Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Atrial Fibrillation


Atrial fibrillation is an abnormal heart rhythm in the upper chambers (atria) of the heart. It can feel like your heart is racing, beating irregularly, fluttering, or pounding. 

Fortunately, atrial fibrillation can be treated. Treatment also helps reduce your risks of stroke and heart failure.

The heart has 4 chambers:

  • 2 upper chambers, called atria
  • 2 lower chambers, called ventricles 

To keep the heartbeat steady, all 4 chambers must contract in a regular order and rhythm. The heart’s electrical system sends tiny signals to maintain a normal heartbeat.

When abnormal electrical signals occur, usually in the left atrium, the upper chambers beat very fast and irregularly. The heart literally quivers (fibrillates).

If atrial fibrillation goes on for weeks or months, it can:

  • Damage the heart muscle.
  • Lead to complications, such as heart failure.

During fibrillation, the atria can’t pump blood normally. Blood clots can form in an atrium. If a clot breaks loose and circulates into the brain, a stroke can occur.

Your heart has 4 separate chambers that pump blood: two atria and two ventricles. The chambers are separated by muscular walls. The heart also has valves that connect to major blood vessels.

The heart's electrical signal travels through pathways (yellow). This stimulates your upper chambers (atria) and lower chambers (ventricles) to contract.


Atrial fibrillation can happen at any age, but is more likely in older people. Symptoms can include:

  • Rapid heartbeat with an irregular rhythm
  • Flopping, fluttering, or pounding feeling in your chest (heart palpitations)
  • Extreme sweating
  • Chest pain or pressure (angina)
  • Difficulty catching your breath
  • Feeling very weak and tired
  • Feeling faint, dizzy, or lightheaded

Some people with atrial fibrillation have no symptoms.


People may not know they have atrial fibrillation because they have no symptoms. Often, we diagnose it after hearing an irregular heartbeat with a stethoscope during a checkup.

If we think you may have atrial fibrillation, we’ll ask you to have an electrocardiogram (EKG/ECG). This test checks your heart's electrical activity. The results can confirm the diagnosis.

We may use other tests to find the cause and guide treatment planning. These may include:

  • Lab tests to check your blood levels of thyroid hormones and certain electrolytes (minerals).
  • Chest X-ray.
  • Echocardiogram, an ultrasound picture of the heart. It checks the heart chambers’ size and function and valve function.


Atrial fibrillation can develop if you have another medical problem, such as one (or more) of these conditions:

  • High blood pressure (hypertension)
  • Coronary artery disease (CAD)
  • Heart valve disorders
  • Obstructive sleep apnea
  • Obesity 
  • Overuse of alcohol, stimulants, or caffeine
  • Lung disease, pneumonia, or hyperthyroidism

Sometimes we find atrial fibrillation in people who have no related medical condition.


By getting treatment for atrial fibrillation, you also reduce your risks for heart failure or stroke.

We’ll talk with you about treatment options, based on the cause, your symptoms, and your stroke risk.

Studies show that people can have fewer atrial fibrillation episodes by:

  • Losing weight and improving their fitness level through walking. 
  • Stopping any use of alcohol and decongestants, and stopping overuse of coffee, tea, and other caffeine sources.

Our usual treatment goals are to:

  • Control your heart rate.
  • Try to restore a normal rhythm.
  • Prevent blood clots from forming in the heart.

We may recommend these types of cardioversion to help your heartbeat return to a normal rhythm. 

Chemical cardioversion. You take medication to restore your heart to its normal rhythm.

Electrical cardioversion. You receive low-voltage electrical shock through paddles or patches on your chest. The shock converts your irregular heart rhythm back to normal. If chemical cardioversion doesn’t work well for you, we may recommend this procedure.


If atrial fibrillation continues with serious chest pain and difficulty breathing, and it can’t be controlled with oral medications, you may need to receive care in the hospital. Intravenous (IV) medications and careful monitoring can be provided there.


We prescribe medications to either slow your heart rate or return it to a normal rhythm. This is usually the first method we use for atrial fibrillation.

Atrial fibrillation sometimes comes back after cardioversion treatment. We would then prescribe antiarrhythmic medications.

These are the medications we use most often.

Rate-control medications. These help keep the heart from beating too fast during atrial fibrillation.

These medications include:

  • Metoprolol (Lopressor), atenolol (Tenormin)
  • Verapamil (Calan, Isoptin)
  • Diltiazem (Cardizem, Tiazac)
  • Digitalis (Digoxin, Lanoxin, Digitoxin)

Rhythm-control medicines (antiarrhythmics). These help return the heart to its normal rhythm and keep it there.

These medications include:

  • Amiodarone (Cordarone, Pacerone)
  • Flecainide (Tambecor) 
  • Propafenone (Rythmol)
  • Sotalol (Betapace)
  • Dofetilide (Tikosyn)

Side effects of antiarrhythmics can include:

  • Nausea
  • Dizziness
  • Fatigue
  • Headache
  • Congestive heart failure 
  • Slow or abnormal heartbeat

We usually also recommend taking a blood-thinning medicine to help prevent strokes, such as the anticoagulant warfarin (Coumadin). 

For those who can’t tolerate warfarin, alternatives include:

  • Dabigatran (Pradaxa)
  • Aspirin
  • Clopidogrel (Plavix)


Sometimes atrial fibrillation doesn’t get better with cardioversion and medications. We may recommend one of these procedures for you.

Ablation. A small area of the heart’s electrical system is turned off. We will:

  • Thread tiny wires into a vein that leads to the heart. 
  • Use an X-ray to track the wires into the proper position.
  • Heat the wire’s end to turn off or disable (ablate) the tissue or node sending the irregular signal.

Patients are often awake during the ablation procedure. We numb the area where the wire enters the body. Ablation usually takes 2 to 4 hours. Afterward, we carefully monitor you as you recover. 

Heart surgery. An open-heart surgery called the maze procedure is often used. The surgeon creates scar tissue, which blocks the abnormal electrical signals causing atrial fibrillation. 

Surgery is used only when all other options haven’t worked. It would be done at the same time as another heart intervention, such as valve replacement or bypass surgery. 

After open-heart surgery, you would stay in the hospital for several days to recover.

Lifestyle Recommendations

Because atrial fibrillation often results from heart disease, making heart-healthy choices can improve your symptoms. You’ll also lower your risks for heart attack and stroke. We can help you find resources and support. 

Start by making one of these changes that means the most to you. As you succeed, you can gradually make other changes.

  • Quit smoking or don’t start. Quitting tobacco can quickly reduce your risk of stroke and heart attack. Don’t smoke marijuana. Recent research shows that it raises risks for some heart conditions. Ask your doctor about resources to help you quit.
  • Eat a heart-healthy diet, including plenty of fish, fruits, vegetables, beans, high-fiber whole grains, and “good” fats, such as olive oil. Avoid saturated and trans fats (in fast foods and many snack foods).
  • Exercise on most days.
  • Control your cholesterol and blood pressure levels. If you have diabetes, keep your blood sugar in your target range.
  • Learn to manage stress. Stress can put extra demands on your heart.
  • Limit your use of caffeine, alcohol, and other stimulants.
  • Lose weight (if needed).
  • Avoid the flu. Get a flu vaccination each year.

Related Health Tools:

Interactive Programs
Prepare for Your Procedure

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.