Understanding Lone Atrial Fibrillation : Causes, Symptoms, and Management

1. What is Atrial Fibrillation

   Atrial fibrillation is a common and serious heart condition characterized by irregular and rapid heartbeats.⁽¹⁾ In this condition, the heart’s upper chambers quiver or fibrillate instead of contracting effectively. This leads to poor blood flow and an increased risk of blood clots.

   The characteristics of atrial fibrillation include:

   • Irregular heartbeat
   • Rapid heart rate
   • Inefficient pumping
   • Risk of blood clots

   Atrial fibrillation is categorized into different types based on the duration:

   • Paroxysmal Atrial Fibrillation: It typically lasts for a few minutes to hours and returns to normal sinus rhythm.
   • Persistent Atrial Fibrillation: In this type abnormal rhythm persists for more than seven days. Treatment is needed to restore normal rhythm.
   • Long-Standing Persistent Atrial Fibrillation: This type persists for more than a year.
   • Permanent Atrial Fibrillation: In this type, attempts to restore normal rhythm have been unsuccessful or are not attempted. It is accepted as a permanent state.

   There is also a subtype called lone atrial fibrillation, which occurs in individuals under 60 years of age and is not associated with any other heart condition or risk factors.

   Atrial fibrillation impacts a person’s quality of life and requires appropriate management to reduce the risk of complications.

2. What is Lone Atrial Fibrillation

   Lone atrial fibrillation is a type of atrial fibrillation that occurs in individuals under 60 years of age and is characterized by a thumping heartbeat and dizziness.

   It occurs in otherwise healthy individuals without any apparent cardiovascular abnormalities or medical conditions. However, even if it occurs in healthy individuals, it does not mean that there would not be any contributing factors or potential underlying causes. Regular medical care would be needed for individuals with lone atrial fibrillation. They would also benefit from lifestyle modifications, medications, and other treatments as deemed appropriate by the healthcare individual.

3. Significance of Understanding Lone Atrial Fibrillation

   Having an understanding of lone atrial fibrillation is essential for the following reasons: 

   • As it occurs in individuals below 60 years of age without any underlying heart condition, specialized attention and tailored treatment approaches would be needed.
   • Having an understanding would allow for prompt intervention and management.
   • There may be a risk of blood clots in the atria in individuals with atrial fibrillation. Appropriate measures can be taken to prevent stroke.
   • It can be helpful in improving the quality of life.
   • Knowing about the risk factors individuals can take proactive steps to reduce the likelihood of recurrent episodes.
   • Individual treatment plans can be developed that can be effective for specific cases.
   • Understanding lone atrial fibrillation can contribute to ongoing research efforts aimed at advancing knowledge of the condition.

The exact cause of lone atrial fibrillation is not known. A 2019 review article explains lone atrial fibrillation as a diagnosis of exclusion.⁽³⁾ The individual under the age of 60, not having any underlying condition, and having symptoms of atrial fibrillation are given this diagnosis.

According to this article, the risk factors of lone atrial fibrillation may include: 

• A person with obstructive sleep apnea
• Acute stress or excessive caffeine consumption
• Engaging in endurance sports
• An individual with obesity
• Alcohol consumption
• Having a family history of lone atrial fibrillation
• Fluctuations in the hormonal levels
• Using stimulants, illicit drugs, or certain medications
• Imbalance in electrolytes and metabolic disorders can influence the heart’s electrical system, leading to arrhythmia
• Females are more likely to have lone atrial fibrillation than males.⁽⁴⁾

The above factors may contribute to the development of lone atrial fibrillation, but the condition can occur without any known cause.

The symptoms of lone atrial fibrillation are similar to those of atrial fibrillation but occur in populations without any known cardiovascular conditions.

The symptoms include:⁽²⁾

• Fluttering and rapid heartbeat sensation
• Heartbeat with an irregular rhythm
• Unexplained tiredness
• Difficulty in breathing especially while engaging in physical activity
• Mild to moderate discomfort or pressure in the chest
• Unsteady or fainting feeling
• General feeling of bodily weakness
• Difficulty in engaging in physical activity
• Heightened sense of anxiety or restlessness
• In severe cases, unconsciousness may occur
• A sensation of forceful beats in the chest and neck

In some people feeling of pressure or pain in the chest may also indicate a heart attack. In such cases, immediate emergency service should be called.

Diagnosis of lone atrial fibrillation involves a combination of medical history assessment, physical examination, and other diagnostic tests.

As in lone atrial fibrillation, no other cardiovascular condition exists, the diagnosis focuses on ruling out the potential causes and confirming the presence of atrial fibrillation.

The doctor takes the complete medical history of the individual and performs a physical examination to check for heart abnormalities and other associated conditions. The steps involved in diagnosis are: 

• Electrocardiogram: It records the electrical activity of the heart and helps in identifying irregular rhythms. Holter monitors or event recorders may be used for long-term monitoring.
• Blood Test: It is performed to assess the thyroid function, electrolyte level, and other metabolic disorders that may play a role in influencing the heart rhythm.
• Echocardiogram: It is used to create images of heart structure and function. It helps in identifying any structural abnormality or underlying heart condition.
• Stress Test: It involves monitoring heart activity while the patient exercises on a treadmill or stationary bike. It can detect atrial fibrillation triggered by physical activity.
• MRI and CT scan: These imaging tests provide detailed images of the heart structure and can be helpful in identifying any underlying anatomical issue.
• Sleep Studies: Sleep apnea contributes to atrial fibrillation and may be recommended to evaluate breathing patterns.
• Electrophysiology Study: In some cases of lone atrial fibrillation, an electrophysiology study may be performed, which involves the insertion of catheters with electrodes into the heart to study the electrical conduction system.

As atrial fibrillation increases the risk of stroke, a healthcare provider helps assess the patient’s stroke risk.

The focus of treatment and management of lone atrial fibrillation is to control the heart rate, maintain normal rhythm, and reduce the risk of complications. It may involve lifestyle changes including: 

• Treating obstructive sleep apnea, using a continuous positive airway pressure (CPAP) machine.
• Avoiding sports needing strenuous physical activity.
• Reducing alcohol intake
• Maintaining optimal weight

Antiarrhythmic drugs may be prescribed by the doctor to help maintain a regular heart rate. Beta-blockers and calcium channel blockers may be used to control heart rate.

Catheter ablation may be suggested for controlling heart rhythm. It involves inserting a small tube or catheter to cause a small amount of scarring inside a person’s heart. If the scarring is done in the right location, it can block irregular electric signals.

Another option is cardioversion, which provides electrical pulses to the heart.

Steps may be taken by doctors to prevent stroke in a person with lone atrial fibrillation. Anticoagulants may be given to inhibit blood clotting.

Adopting a heart-healthy lifestyle is crucial for individuals with lone atrial fibrillation. This helps in managing the condition and improving the overall well-being.

The lifestyle recommendations include: 

• Consuming a balanced diet rich in fruits, vegetables, grains, pulses and legumes. The intake of saturated and trans fats should also be limited. Caffeinated and alcoholic beverages should also be consumed in moderation.
• Engaging in moderate physical activity is important. Swimming and cycling can be helpful in improving cardiovascular health. Exercises involving extreme physical exertion should be avoided.
• Stress management techniques such as yoga, meditation, and mindfulness should be practiced.
• Getting adequate and quality sleep every night is important. This can be done by creating a comfortable sleep environment.
• One should concentrate on maintaining a healthy weight with a combination of exercise and balanced nutrition.
• The medication prescribed should be taken consistently.

A person with lone atrial fibrillation should attend regular follow-up appointments with the healthcare provider to monitor heart health and work on a personalized lifestyle plan.

Lone atrial fibrillation carries a low risk of serious complications. A study showed that 99.4% of people with lone atrial fibrillation survived for 1 year post-diagnosis without serious complications and after 3 years the figure was 98.3%.⁽⁵⁾

Understanding and managing lone atrial fibrillation is of extreme importance for an individual. It is known to occur in individuals below 60 years of age without any cardiovascular complications.

The symptoms include rapid and irregular heartbeat, fluttering of the chest, and dizziness. There may also be chest pain which might signal a medical emergency. Lone atrial fibrillation is diagnosed by excluding typical atrial fibrillation and comorbidities which include congenital heart disease and underlying heart or lung disease.

It is treated by addressing underlying factors with the help of medications, catheter ablation, and anticoagulants. Lifestyle factors play a pivotal role in empowering individuals to take an active role in managing their condition.