At a Glance

Q: How can I tell if I have atrial fibrillation?
A: AFib may cause fluttering, fatigue, or dizziness, but up to 30% have no symptoms. Find out how it’s detected and treated.

• AFib affects blood flow in the atria.
• Wearables and exams can spot silent AFib.
• Causes include age, sleep apnea, and alcohol.

---

Terry was working in her yard one day when she noticed she felt a little weak and dizzy. She is 62, in fairly good health, but it was a warm day, so she just sat down to rest and assumed she’d overdone it a bit.

A few days later, she was folding laundry and felt the same sensation, only this time she could tell her heart was acting strangely – it felt like a fish was flopping around in her chest. She was light-headed and very tired. Something was wrong, and this time the hot sun couldn’t be the culprit.

Terry’s daughter decided she should get this checked out. She took Terry to the emergency room, where they learned she had a type of irregular heartbeat called atrial fibrillation (AFib).

What AFib is

A regular heartbeat has a steady frequency and a consistent time between each beat. It is smooth and rhythmic, increasing and decreasing with the demand for blood, based on the level of physical activity.

During atrial fibrillation, the heartbeat is irregular; in this case, it is no longer beating evenly. It is out of sync.

This means the flow of blood is sluggish and moving more slowly in the top chambers of the heart (atria). This slowly moving blood can potentially create clots inside the heart chamber. If a clot forms and travels to the brain’s blood vessels, it could block vital blood flow to the brain, which could result in a stroke.

The Centers for Disease Control and Prevention estimates that up to 12 million people in the United States will have atrial fibrillation by 2030.

What AFib feels like

AFib can affect everyday activity in a number of ways. In extreme cases, the patient feels tired and short of breath with everyday activity. They get winded quickly and fatigued from even the most basic daily chores. And there are many people who, like Terry, have atrial fibrillation and never even know it, attributing their symptoms to over-exertion or just being out of breath due to age or weight.

Many patients find out they have the condition from a wearable device like a smart watch, after having a routine medical exam, or while being treated for some other condition. “Up to 30% of people have no symptoms, and we diagnose the problem by chance,” explained Sameh Khouzam, MD, a cardiac electrophysiologist for Kettering Health. “Many people will feel something in their chest and don’t know what it means, so they go to the emergency room.”

What causes AFib

The causes of atrial fibrillation are widely debated, and it cannot be prevented entirely. Age is known to be a major factor in the development of the disorder. Sleep apnea (often suspected due to daytime sleepiness) or snoring while sleeping can trigger AFib. Someone with these conditions should be checked for atrial fibrillation because treating one may help the other.

There are things people can do to reduce their risk. Maintaining a healthy weight and blood pressure can help, although there are instances where people with perfect blood pressure still have AFib. Limiting alcohol consumption is also an important factor in controlling the condition.

How AFib is treated

Once diagnosed, treatment for atrial fibrillation varies based on the situation, but the most typical treatments are medication or ablation.

“There are several different types of medications that can be used to treat AFib, but in general, those have about a 40% success rate of keeping people in a normal rhythm,” said Dr. Khouzam.

An ablation is accomplished in one of three ways: using radio frequency (heating), cyroablation (freezing), or pulsed field ablation of the affected tissue to effectively isolate the AFib triggers to prevent these misfires from traveling to the rest of the heart. These procedures involve going through veins on the side of the groin, up to the left atrium of the heart.

In AFib, pulmonary veins (the blood vessels that drain blood from the lungs to the left atrium) have a misfire or “short circuit” around them, which travels to the rest of the heart. In this case, the procedure will control the abnormal signals around these veins and create an electrical roadblock to prevent the heart from going out of normal rhythm.

Dr. Khouzam notes that ablation procedures have about a 70-80% success rate, but the sooner a patient sees a healthcare provider, the better. “If a patient has been in AFib for a long time, say for more than a year, the success rate of the procedure is greatly reduced.”