Can AFib cause heart failure if it keeps recurring?

Question

Hello doctor,

I am having another atrial fibrillation episode and am more and more worried about the frequency. I was first diagnosed with AFib 2 years ago at the age of 63, and now the episodes seem to be happening more often. I have had three instances this week alone, each lasting several hours.

When it happens, I have this quick, irregular fluttering in my chest, and my heart rate seems to jump all over the place. In a short space of time, my Apple Watch has recorded heart rates ranging from about 50 to 170 beats per minute. I also get dizzy when standing up, shortness of breath when walking up stairs, and extreme weariness. During these moments, sleep has been really tough, and most days I am weary.

I take Metoprolol now, but it does not appear to be regulating my symptoms as well as it used to. I also take Eliquis, but I have been getting a lot of bruises on my arms as a side effect.

My cardiologist just proposed catheter ablation as a possible next step, but I am feeling apprehensive about undergoing a treatment. I had planned on a hiking vacation next month, but I have decided to cancel since I am afraid of having an episode when I am away from medical treatment.

I am especially concerned about it because my mother had a stroke at the same age I am now, and I worry about my own risk. An emergency department doctor also told me that untreated or poorly managed AFib can lead to heart failure, which has made me even more anxious about the whole thing.

Can you tell me that my illness is likely to get worse?
Are there solutions I may pursue, such as catheter ablation, a pacemaker, or calcium channel blockers?

I want to look into effective therapy choices and improve my quality of life.

Thank you for your time and guidance.

I look forward to your recommendations.

Answer 1

Hi,

Welcome to icliniq.com

I hope you are doing well.

I understand your concerns regarding your atrial fibrillation (AFib), particularly since your heart rate was previously well controlled with Metoprolol but now appears to be less responsive to the same medication. I also understand your concerns about the bruising you are experiencing while taking Eliquis (apixaban).

The symptoms you mention, such as palpitations, dizziness, shortness of breath, and fatigue, can happen when AFib is not well controlled. If Metoprolol used to help but is not working as well now, it is important to find out why this change occurred.

Some things can make atrial fibrillation worse. These include:

Fever.
Infection.
Stress & Anxiety
Too much alcohol, nicotine, or caffeine
Loss of fluids.
Bad sleep quality.
Imbalances in electrolytes.

As your physician mentioned, persistent uncontrolled AFib can, over time, lead to tachycardia-induced cardiomyopathy and potentially contribute to heart failure. For this reason, achieving adequate control of heart rate and rhythm is important.

Your cardiologist may consider adjusting your treatment plan by increasing your metoprolol dose if appropriate. If you are already taking the maximum tolerated dose, additional medications may be considered, such as the following:

Calcium channel blockers.
Digoxin.
Antiarrhythmic medications, including Amiodarone, when clinically appropriate.

The most suitable option will depend on your overall health, medical history, and the characteristics of your AFib.

Additionally, potential causes of atrial fibrillation such as hypertension, coronary artery disease, structural heart disease, or metabolic and electrolyte imbalances should be evaluated and managed.

The treatment of AFib is usually focused on five major issues:

1. Heart rate regulation.

2. Rhythm management.

3. Prevention of stroke with anticoagulants where appropriate.

4. Treating underlying causes.

5. Procedural interventions as needed.

If restoring normal heart rhythm is the goal, antiarrhythmic medications may be used to convert AFib to normal sinus rhythm. If medications are ineffective or symptoms worsen, electrical cardioversion, a brief procedure performed under sedation, may be recommended. It is generally considered safe when appropriate precautions are taken.

For recurrent or persistent AFib, an electrophysiologist may recommend an electrophysiological investigation and catheter ablation. This technique uses specialized catheters that are threaded through blood vessels to locate and treat the parts of the heart that are responsible for the irregular rhythm. Results of ablation have improved markedly and may be quite beneficial in selected patients.

Wearable technologies, such as your Apple Watch readings, can help detect rhythm anomalies, but they may not always precisely monitor your heart rate during episodes of fast AFib. The most reliable way to know your exact heart rhythm and heart rate is to have a conventional electrocardiogram (ECG).

If there is concern about episodes of a slow heart rate (bradycardia), your cardiologist may recommend Holter monitoring or other extended rhythm monitoring. If clinically significant bradycardia is confirmed, a pacemaker may be considered. In certain situations, patients undergo AV node ablation followed by pacemaker implantation to manage difficult-to-control AFib better.

I would recommend talking to your cardiologist about the bruising that you are experiencing while on Eliquis. They can see how bad the bruising is, how often you bleed, and whether you might need a different dose or even a different blood thinner.

Hope this helps and gives you a little peace of mind.

If you have any other queries or issues, please feel free to contact me, and I would be pleased to help.

Thank you.