Atrial Fibrillation: Know the Warning Signs

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We rely on our hearts to keep perfect time—to measure out the rhythm of our daily lives in a dependable way. When that rhythm falters, it’s often a sign of atrial fibrillation (AFib), the most common type of abnormal heart rhythm signaling.

Known as arrhythmia, untreated AFib can lead to serious health problems, including stroke and heart failure.

It’s important for everyone to learn the dangers and warning signs of AFib, said Sumeet Chugh, MD, director of the Center for Cardiac Arrest Prevention at the Smidt Heart Institute, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research at Cedars-Sinai and a global expert in cardiac electrophysiology.

The good news: You can prevent AFib. And if you are diagnosed, monitoring can improve health outcomes and prevent serious complications.

The moment you hear the words “atrial fibrillation,” that’s the time to start asking what’s next. Seeing the right specialist sooner rather than later can change the trajectory of the disease.

“Today, there are more options than ever before to easily and effectively treat AFib, particularly for older adults who may not have been candidates for certain treatment options previously,” said Archana Ramireddy, MD, a clinical electrophysiologist at the Smidt Heart Institute.  

Here are evidence-based tips for managing AFib.

Tip #1: Don’t Panic

“The first thing to know is you shouldn't panic if you get this diagnosis,” Chugh said.

More than a decade ago, as head of a World Health Organization panel studying arrhythmias, Chugh helped develop a process to estimate the number of people experiencing AFib globally. The figure he and his colleagues arrived at was about .5%. Since then, that number has roughly doubled, largely due to an aging population.

“The earlier we recognize it, the more options we have to reduce long-term risks like stroke, heart failure and cognitive decline,” said Ramireddy. “AFib becomes increasingly common with age, but it’s not benign.”

Tip #2: Know the Warning Signs of AFib

Many people expect AFib to produce dramatic symptoms—a racing heart, palpitations, chest pain or shortness of breath. While those symptoms do occur with AFib, older adults and women are more likely to experience subtle or atypical warning signs, such as:

• Persistent fatigue
• Exercise intolerance
• Trouble concentrating (brain fog)
• Waking up in the middle of the night feeling sick
• Anxiety

“These symptoms are often dismissed as normal aging, stress or hormonal changes associated with perimenopause and menopause,” said Ramireddy. “Some patients are treated for anxiety or sleep disturbances for years before discovering they actually have AFib.”

Unfortunately, delays in diagnosing AFib can lead to serious complications, ranging from an increased risk of cognitive decline to stroke and heart failure. So, if something doesn’t feel quite right, it’s important to raise the issue with your healthcare provider and ask for a referral to electrophysiology or cardiology for further investigation. ‍

Tip #3: Lifestyle Changes and Medical Treatment Can Improve AFib

Lifestyle choices play an important role in AFib risk. High blood pressure, obesity and alcohol consumption are key contributors. Weight loss, regular exercise, good sleep and limiting alcohol can lower your risk of developing AFib. If you already have AFib, improving your health can also reduce the burden of the disease.

In clinical trials, as participants lost weight, the signs of AFib diminished, and in some cases, it went away completely.

“AFib risk is a tapestry, a series of individual but interconnected threads that form a picture and tell a larger story,” said Chugh. “If you eat well and exercise, you can avoid obesity. If you avoid obesity, you can avoid sleep apnea—another risk factor for AFib.”

Lifestyle measures alone may not be enough once AFib sets in. Instead, most patients benefit from a combination of lifestyle changes and medical treatment.

“Once the heart has had a ‘taste’ of AFib, it’s more likely to revert to it,” Ramireddy said. “That’s why early detection and rhythm-focused treatment are so important.”

Tip #4: Lean on New Detection and Treatment Techniques

Diagnosis today is simpler than most patients realize. Newer technologies, including wearable devices and extended ECG monitors are helping physicians detect AFib sooner than ever before. Smartwatches and patch-style heart monitors can identify intermittent or nighttime AFib that might otherwise go unnoticed.

Treatment options also have evolved. In addition to medications such as beta blockers, anticoagulants and antiarrhythmics, catheter ablation is now considered first-line therapy for many patients. Newer ablation techniques are safer, faster and more effective than in the past, making them a reasonable option—even for older adults.

“We work with patients to optimize their risk factors and work toward a common goal of keeping them in normal rhythm,” Ramireddy said. “That’s what offers the greatest protection against long-term complications.”

Tip #5: Know the Latest Treatment Options for AFib

Age remains one of the biggest risk factors for AFib, and experts expect diagnoses to rise sharply as the population continues to age. Currently, more than 10 million Americans are living with AFib, and that number is projected to grow in the coming years.

But AFib doesn’t have to prevent you from living a full, active life, regardless of your age.

Procedures once considered too risky for older adults are now shorter, safer and increasingly a first-line option, even for older adults. In some cases, physicians can even combine AFib ablation with stroke-prevention procedures during the same visit.

“People are aging differently than they did 20 years ago,” said Ramireddy. “Many older adults are active, independent and excellent candidates for treatments that restore normal rhythm and reduce their risk for long-term complications.”

No matter your age or medical history, detecting AFib early can make a critical difference. AFib is easier to treat when it’s caught close to onset, before it becomes persistent.

“The moment you hear the words ‘atrial fibrillation,’ that’s the time to start asking what’s next,” said Ramireddy. “Seeing the right specialist sooner rather than later can change the trajectory of the disease.”