Atrial Fibrillation (AFib) is the most common type of heart arrhythmia, characterized by rapid, chaotic, and irregular electrical activity in the heart’s upper chambers, the atria. This causes the atria to quiver instead of contracting effectively, resulting in a fast and irregular ventricular heartbeat. An acute AFib episode requires prompt attention to return the heart to a normal sinus rhythm. Restoring a regular rhythm ensures efficient blood pumping and reduces the risk of stroke, which occurs when blood pools and clots in the atria.
Immediate Self-Management Techniques
When a paroxysmal AFib episode begins, some individuals attempt non-pharmacological techniques to slow the heart rate by stimulating the vagus nerve. Activating this nerve prompts a reflex that slows the heart’s electrical conduction. The Valsalva maneuver involves taking a deep breath, holding it, and straining forcefully, as if bearing down, for 10 to 15 seconds. Releasing the breath afterward can sometimes trigger the heart to revert to a regular rhythm.
The “diving reflex” achieves a similar effect by briefly exposing the face to very cold water, such as splashing ice-cold water or submerging the face. This action can activate the vagus nerve and slow the heart rate. Controlled, slow breathing exercises may also help to relax the body and reduce the heart’s pace.
These vagal maneuvers are often attempted as a first step for people with paroxysmal AFib, but their effectiveness varies significantly from person to person. Resting and reducing anxiety are also beneficial, as stress hormones can exacerbate irregular heart rhythms. It is advisable to discuss these maneuvers with a healthcare provider beforehand to ensure they are appropriate and to learn the correct, safe technique.
Recognizing Severe Symptoms and When to Call for Help
While many AFib episodes are managed at home, certain symptoms demand immediate emergency medical attention. Severe chest pain or significant pressure in the chest requires an immediate call to emergency services, as it may indicate a heart attack or severe strain on the heart. Sudden or worsening shortness of breath is a red flag, suggesting the heart is not pumping adequately and fluid is backing up into the lungs.
Fainting (syncope) or severe, persistent dizziness indicates a dangerous drop in blood pressure or compromised blood flow to the brain. Other symptoms prompting an emergency call include signs of a stroke, such as sudden weakness or numbness on one side of the body, difficulty speaking, or blurred vision. For patients who are otherwise stable, medical guidelines suggest seeking professional help if an AFib episode lasts longer than 24 to 48 hours, even without these severe symptoms, to determine the safest next steps.
Medical Interventions to Restore Heart Rhythm
When an acute AFib episode requires professional intervention, medical teams focus on quickly restoring a normal heart rhythm, a process called cardioversion. Immediate electrical cardioversion is the treatment of choice for hemodynamically unstable patients (those with dangerously low blood pressure or signs of shock). This procedure delivers a controlled, synchronized electrical shock to the chest wall while the patient is under mild sedation. The shock momentarily resets the heart’s electrical system, allowing the natural pacemaker to restore the correct rhythm.
Pharmacological Cardioversion
For stable patients whose AFib onset is recent (typically less than 48 hours), doctors may attempt pharmacological cardioversion. This chemical approach uses intravenous antiarrhythmic medications, such as flecainide, amiodarone, or propafenone, to restore a normal rhythm. Pharmacological cardioversion does not require sedation but may take longer to work and carries the risk of temporary side effects.
Clot Risk and Anticoagulation
Before any cardioversion, the risk of blood clots must be considered, especially if the AFib episode lasted over 48 hours or the onset time is unknown. If a clot has formed inside the atria, an immediate rhythm reset could cause it to dislodge and travel to the brain, causing a stroke. In such cases, a transesophageal echocardiogram (TEE) may be performed to check for clots before the procedure. If a clot is found, or if the duration is uncertain, the patient must receive anticoagulation therapy for several weeks before cardioversion can be performed safely.