Atrial Fibrillation Pathophysiology: What You Need to Know

Fact checked by Olga Sadouskaya, MD
Clinical Pharmacologist, Chief Medical Officer

Have you ever heard someone complain of chest pains and wondered what was causing it? Atrial fibrillation is a common heart condition that affects millions of people. An estimated 3 to 6 million people have it in the United States alone. It can be hard to understand and even harder to manage, but it doesn’t have to be scary.

Let’s take an in-depth look at atrial fibrillation (AFib) pathophysiology to better understand what it is and its effect on our hearts.

What is atrial fibrillation?

Atrial fibrillation is a type of heart rhythm disorder that causes the heart’s upper chambers (the atria) to beat irregularly and rapidly. The atria are responsible for pumping blood into the lower chambers of your heart, called ventricles. Atrial fibrillation happens when an electrical disturbance occurs within these chambers, and they can’t pump blood effectively through your body, causing an irregular beating pattern. It is often seen on an AFib rhythm strip.

The condition can cause blood to pool in the atria, leading to blood clots that travel to other parts of the body and cause strokes, heart failure, and other cardiovascular complications.

Atrial fibrillation is the most common type of arrhythmia.

While it is manageable and not life threatening in most cases, it’s still important to take it seriously. Here are some of its signs and symptoms:

  • Heart palpitations that feel like extra beats or skipped beats
  • Shortness of breath after exercising or lying down
  • Dizziness
  • Fatigue
  • Weakness
  • Lightheadedness
  • Fainting spells
  • Worse atrial fibrillation in certain sleep positions
  • Chest pain that comes and goes suddenly
A young Asian men having shortness of breath as a sign of atrial fibrillation

Triggers and risk factors for atrial fibrillation

Several triggers and risk factors can contribute to atrial fibrillation development, such as:

  • Age: AFib is more common in older adults, particularly those over 60.
  • Underlying health conditions: AFib is more common in people with other conditions, such as high blood pressure, diabetes, hyperthyroidism, heart disease, and sleep apnea.
  • Alcohol and tobacco use: Excessive alcohol consumption and tobacco use can increase the risk of developing AFib.
  • Stress: Stress and anxiety can contribute to AFib, particularly in people prone to the condition.
  • Medications: Certain medications, including cardiovascular medications, anticancer agents, and immunomodulators, can increase the risk of AFib.
  • Family history: A family history of AFib can increase the risk of developing the condition.

How to prevent atrial fibrillation

You can do several things to help prevent or manage AFib. Here are some helpful tips:

  • Control your blood pressure. High blood pressure is a major risk factor for AFib. Maintaining a healthy blood pressure can help prevent AFib and reduce the risk of other health problems.
  • Manage your stress. Learning stress management techniques, such as relaxation techniques, can help reduce the risk of AFib.
  • Eat a healthy diet. A diet low in salt and high in fruits, vegetables, and whole grains can help prevent AFib and other health problems.
  • Exercise regularly. Regular physical activity can help prevent AFib and improve your overall well-being.
  • Avoid tobacco, alcohol, and caffeine. Reducing your intake of tobacco, alcohol, and caffeine lowers your risk of AFib.
  • Get treatment for other health conditions. Treating underlying health conditions, such as sleep apnea, thyroid problems, and heart disease, can help prevent AFib and improve your overall health.

If you have AFib, your doctor may also recommend medications or procedures to help prevent AFib episodes and reduce the risk of complications.

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AFib medications

Several medications can be used to treat atrial fibrillation. The best medications for your condition will depend on your individual needs and medical history. Some common AFib medications include:

  • Heart rate drugs: These medications help slow down the heart rate. Examples include beta blockers, calcium channel blockers, and digitalis. Beta blockers can decrease the force of each heartbeat and slow down how fast your heart pumps blood. Calcium channel blockers work on the electrical system in the heart and slow down its rhythm.
  • Blood thinners: AFib can increase the risk of blood clots, leading to stroke. Blood thinners, such as warfarin and dabigatran, can help reduce the risk of blood clots and stroke. It is often a recommended treatment for atrial fibrillation treatment in elderly people.
  • Rhythm control medications: Antiarrhythmics are drugs that help control abnormal heart rhythms by blocking signals that cause rapid beats to prevent them from occurring again later on. They help regulate the heart’s rhythm and prevent AFib episodes.

You can also use a pacemaker for AFib. A pacemaker is a small device implanted in the chest or abdomen to help regulate the heart’s rhythm. It uses electrical pulses to prompt the heart to beat normally. Pacemakers are typically used to treat AFib in people with symptoms that are not controlled by medications or other nonsurgical treatments.

Working with your doctor to determine the best medication plan for your specific situation is important. Finding the right medication or combination that works best for you may take some time.

AFib-friendly diet

The American Heart Association recommends a heart-healthy AFib diet low in saturated fat and cholesterol and rich in fruits, vegetables, and whole grains for persistent atrial fibrillation. This diet is also low in sodium and sugar but not necessarily fat free.

This heart-healthy diet is designed to lower the risk of heart disease by lowering bad cholesterol and reducing blood pressure.

If you have atrial fibrillation, ensure your doctor approves your diet before making any major changes.

While these diets cannot reverse atrial fibrillation, they can help minimize your risk of stroke and other heart problems. Follow these tips to make your diet more heart friendly:

  • Limit alcohol consumption to two drinks per day for men or one per day for women. Alcohol is high in calories (which can lead to weight gain), raises blood pressure, and increases your risk of heart disease and stroke.
  • Don’t smoke cigarettes or tobacco products. Smoking increases the risk of stroke by about 50 percent among those with no previous strokes.
  • Avoid caffeine. Caffeine can worsen arrhythmias by raising blood pressure and increasing the heart rate.
  • Discuss dietary changes with your doctor. If you’re taking any medications like blood thinners, discuss with your doctor any foods you need to limit or avoid, as they can decrease the effectiveness of certain medications.
  • Eat more fruit. Research shows that a low potassium level puts you at a higher risk for AFib. To help prevent attacks, snack on bananas. The sweet treat is packed with potassium and other heart-healthy ingredients that effectively reduce the occurrence of AFib.

FAQs about atrial fibrillation

Can anxiety cause atrial fibrillation?

Anxiety is an emotional state that is caused by tension, stress, and physical changes. Anxious people often feel stressed, irritable, on edge, or panicky.

So, can atrial fibrillation be caused by anxiety? When it comes to stress and heart disease, there’s a lack of research on whether anxiety can cause atrial fibrillation. However, there’s some evidence that people with AFib are more likely than others to have panic attacks, which are sudden feelings of terror that occur without warning.

A woman with atrial fibrillation measuring heartbeat

Is AFib hereditary?

Yes, as it turns out. If you have a family history of atrial fibrillation, then your chances of developing it yourself are higher. There is no one gene or gene mutation, however, that causes AFib. It’s more likely caused by several genes interacting with other lifestyle and environmental factors.

That being said, having a family history of AFib doesn’t mean that you will necessarily develop the condition.

How long can you live with atrial fibrillation?

There are treatments for atrial fibrillation, but it can be hard to predict each person’s prognosis. How long you can live with atrial fibrillation generally depends on whether you have any other underlying conditions.

Studies have shown that people with atrial fibrillation have a shortened life expectancy by about two years. This varies for everyone. Some people live with AFib for years without symptoms or complications; others may need medication or surgery.

When to go to the hospital with atrial fibrillation

In some cases, AFib may not cause symptoms and may be discovered during a routine medical exam. If you have been diagnosed with AFib and are experiencing any new or worsening symptoms, you should also seek medical attention.

If you are experiencing any of the following symptoms, you should go to the hospital immediately:

  • Chest pain or pressure
  • Shortness of breath or difficulty breathing
  • Fainting or feeling lightheaded
  • Rapid or irregular pulse


Atrial fibrillation is a serious condition that can lead to other health problems if left untreated. Although there is no cure for AFib, many medications can help manage your symptoms and prevent them from worsening. If you think you have atrial fibrillation or another heart condition, be sure to get checked out by a doctor immediately.

March 3, 2023