Dear Savvy Senior,
What can you tell me about atrial fibrillation? Every so often, I’ve noticed my heart starts beating rapidly for no particular reason. Is this something I should be worried about?
Heart palpitations can be harmless if they are brief and infrequent. But if you’re experiencing an erratic heart rhythm, you need to get checked out by a doctor for atrial fibrillation, or AFib.
AFib – which is marked by rapid, fluttering beats – can lead to serious complications such as stroke and heart failure, when the weakened heart can’t pump enough blood to the rest of the body.
Normally, your heartbeat follows a steady rhythm as your heart contracts and relaxes. But when you have AFib, the upper chambers of your heart (atria) beat rapidly and irregularly, sending blood to the lower chambers (ventricles) less efficiently. These episodes can last for minutes to hours or longer, and can cause palpitations, lightheadedness, fatigue, and/or shortness of breath. Over time, AFib tends to become chronic.
Age is a common risk factor for AFib, which affects roughly 10 percent of people older than 75. Other factors include genetics, obesity, diabetes, high blood pressure, and alcohol and tobacco use. The condition has also been linked to viral infections, including COVID-19.
If you’re experiencing AFib-like symptoms you need to see your doctor who will listen to your heart and likely recommend an electrocardiogram (EKG) or a treadmill heart test, or you may wear a portable monitor for several weeks to look for abnormal heart rhythms to confirm a diagnosis of AFib. Such tests can help distinguish AFib from less serious conditions that may cause the heart to flutter, like anxiety and stress.
AFib affects some three million adults in the United States, a number that is expected to quadruple in the coming decade as the population ages and risk factors like obesity, diabetes and high blood pressure become even more common. The lifetime risk of developing AFib is greater than 20 percent, yet many people don’t even know they have it.
A growing body of research underscores the importance of lifestyle steps such as exercise, a healthy diet, and limiting alcohol for treating AFib.
Depending on your age and symptoms, your doctor may prescribe drugs to help control your heart rate, like beta blockers such as metoprolol (Toprol XL); and/or rhythm, such as antiarrhythmics like flecainide (Tambocor).
You may also need an electrical cardioversion, an outpatient procedure that delivers an electrical shock to the heart to restore a normal rhythm. You will be sedated for this brief procedure and not feel the shocks.
Catheter ablation is another outpatient treatment for AFib that scars a small area of heart tissue that causes irregular heartbeats. This procedure is becoming more common based on evidence of its safety and ability to normalize the heart rhythm and ease symptoms. Ablations can be effective in people 75 and older, but medication may still be required afterward.
If you’re at higher risk for stroke, you may be prescribed a blood thinner, too. In the past, Coumadin (warfarin) was the only such drug widely available, but it requires monitoring with regular blood tests. Newer anticoagulants, like apixaban (Eliquis) and rivaroxaban (Xarelto), don’t have that requirement and have been shown to be just as effective at preventing strokes.