial fibrillation is a type of arrhythmia. There are four main types of atrial fibrillation—paroxysmal, persistent, long-term persistent, and permanent atrial fibrillation. The type of atrial fibrillation that you have depends on how often atrial fibrillation occurs and how it responds to treatment.
Paroxysmal atrial fibrillation
You may experience a brief event—a paroxysm—of atrial fibrillation. It may pass without, or you may feel it strongly. It usually stops in less than 24 hours but may last up to a week. Paroxysmal atrial fibrillation can happen repeatedly.
You may need treatment or your symptoms may go away on their own. When this kind of atrial fibrillation alternates with a heartbeat that is slower than normal, it is called tachybrady syndrome.
Persistent atrial fibrillation
Persistent atrial fibrillation is a condition in which the abnormal heart rhythm lasts for more than a week. It may ultimately stop on its own but probably will need treatment.
Long-term persistent atrial fibrillation
With this condition, the abnormal heart rhythms last for more than a year without going away.
Permanent atrial fibrillation
Sometimes atrial fibrillation does not get better, even when you have tried several times to restore a normal heart rhythm with other medicines or other treatments. At this point, your atrial fibrillation is considered permanent.
Changes to the heart’s tissue and to its electrical signals most often cause atrial fibrillation. To understand atrial fibrillation, it helps to know how the heart works. When the heart’s tissue or signaling is damaged, the regular pumping of the heart muscle becomes fast and irregular. Most often, damage to the heart is the result of other conditions such as high blood pressure and ischemic heart disease. Other factors can also raise your risk of atrial fibrillation.
Changes in heart tissue
Usually the cells of the heart fire and contract together. However, when aging, heart disease, infection,, or other factors change heart tissue, that pattern breaks down. This can happen because of , , a thinning or thickening of the heart walls, lack of blood flow to the heart, or an abnormal buildup of proteins, cells, or minerals in heart tissue.
Changes in electrical signaling
Usually, a trigger heartbeat sets off atrial fibrillation. Electrical signals from this trigger may then cause the heart to beat slower or faster than usual because of changes in heart tissue. Sometimes, the signals create an atypical loop, telling the heart to contract over and over. This can create the fast, chaotic beating that defines atrial fibrillation.
Variations in the heart’s electrical signaling can be due to differences in heart anatomy, premature or extra heartbeats, normal heart rate adjustments, patches of faster or slower tissue, and repeated stimulation of certain tissue patches.
- Treatment will discuss medicines and procedures that your doctors may recommend if you are diagnosed with atrial fibrillation.
Age, family history and genetics, lifestyle, heart disease or other medical conditions, race, sex, and a history of surgery can all raise your risk of developing the structural and electrical anomalies that cause atrial fibrillation. Even in a healthy heart, a fast or slow heart rate—from exercising or sleeping, for example—can trigger atrial fibrillation.
The risk of atrial fibrillation increases as you age, especially after age 65. Atrial fibrillation is rare in children, but it does occur, especially in boys and in children who have obesity.
Family history and genetics
If someone in your family has had atrial fibrillation, you have a higher risk of developing atrial fibrillation, too. Scientists have found somewith that raise the risk of atrial fibrillation. Some of these genes influence fetal organ development or heart cell channels. Sometimes these genetic patterns are also linked to heart disease. Some genetic factors may raise the risk of atrial fibrillation in combination with such factors as age, weight, or sex.
Some lifestyle habits can raise or lower your risk of atrial fibrillation, including the following:
- Alcohol. Drinking large amounts of alcohol, especially binge drinking, raises your risk of atrial fibrillation. Even modest amounts of alcohol can trigger atrial fibrillation in some people.
- Illegal drugs. Some street drugs, such as cocaine, can trigger atrial fibrillation or make it worse.
- Physical activity. Some competitive athletes and people—men, in particular—participating in endurance sports or exerting themselves at work may have a higher risk of atrial fibrillation. At the same time, moderate physical activity can have a protective effect. Physical fitness appears to be linked to a lower risk of atrial fibrillation.
- Smoking. Studies have found that smoking increases the risk of atrial fibrillation. The risk appears to be higher the longer you smoke and decreases if you quit. Exposure to secondhand smoke, even in the womb, can increase a child’s risk of developing atrial fibrillation.
- Stress. Stressful situations, panic disorders, and other types of emotional stress may be linked to a higher risk of atrial fibrillation.
Other medical conditions
Many other medical conditions can increase your risk of atrial fibrillation, especially heart problems. As you age, having more than one condition may increase your risk. Conditions that raise the risk of atrial fibrillation include:
- Chronic kidney disease
- Conduction disorders
- Congenital heart defect
- Heart attack
- Heart failure
- Heart inflammation
- Heart tissue that is too thick or stiff
- Heart valve disease
- High blood pressure
- Hyperthyroidism, an overactive thyroid gland
- Ischemic heart disease
- Lung diseases, including COPD
- Sleep apnea
- Venous thromboembolism
Race or ethnicity
In the United States, atrial fibrillation is more common among whites than among African Americans, Hispanic Americans, or Asian Americans. Although people of European ancestry are more likely to develop the condition, African Americans with atrial fibrillation are more likely to have complications such as stroke, heart failure, or ischemic heart disease.
You may be at risk for atrial fibrillation in the early days and weeks after surgery of the heart, lungs, or esophagus. Surgery to correct a congenital heart defect can also raise the risk of atrial fibrillation. This can happen years after a childhood surgery or when you have surgery as an adult to correct a lifelong condition.
Screening and Prevention
Typically doctors screen for atrial fibrillation only when you have symptoms. However, your doctor may check for of atrial fibrillation as part of your regular medical care. Screening tests include checking your pulse or recording your heart’s electrical activity. Your doctor may recommend healthy lifestyle changes to help you lower your risk of developing atrial fibrillation.
Screening tests and results
Screening may be part of your regular care if you are 65 or older or if you have other risk factors.
- Your doctor may check your pulse. Even without symptoms, your heart may have an irregular speed or faulty rhythm that your doctor can detect.
- If you have had a stroke and there is no clear cause, your doctor may recommend screening for atrial fibrillation with a Holter or event monitor.
- Several devices are now available to detect and record your heart’s rhythm similar to an electrocardiogram (EKG). These devices may also email the data to your doctor.
To help you lower your risk of atrial fibrillation, your doctor may recommend certain heart-healthy lifestyle changes, including aiming for a healthy weight, being physically active, controlling your blood sugar, limiting alcohol, lowering your blood pressure, managing stress, and quitting smoking.
In addition, some illegal drugs, such as cocaine, can trigger atrial fibrillation or make it worse. Ask your doctor for help avoiding these triggers to prevent arrhythmia.
If you are having heart surgery, your medical team will monitor you. To prevent arrhythmia, your doctor may recommend antiarrhythmic medicine or treatment to maintain or supplementlevels during or after the procedure.
- Diagnosis will explain tests and procedures that your doctor may use to diagnose types of atrial fibrillation.
- Living With will discuss what your doctor may recommend to prevent your atrial fibrillation from recurring, getting worse, or causing complications.
- Research for Your Health will discuss how we are using current and advancing research to prevent atrial fibrillation.
- Participate in NHLBI Clinical Trials will explain our open and enrolling clinical studies that are investigating prevention strategies for atrial fibrillation.
Signs, Symptoms, and Complications
You may or may not notice atrial fibrillation. It often occurs with no signs or symptoms. If you do have symptoms, you may notice something that occurs only occasionally. Or, your symptoms may be frequent or serious. If you have heart disease that is worsening, you may notice more symptoms of atrial fibrillation. If your atrial fibrillation is undetected or left untreated, serious and even life-threatening complications can arise. They include stroke and heart failure.
Signs and symptoms
The most common symptom of atrial fibrillation is. Other signs and symptoms include:
- Heart palpitations
- Difficulty breathing, especially when lying down
- Chest pain
- Hypotension, or low blood pressure
- Dizziness or fainting
Keep track of when and how often your symptoms occur, what you feel, and whether these things change over time. They are all important clues for your doctor.
When it is undetected or untreated, atrial fibrillation can lead to serious complications. This is especially significant for African Americans. Even though whites have atrial fibrillation at higher rates, research has found that many of its complications—including stroke, heart disease, and heart failure—are more common among African Americans. Some complications of atrial fibrillation include:
- . With atrial fibrillation, the heart may not be able to pump the blood out properly, causing it to pool and form an abnormal blood clot in the heart. A piece of the clot—a type of —can break off and travel through the blood to different parts of the body, blocking blood flow to the brain, lungs, intestine, spleen, or kidneys. Atrial fibrillation may also increase the risk of venous thromboembolism, which is a blood clot that forms in a vein.
- vascular dementia occur more often among people with atrial fibrillation. This may be due to blockages in the blood vessels of the brain or reduced blood flow to the brain. impairment and dementia. Some studies suggest that impaired cognition, Alzheimer’s disease, and
- Heart attack. The risk of a heart attack from atrial fibrillation is highest among women and African Americans and especially in the first year after atrial fibrillation is diagnosed.
- Heart failure. Atrial fibrillation raises your risk of heart failure because the heart is beating fast and unevenly. The heart’s chambers do not fill completely with blood and cannot pump enough blood to the lungs and body. Atrial fibrillation may also make your heart failure symptoms worse.
- Stroke. If an embolus travels to the brain, it can cause a stroke. For some people, atrial fibrillation has no symptoms, and a stroke is the first sign of the condition. If you have atrial fibrillation, the risk of a stroke is higher if you are a woman.
- Sudden cardiac arrest. With atrial fibrillation, there is an increased risk that the heart may suddenly and unexpectedly stop beating if you have another serious heart condition.
A doctor will diagnose atrial fibrillation based on your medical and family history, a physical exam, the results from an electrocardiogram (EKG), and possibly other tests and procedures. If you have atrial fibrillation, your doctor will also look for any disease that may be causing it and assess your risk of developing dangerous blood clots. This will help him or her plan the best way to treat you.
To help diagnose atrial fibrillation, your doctor will ask about your eating and physical activity habits, family history, and other risk factors for atrial fibrillation and heart disease. Your doctor may ask whether you have any other signs or symptoms. This information can help your doctor determine whether you have complications or other conditions that may be causing you to have atrial fibrillation.
Your doctor will do a complete examination of your heart and lungs, including:
- Checking for signs of too much thyroid hormone, such as a thyroid gland that is larger than normal
- Checking for swelling in your legs or feet, which could be a sign of heart failure or a heart that is larger than normal
- Checking your pulse to find out how fast your heart is beating
- Listening to the rhythm of your heartbeat
- Listening to your lungs to check for signs of heart failure or infection
- Measuring your blood pressure
To diagnose atrial fibrillation, your doctor will likely do an EKG first to record your heart’s electrical activity. If the diagnosis is unclear from the EKG or your doctor would like more information, your doctor may order additional testing:
- Blood tests to check the level of substances in the blood such as potassium and thyroid hormone.
- Echocardiography to show areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. It may also identify harmful blood clots in the heart’s chambers.
Your doctor may order other tests to record abnormal heart rhythms that happen under specific conditions or outside of the clinic, confirm whether you have atrial fibrillation or another arrhythmia, and figure out which treatment is best. These tests may include:
- Chest X-ray to look for signs of complications from atrial fibrillation, such as fluid buildup in the lungs or a heart that is larger than normal.
- Electrophysiology study (EPS) to record your heart’s electrical signals if your doctor wants more detail about what is causing a particular EKG reading or to distinguish among possible types of arrhythmias.
- Holter and event monitors to record your heart’s electrical activity over long periods of time while you do normal, day-to-day activities. These portable EKG monitors can help assess the cause of symptoms, like palpitations or feeling dizzy, that happen outside the doctor’s office. Most portable monitors will send data directly to your doctor.
- Loop recorder to record the heart’s electrical activity. Some loop recorder models are worn externally and some require minor surgery to place the device under the skin in the chest area. Implanted devices can record data for months and are used to detect patterns in abnormal heart rhythms that do not happen very often.
- Sleep study to see if sleep apnea is causing your symptoms.
- Stress test or exercise stress test to look at changes in your heart’s activity that occur with increase in heart rate, and recovery after exercise. If you cannot exercise, you may be given medicine to make your heart work hard and beat fast.
- Transesophageal echocardiography (TEE) to detect blood clots that may be forming in the heart’s upper chambers because of atrial fibrillation. It uses sound waves to take pictures of your heart through the esophagus.
- Walking test to measure your heart activity while you walk for six minutes. This can help determine how well your body can control your heart rate under normal circumstances.
- Return to Risk Factors to review family history, lifestyle habits, or other medical conditions that increase your risk of developing atrial fibrillation.
- Return to Signs, Symptoms, and Complications to review common signs and symptoms of atrial fibrillation.
- Return to Screening and Prevention to review how to screen for atrial fibrillation.
Atrial fibrillation is treated with lifestyle changes, medicines, procedures, and surgery to help prevent blood clots, slow your heart beat, or restore your heart’s normal rhythm.
Your doctor may also treat you for an underlying disorder that is causing or raising the risk of atrial fibrillation, such as sleep apnea or an overactive thyroid gland.
Your doctor may recommend adopting heart-healthy lifestyle changes, such as the following:
- Heart-healthy eating patterns such as the DASH eating plan, which reduces salt intake to help lower blood pressure
- Being physically active
- Getting help if you are trying to stop using street drugs
- Limiting or avoiding alcohol or other stimulants that may increase your heart rate
- Managing stress
- Quitting smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Your doctor may consider treating your atrial fibrillation with medicines to slow your heart rate or to make your heart’s rhythm more even:
- Beta blockers, such as metoprolol, carvedilol, and atenolol, to help slow the rate at which the heart’s lower chambers pump blood throughout the body. Rate control is important because it allows the ventricles enough time to fill with blood completely. With this approach, the abnormal heart rhythm continues, but you may feel better and have fewer symptoms. Beta blockers are usually taken by mouth, but they may be delivered through a tube in an emergency situation. If the dose is too high, it can cause the heart to beat too slowly. These medicines can also make COPD and arrhythmia worse.
- Blood thinners to prevent blood clots and lower the risk of stroke. These medicines include warfarin, dabigatran, heparin, and clopidogrel. You may not need to take blood thinners if you are not at risk of a stroke. Blood-thinning medicines carry a risk of bleeding. Other side effects include indigestion and heart attack.
- Calcium channel blockers to control the rate at which the heart’s lower chambers pump blood throughout the body. They include diltiazem and verapamil.
- Digitalis, or digoxin, to control the rate blood is pumped throughout the body. It should be used with caution, as its use can lead to other arrhythmias.
- Other heart rhythm medicines to slow a heart that is beating too fast or change an abnormal heart rhythm to a normal, steady rhythm. Rhythm control is an approach recommended for people who continue to have symptoms or otherwise are not getting better with rate control medicines. Rhythm control also may be used for people who have only recently started having atrial fibrillation or for highly physically active people and athletes. These medicines may be used alone or in combination with electrical cardioversion. Or your doctor may prescribe some of these medicines for you to take on an as-needed basis when you feel symptoms of atrial fibrillation. Some heart rhythm medicines can make arrhythmia worse. Other side effects include effects on the liver, lung, and other organs, low blood pressure, and indigestion.
Your doctor may recommend treatments for an underlying cause or to reduce atrial fibrillation risk factors. For example, he or she may prescribe medicines to treat an overactive thyroid, lower high blood pressure, or manage high blood cholesterol.
Procedures or surgery
Your doctor may recommend a procedure or surgery, especially if lifestyle changes and medicine alone did not improve your symptoms. Typically, your doctor will consider a surgical procedure to treat your atrial fibrillation only if you will be having surgery to treat some other heart condition.
- Catheter ablation to destroy the tissue that is causing the arrhythmia. Ablation is not always successful and in rare cases may lead to serious complications, such as stroke. The risk that atrial fibrillation will reoccur is highest in the first few weeks after the procedure. If this happens, your doctor may repeat the procedure. In some cases, your doctor will place a pacemaker at the time of the procedure to make sure your heart beats correctly once the tissue causing problems is destroyed.
- Electrical cardioversion to restore your heart rhythm using low-energy shocks to your heart. This may be done in an emergency or if medicines have not worked.
- Pacemaker to reduce atrial fibrillation when it is triggered by a slow heartbeat. Typically, a pacemaker is used to treat atrial fibrillation only when it is diagnosed along with another arrhythmia. For example, if you are diagnosed with a slow heart rate or sick sinus syndrome, a pacemaker implanted for that condition can also prevent atrial fibrillation. If you have surgery for a pacemaker, you will need to take blood-thinning medicines.
- Plugging, closing, or cutting off the left atrial appendage to prevent clots from forming in the area and causing a stroke. Your doctor may do this at the same time as surgical ablation. It can be difficult to close off the appendage entirely, and leaking can contribute to ongoing clotting risk.
- Surgical ablation to destroy heart tissue generating faulty electrical signals. The surgeon usually does surgical ablation at the same time as surgery to repair heart valves, but in some cases, surgical ablation can be done on its own.
- Living With will explain what your doctor may recommend, including lifelong lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications.
- Research for Your Health will explain how we are using current research and advancing research to treat people with atrial fibrillation.
- Participate in NHLBI Clinical Trials will discuss our open and enrolling clinical studies that are investigating treatments for atrial fibrillation.
If you have been diagnosed with atrial fibrillation, it is important that you continue your treatment. Follow-up care can help your doctor check your condition and talk to you about how to prevent repeat events and what to do in an emergency. Sometimes, atrial fibrillation may go back to a normal heart rhythm without treatment.
Receive routine follow-up care
How often you need to see your doctor for follow-up care will depend on your symptoms and treatment.
- Keep all your medical appointments. Bring a list of all the medicines you are taking to every doctor and emergency room visit. This will help your doctor know exactly what medicines you are taking.
- Take your medicines as prescribed. If you are taking medicines to treat your atrial fibrillation, your doctor will monitor their effects, including the dose, your body’s electrolyte levels, and the medicines’ effect on other organs.
- Tell your doctor if your medicines are causing side effects, if your symptoms are getting worse, or if you have new symptoms.
- Ask your doctor about physical activity, weight control, and alcohol use. Find out what steps you can take to manage your condition. If you use illegal drugs, ask your doctor for help stopping.
- Check with your doctor before taking over-the-counter medicines, nutritional supplements, or cold and allergy medicines. Some of these products can trigger rapid heart rhythms or interact poorly with other medicines. In addition, the effect of blood thinners can be enhanced by medicines to treat arrhythmia.
- If you have had an ablation, your doctor will want to see you regularly for three months to check on the healing process, to check for the reappearance of atrial fibrillation events, and to make adjustments to blood thinning medicines as needed. You will continue to take blood thinners for several months and maybe much longer. Report any lasting pain, for example at the site, or any other signs of a complication. Your doctor will want to see you at least once a year after the initial follow-up period.
- If you are taking warfarin, it is important to monitor the dose by measuring how quickly your blood clots. Your doctor will do blood tests every week at first, then monthly once the level has stabilized. You may be able to do this yourself at home. You will need to avoid certain other medicines and watch what you eat. Some foods, such as leafy green vegetables, may interfere with warfarin.
Return to Treatment to review possible treatment options for your atrial fibrillation.
Monitor your condition
Regular visits to the clinic give your doctor a chance to see how well medicines are controlling your atrial fibrillation, monitor your ongoing risks of clotting or bleeding, and see how well you are healing from any procedures. Your doctor may also ask you to wear a heart rhythm monitor and send data in between visits to see how well your treatment is working and to detect any repeat events.
- Electrocardiogram (EKG). Regular EKG monitoring can help your doctor detect a repeat atrial fibrillation event or assess your response to changes in dose or medicine, or to ending treatment with medicines. Your doctor may record an EKG during your regular visits or recommend a portable monitor. A band that can record a 30-second EKG has also been approved by the U.S. Food and Drug Administration.
- Stress tests or a six-minute walking test can help your doctor see whether your medicine prevents atrial fibrillation while you are doing typical everyday activities.
- Blood tests to check the effect of certain heart rhythm medicines on your thyroid, kidneys, or liver. The blood thinner warfarin also requires regular testing to make sure the dose is correct. In some cases, your doctor may talk to you about devices available for monitoring your blood thinning medicines at home. Blood thinners can be stopped or adjusted if you are going into surgery.
Prevent repeat atrial fibrillation
To help prevent a repeat episode of atrial fibrillation, your doctor may recommend the following:
- Medicine that you can take at home as needed to correct your heart rhythm. Before giving you this medicine, the doctor will ask you to take a dose and try to trigger an event to see if the medicine prevents it effectively. You can take this medicine if you start feeling symptoms of atrial fibrillation.
- Treatment for an underlying condition, such as sleep apnea, high blood pressure, and diabetes.
- Heart-healthy lifestyle changes, including aiming for a healthy weight. Combining weight loss with physical activity and the management of other risk factors, such as high blood pressure, diabetes, alcohol use, and smoking, can improve symptoms more than weight loss alone.
Learn the warning signs of serious complications and have a plan
Atrial fibrillation can lead to serious complications such as sudden cardiac arrest and stroke. Risks of treatment with blood thinners include severe bleeding in the brain. If you suspect any of the following in you or someone else, call 9-1-1 immediately:
- Bleeding in the brain, digestive system, or urinary tract. This can happen if you take a dose of blood-thinning medicines that is too high. Signs and symptoms may include bright red vomit; bright red blood in your stool or black, tarry stools; blood in your urine; severe pain in the abdomen or head; sudden, severe changes in your vision or ability to move your arms or legs; or memory loss. A lot of bleeding after a fall or injury, or easy bruising or bleeding, may mean that your blood is too thin. Excessive bleeding is bleeding that will not stop after you apply pressure to a wound for 10 minutes. Call your doctor right away if you have any of these signs.
- Heart attack. Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
- Stroke. If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Every minute matters.
Read more about the signs and symptoms of a stroke.
- Sudden cardiac arrest. Usually, the first sign of sudden cardiac arrest is fainting. At the same time, no heartbeat can be felt. Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. Within an hour before cardiac arrest, some people have chest pain, shortness of breath, nausea, or vomiting. Call 9-1-1 right away if someone has signs or symptoms of sudden cardiac arrest. Look for a defibrillator nearby and follow the instructions.
Improving health with current research
Atrial fibrillation research is a major focus of NHLBI funding and the source of findings with important consequences for clinical care. Learn about the following ways the NHLBI continues to translate current research into improved health for people with atrial fibrillation. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
- Studying innovations to improve heart and vascular disease outcomes. The Cardiothoracic Surgical Trials Network (CTSN) is an international network that studies heart valve disease, arrhythmias, heart failure, coronary heart disease, and the complications of surgery. CTSN researchers have studied the success of treatments for people with atrial fibrillation who need heart valve surgery and compared rate control and rhythm control as a first treatment after surgery.
- Uncovering disparities in atrial fibrillation outcomes. Findings from the NHLBI’s Atherosclerosis Risk in Communities (ARIC) study linked obesity and other risk factors to the development of atrial fibrillation. For example, the study found that atrial fibrillation increased patients’ risk of venous thromboembolism (VTE) and that VTE is a risk factor for atrial fibrillation, especially for African Americans. ARIC researchers also showed that African-American participants in an atrial fibrillation study tended to have higher rates of heart complications—including stroke, heart failure, and coronary heart disease—even though white participants were more likely to develop atrial fibrillation. African Americans with atrial fibrillation were also twice as likely than whites to die prematurely.
- Testing varied approaches to treatment. The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial compared catheter ablation with medicine to treat atrial fibrillation. First results seemed to indicate that catheter ablation may be no better than medicines for preventing strokes or death.
- Establishing a foundation for the understanding of atrial fibrillation risk. The Framingham Heart Study established a link between atrial fibrillation and risk factors such as obesity, age, diabetes, and heart disease. The study also documented the link between atrial fibrillation and its health outcomes and found that risk for atrial fibrillation can be inherited.
- Investigating women’s experience of atrial fibrillation. The Women’s Health Study demonstrated that weight gain, especially obesity, can raise a woman’s risk of atrial fibrillation and that weight loss can lower it. The study also found that high blood pressure and two or more drinks of alcohol daily can increase women’s risk of atrial fibrillation. The study found that the top number in a blood pressure reading— blood pressure—better predicted which women would develop atrial fibrillation than the bottom, or , number.
- Identifying characteristics of atrial fibrillation in women. Researchers for the Women’s Health Initiative specifically examined the effects of hormone treatment on a participant’s risk of developing atrial fibrillation. In addition, physical activity was linked to a lower risk of atrial fibrillation, compared with women who did not exercise.
- Expanding understanding of how atrial fibrillation appears in diverse populations. Researchers with the Multi-Ethnic Study of Atherosclerosis (MESA) helped document how common atrial fibrillation is in Hispanic and Asian communities in the United States.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
- Comparing effectiveness of treatment options. The AFFIRM trial showed that using medicines to control heart rhythm did not improve patients’ survival, compared with a strategy of controlling heart rate. The findings helped shape professional guidance that prioritizes rate control as a primary approach.
- Identifying risk factors for atrial fibrillation among older patients. The goal of the Cardiovascular Health Study (CHS) is to identify risk factors for cardiovascular disease related to the onset of coronary heart disease and stroke in adults age 65 or older. Many CHS papers have evaluated measures of risk factors in early cardiovascular disease for later onset of atrial fibrillation. The CHS also has documented the incidence of, risk factors for, and health consequences of atrial fibrillation.
- Investigating alcohol’s effects on the heart. An NHLBI study found that drinking alcohol, even in moderate amounts, can increase the size of the heart’s left . When the left atrium is larger than normal, a person is at higher risk for developing atrial fibrillation.
- Drawing attention to new approaches to prevention. The NHLBI helped spur activity on the topic of atrial fibrillation prevention by organizing a panel of experts who identified recommendations to move research forward.
- Examining ways to manage atrial fibrillation in cases of surgery. Researchers in an NHLBI-funded study collected evidence suggesting that blood thinners are not needed during surgery among patients with atrial fibrillation and may cause more harm than good. In the study, the scientists showed that heart patients who stopped taking the blood thinner warfarin prior to surgery did not have an increased risk of stroke and had a lower risk of bleeding, compared with patients who received a bridge treatment using another blood thinner. The finding helps resolve inconsistent practice guidelines that affect an estimated 250,000 surgery patients each year who are using warfarin for atrial fibrillation.
Advancing research for improved health
In support of our mission, we are committed to advancing atrial fibrillation research in part through the following ways.
- We perform research. Our Division of Intramural Research (DIR) and Cardiovascular Branch conduct research on diseases that affect the heart and blood vessels, including atrial fibrillation. Other DIR groups, such as the Systems Biology Center, perform research on heart and vascular diseases.
- We fund research. The research we fund today will help improve our future health. The Division of Cardiovascular Sciences and its Heart Failure and Arrhythmias Branch supports research to advance our understanding of and interventions for arrhythmia and other pediatric and adult cardiovascular diseases. The Division also supports the development of innovative technologies to diagnose, prevent, and treat heart and vascular diseases. The Center for Translation Research and Implementation Science supports research to translate these discoveries into clinical practice. Search the NIH RePORTer to learn about research we support on atrial fibrillation.
- We stimulate high-impact research. Our Trans-Omics for Precision Medicine (TOPMed) Program now includes participants with atrial fibrillation, which may help us understand how genes contribute to differences in disease severity and how patients respond to treatment. The NHLBI Strategic Vision highlights ways we may support research over the next decade, including efforts to treat and prevent atrial fibrillation.
Learn about exciting research areas that the NHLBI is exploring about atrial fibrillation.
- Furthering our understanding of the causes of atrial fibrillation to target treatment. Research we support aims to build on a discovery that atrial fibrillation is caused by a small number of sources in the form of rotors, which are similar to electrical spinning tops. These rotors may be located in different regions of the heart from person to person and often not where ablation targets treatment. This study will map atrial fibrillation, study the rotor locations, and examine the effects of targeted treatment.
- Probing energy levels and electric signals in heart cells. We support research that aims to reveal molecular and cellular mechanisms of atrial fibrillation. Focusing on energy-producing elements in the cell, researchers aim to examine how alterations in their activity might cause damage to heart cells and their ability to conduct electric signals in order to discover ways to prevent and treat atrial fibrillation.
- Investigating the effect of aging on electrical changes in the heart. NHLBI-supported research aims to better understand the increased risk of atrial fibrillation as we age and how oxidative stress, or free radicals caused by unhealthy lifestyle habits, affects this risk. Researchers are investigating the changes activated by oxidative stress to aid development of atrial fibrillation treatments.
We lead or sponsor many studies on atrial fibrillation. See if you or someone you know is eligible to participate in our.
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Related Health Topics
- Atherosclerosis Risk in Communities (ARIC)
- Cardiovascular Health Study (CHS)
- Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA)
- Heart Failure Clinical Research Network (HFN)
- Framingham Heart Study (FHS)
- Multi-Ethnic Study of Atherosclerosis (MESA)
- Trans-Omics for Precision Medicine (TOPMed) Program
- Whole-Genome Sequencing (WGS) Project
- Women’s Health Initiative (WHI)
- Your Guide to Living Well with Heart Disease
- Arrhythmia (U.S. National Library of Medicine [NLM], MedlinePlus)
- Atrial Fibrillation (NLM, MedlinePlus)
- Atrial Fibrillation Fact Sheet (Centers for Disease Control and Prevention)
- Blood Thinner Pills: Your Guide to Using Them Safely (Agency for Healthcare Research and Quality)
- Cardiac Arrhythmia (Arrhythmia) (PubMed Health)
- Chronic Kidney Disease (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK])
- Diabetes (NIDDK)
- Hyperthyroidism (NLM, MedlinePlus)