Conditions We Treat
Atrial Fibrillation and Arrhythmias
Heart Rhythm Problems
Heart rhythm problems such as atrial fibrillation and arrhythmias are common, and most of them respond well to treatment once properly diagnosed. These experiences can feel alarming, and they should be evaluated by physicians who specialize in heart rhythm issues called electrophysiologists.
What Is Atrial Fibrillation?
Atrial fibrillation, often called AFib, is the most common sustained heart rhythm disorder. In a normally beating heart, the upper chambers (atria) fire in an organized pattern that coordinates with the lower chambers (ventricles). In AFib, the upper chambers fire chaotically and rapidly instead. The result is an irregular, often fast heartbeat that the person may feel as a flutter, a pounding, or simply an unusual awareness of their own heart.
Beyond the uncomfortable sensation, atrial fibrillation carries a serious risk: when the upper chambers quiver rather than contract properly, blood can pool and form clots. If a clot escapes into the circulation, it can travel to the brain and cause a stroke. Managing AFib means addressing both the rhythm problem and the stroke risk.
Signs of a potential heart rhythm problem include:
A heartbeat that races suddenly for no clear reason. A fluttering sensation in the chest that stops as quickly as it started. Dizziness that hits without warning, or a general fatigue that seems disconnected from how much you have actually been doing.
Symptoms of Atrial Fibrillation
AFib does not feel the same for everyone. Some people experience symptoms that are hard to ignore. Others discover they have the condition during a routine exam or EKG and had no idea anything was wrong.
Fatigue
Feeling unusually tired, even with normal activity levels, because the heart is not pumping as efficiently as it should.
Chest discomfort.
Pressure, tightness, or a vague aching sensation in the chest that is not necessarily severe.
Dizziness or lightheadedness.
A sensation of feeling faint or off-balance that can come on without warning.
Anxiety
A sense of unease or racing thoughts that sometimes accompanies an irregular or rapid heart rate.
Shortness of breath.
Difficulty catching your breath, particularly during physical activity or when lying flat.
Irregular heartbeat or palpitations.
A fluttering, racing, or pounding sensation in the chest that comes on suddenly and may stop just as quickly.
Fainting.
A brief loss of consciousness, which can occur when the heart rate drops suddenly or becomes too irregular to maintain adequate blood flow to the brain.
If you have noticed any of these symptoms, even occasionally, it is worth getting evaluated. Intermittent symptoms are easy to dismiss, but they can be a sign that something in your heart’s rhythm deserves attention.
Causes and Risk Factors
AFib develops when the heart’s electrical system becomes disrupted. In many cases, there is more than one contributing factor. Understanding what raises the risk can help you and your care team make decisions about monitoring and treatment.
Common causes and risk factors include:
Older age.
The risk of developing AFib increases with age, particularly after 60.
High blood pressure.
Sustained hypertension puts extra strain on the heart over time and is one of the most common AFib triggers.
Coronary artery disease.
Narrowed or blocked arteries can affect the heart muscle in ways that disrupt normal rhythm.
Heart valve disorders.
Problems with the mitral or other valves can change the way blood flows through the heart and contribute to AFib.
Heart failure.
When the heart struggles to pump efficiently, the electrical system often becomes unstable.
Excessive alcohol use.
Heavy or binge drinking is a well-established AFib trigger, sometimes called "holiday heart" when it follows a period of increased drinking.
Smoking.
Tobacco use damages blood vessels and contributes to inflammation and structural heart changes.
Obesity.
Excess weight increases the workload on the heart and is linked to a higher risk of AFib.
Physical inactivity.
A sedentary lifestyle contributes to several cardiovascular risk factors that can raise AFib risk over time.
Thyroid disorders.
An overactive thyroid (hyperthyroidism) can trigger a fast, irregular heartbeat.
Sleep apnea.
Repeated disruptions to breathing during sleep place significant stress on the heart's electrical system.
Chronic lung disease.
Conditions such as COPD can reduce oxygen levels and affect heart function.
Family History.
AFib can run in families, suggesting a genetic component in some cases.
Prior heart surgery.
Procedures involving the heart can occasionally disrupt the electrical pathways and lead to AFib in the recovery period or later.
Having one or more of these risk factors does not mean you will develop AFib, but it is a reason to talk with your cardiologist about monitoring and prevention.
Early Detection Saves Lives
Cardiovascular disease is the leading cause of death in the United States, but most heart conditions are manageable when caught early with the right care plan. Our team is built to catch problems before they become emergencies, so you can stay ahead of your cardiovascular health rather than react to it.
Same-Week Access
New patient appointments are generally available within 1 week, because your heart health should not wait.
In-House Testing
All diagnostic testing is done on-site. No outside facility referrals, no extra wait times. Echocardiography, vascular imaging, nuclear cardiology, and more.
One Coordinated Team
Cardiology, vascular, electrophysiology, and structural heart under one roof, working together on your plan of care
Types of Atrial Fibrillation
Doctors classify AFib into four types based on how long episodes last and how the condition behaves over time. Knowing the type helps guide treatment decisions.
Paroxysmal AFib
Paroxysmal AFib comes and goes on its own. Episodes begin suddenly, may last minutes or hours, and then stop without any intervention. Even though the rhythm returns to normal on its own, paroxysmal AFib still carries stroke risk and typically warrants treatment.
Persistent AFib
Persistent AFib does not stop without treatment. The abnormal rhythm continues until a procedure or medication is used to restore a normal heartbeat. Episodes lasting longer than seven days fall into this category.
Long-standing persistent AFib
Long-standing persistent AFib describes a continuous abnormal rhythm that has been present for more than 12 months. At this stage, restoring normal rhythm is still possible but often requires more involved treatment.
Permanent AFib
Permanent AFib is a label used when a patient and their care team have made a shared decision to stop pursuing rhythm restoration. The focus shifts to controlling the heart rate and managing stroke risk, rather than attempting to return the heart to a normal rhythm.
Other Heart Rhythm Disorders
Atrial fibrillation is the most common arrhythmia, but it is not the only one.
Supraventricular Tachycardia (SVT)
Supraventricular tachycardia (SVT) causes episodes of rapid heart rate that originate in the upper part of the heart. These episodes often begin and end abruptly and can cause palpitations, lightheadedness, or breathing difficulty.
Ventricular Tachycardia
Ventricular tachycardia is a fast rhythm that starts in the lower chambers. It can range from brief and benign to an urgent situation requiring immediate treatment, depending on whether the heart muscle is structurally normal.
Bradycardia
Bradycardia is the opposite problem: a heart rate that is too slow. It can cause fatigue, dizziness, or fainting when the heart cannot move enough blood to meet the brain's and body's needs.
How We Evaluate It
A recording of the heart’s electrical activity is the starting point for a diagnosis. A resting EKG records the heart’s electrical activity and can detect ongoing rhythm disturbances.
If the physician needs to evaluate the rhythm over time, they may use an external monitor to evaluate your heart. This is a wearable device worn continuously over a period of days or weeks such as an event monitor or holter monitor.
When a more detailed or extended evaluation is needed, an implantable loop recorder can be used to monitor the heart rhythm remotely on an extended basis while an electrophysiology study maps the heart’s electrical pathways from the inside to identify the precise source of the abnormal rhythm.
How We Treat It
Treatment for arrhythmias is matched to the type of rhythm disorder, how often it occurs, and how it is affecting your quality of life.
Rate Control Medications
Rate control medications slow the ventricular response in AFib so the heart does not beat too rapidly.
Rhythm Control Medications
Rhythm control medications attempt to restore a more normal pattern.
Anticoagulation Therapy
Anticoagulation therapy, including blood thinners, reduces stroke risk in patients with AFib and is a central part of long-term management for most patients.
Device Therapy
For patients with bradycardia or other conditions requiring rate support, device therapy such as a permanent pacemaker may be recommended.
Catheter Ablation
For patients who want a more lasting solution, catheter ablation targets the specific tissue responsible for triggering the abnormal rhythm. Our [AFib Ablation](#) program offers this option for appropriate candidates.
Why Choose Richmond Heart and Vascular Associates
Locations in Chesterfield, Mechanicsville and Hopewell make consistent follow-up care practical
Schedule an appointment online or call Richmond Heart and Vascular Associates at 804.800.6600. Our offices are open Monday through Friday, 8:00am to 5:00pm.
Full range of rhythm monitoring tools in-office, from EKG to Holter and event monitoring
Implant and monitoring of cardiac devices to control rhythm including pacemakers and internal defibrillators.
Catheter ablation available for eligible patients looking for a long-term rhythm solution
Coordinated stroke prevention management for patients living with AFib