What to know about atrial fibrillation symptoms and treatments
Atrial fibrillation, commonly called A-fib, is a heart rhythm disorder in which the heart’s upper chambers do not beat in sync with the lower chambers, leading to an irregular or quivering heartbeat. The condition can be alarming in the moment, and it can also matter medically over time because it can promote blood pooling in the heart that may lead to clots, stroke and heart failure. Some people learn they have A-fib only after using medical devices or after symptoms prompt them to seek care.
Radiologist Daniel Moore, who is now 60, described first noticing what he later recognized as A-fib when he was about 30. “It felt like a bunny rabbit trying to jump out of my chest,” Moore said. He reported symptoms that affected everyday activity, including trouble exercising and feeling light-headed when standing up. For people with A-fib, heart rates can also rise sharply, with the heart sometimes reaching more than 200 beats per minute.
Not everyone experiences the same warning signs. Some people may not realize anything is wrong, while others report symptoms such as a pounding heartbeat and shortness of breath. Moore said that when he was in A-fib, he had “no exercise tolerance,” adding, “I can’t run. Walking is tiring faster. I get a little light-headed standing up.”
A-fib is often described as not usually life-threatening by itself, but its erratic rhythm can increase the risk of serious complications. The disorder can allow blood to pool in the heart and create clots that can travel to the brain and cause strokes. Experts also note that A-fib can increase the risk of developing ventricular fibrillation, which is more serious.
Diagnoses are becoming more common, experts say, with smartwatches and other devices cited as one reason. The American Heart Association has found that more than half of people with A-fib did not know about the condition before they were diagnosed. Some researchers also estimate that more than 10 million Americans have A-fib, most of them older, and they expect the condition to become even more common.
Researchers say the underlying contributors to A-fib include damage to the heart’s upper chambers and its electrical signaling, with genetics sometimes playing a role. Other contributors they cited include high blood pressure, diabetes, stress, sleep apnea, smoking and alcohol. Dr. T. Jared Bunch of the University of Utah said about 70% of A-fib cases involve people 65 and older, noting the ways those harms accumulate over time.
Viruses can also play a role, experts said, by affecting proteins tied to the heart’s electrical signals or by triggering an immune response that damages heart tissue. COVID-19 is among the viruses experts listed as possible contributors in some patients. They also pointed to studies finding no link between A-fib and COVID-19 shots, with Dr. Jose Joglar, a Dallas-based expert who helped author American Heart Association guidelines, stating that finding.
Treatment can vary based on a patient’s needs, but doctors say there is no cure for A-fib. One approach is cardioversion, which uses an electric shock delivered by a defibrillator to restore heart rhythm. The procedure is often successful, but it can sometimes work only temporarily. For some patients, doctors may recommend implanted devices: pacemakers to regulate heart rhythm, or a Watchman device designed to close off a clot-prone area of the upper heart.
Ablation is another key option. Doctors perform ablation by using heat, cold or electric pulses to target areas of the heart and create scars that block faulty electrical signals. Laurence Epstein, of Hofstra University and Northwell Health, said, “We’re miles beyond where we used to be” in treating A-fib and that “the technology has really evolved.” He and other clinicians described how ablation techniques have become more advanced and have become a first choice for some patients, including those with heart failure.
Medications can also play a role, either to regulate heart rhythm or to thin the blood to reduce stroke risk. Doctors say these treatments can bring problematic side effects, which can affect how clinicians choose among options. Experts also emphasize prevention and early evaluation for people who notice symptoms.
To lower the risk of developing A-fib, doctors said people can focus on a healthy lifestyle, including exercising, getting enough sleep, eating a healthy diet, managing high blood pressure, and avoiding tobacco products and alcohol. They also said physicians have long warned about excessive caffeine, while noting that at least some evidence suggests that small amounts may be acceptable; the Associated Press story cited a small study in which patients averaging one cup a day had less recurrence of A-fib symptoms than those who abstained entirely.
Amy Stahley, who was first diagnosed three years ago and described her experience as urgent, said it matters to get symptoms checked. She said she went to bed one night and her heart began racing to more than 150 beats per minute, prompting her to go to a hospital. “If you’re feeling a little off, get it checked out,” Stahley said, adding that she is a nurse and dean at Davenport University’s College of Health Professions in Michigan. Moore agreed that prompt care matters, saying, “The longer you stay in A-fib, the more likely you are to stay in it for life.”