A closer look at atrial fibrillation: Understanding the types of AFib

Heart Health
Stethoscope on electrocardiogram

Your heart has two upper chambers (the atria) and two lower chambers (the ventricles). Every time your heart beats, an electrical signal goes through the upper chambers and then to the lower chambers, pumping blood throughout your body.

"If you have atrial fibrillation (AFib), this process doesn’t always work as it should. The signals in the upper chambers are off, causing your heartbeat to sometimes be irregular or quicker than normal," says Bindi K. Shah, MD, FACC, an electrophysiologist at Lankenau Medical Center, part of Main Line Health. In people with AFib, their heart rate can be slow, fast or normal. We often see hearts rates of 100 to 175 beats per minute compared to the normal 60 to 100 beats per minute."

A rapid or flutter in your chest is a telltale sign of AFib. We call these "palpitations." It can also cause other symptoms, like chest pain, fatigue, shortness of breath, dizziness and weakness.

If left untreated, AFib can be dangerous. The flutter of AFib makes the heart 20% less efficient at getting blood to the rest of your body. It can cause heart failure or fatigue and weakness. It also puts you at a higher risk of stroke.

Treating AFib depends on the type you have. Different kinds of atrial fibrillation refer to the cause of it as well as the intensity of it. Here’s an overview of the types of AFib and what to do if you are experiencing symptoms.

What are the types of atrial fibrillation?

Any kind of AFib indicates a type of irregular heartbeat, and the symptoms are usually similar. However, there are AFib categories related to how frequently it occurs and which treatments are most effective.

Types of AFib include:

  • Paroxysmal atrial fibrillation, which is when you have brief episodes of AFib. You might have strong symptoms, or you might not have any at all. This type can last a few hours or up to a week, it can recur intermittently, and it goes away on its own or with treatment.
  • Persistent atrial fibrillation, which is AFib that lasts more than a week and can require treatment to return to normal, though it can return to normal on its own.
  • Long-term persistent (or longstanding) atrial fibrillation, which is AFib that lasts more than a year.
  • Permanent atrial fibrillation, which is AFib that occurs indefinitely. In this type, health care providers have decided not to continue attempting to return the heart to its natural rhythm.

Valvular vs. nonvalvular AFib

Another categorization of AFib is based on whether or not it involves the heart valves.

"If your heart’s chambers are like rooms, its valves are like doors, directing the flow of blood through the chambers and to the rest of your body," says Dr. Shah. "They open and shut to ensure the blood goes in the right direction at the right time, creating the sound of your heartbeat."

AFib associated with certain types of heart valve disease is sometimes referred to as "valvular AFib."

AFib that isn’t related to heart valves — sometimes called "nonvalvular AFib" — can be caused by:

  • High blood pressure
  • Heart attack
  • Coronary artery disease (when the arteries are blocked or narrowed)
  • A congenital heart defect (a heart problem you have when you’re born)
  • A problem with the natural pacemaker of the heart
  • Obstructive sleep apnea
  • Lung diseases, like pneumonia or lung scarring
  • Thyroid disease
  • An infection from a virus

However, the terms "valvular AFib" and "nonvalvular AFib" have recently been debated and are being used less often.

Treating atrial fibrillation

The purpose of treatment for AFib is to restore your heart to its normal rhythm and avoid blood clots that could cause additional problems. The type of treatment you’ll need depends on your symptoms, how long you’ve been experiencing AFib and what might be causing it.

Treating AFib may include:

  • Lifestyle changes, such as maintaining a healthy weight, limiting alcohol, quitting smoking and managing stress
  • Medication, such as beta blockers and blood thinners
  • Treating the cause of AFib, such as sleep apnea or thyroid disease
  • Cardioversion therapy, which is a non-surgical procedure to reset the heart’s rhythm
  • Surgery, such as cardiac ablation, which uses a heating or freezing technique to make tiny scars in the heart to interrupt irregular heart signals and restore a normal heartbeat

Living with atrial fibrillation

With the wide range of treatment options available for AFib, many people with this condition live normal lives. Still, if you’re diagnosed with AFib, you’ll need to keep an extra close eye on your heart. This includes visiting your health care provider for follow-up appointments, monitoring your condition at home and learning the warning signs of serious complications, such as sudden weakness or trouble speaking (which can indicate a stroke) and chest pain (which can indicate a heart attack).

By adopting healthy lifestyle changes, taking your medication as prescribed and staying in close contact with your health care provider, you can live a long and happy life with atrial fibrillation.

Next steps:

Make an appointment with Bindi K. Shah, MD, FACC
Watch: Atrial Fibrillation and Ablation Therapy: Your Roadmap to a Rhythm Restored
Listening to the beat of your heart: Advanced treatments for atrial fibrillation