When Your Heart Goes Pitter-Pat: Could that Flutter Be Atrial Fibrillation?

Atrial fibrillation, also known as aFib, is an increasingly widespread condition in which electrical signals to the heart misfire, causing an irregular heartbeat and inefficient blood flow. It can lead to blood clots, stroke, heart failure and other heart-related complications.

According to the CDC, as many as 6.1 million people in the United States have aFib. Some 2 percent of people younger than 65 have the condition, while about 9 percent of people age 65 and older have it. Projections estimate that by 2030, the number of people in the U.S. with atrial fibrillation will nearly double to 12 million.

Mario Pascual, M.D., an electrophysiologist with Baptist Health Miami Cardiac & Vascular Institute.

 

“It essentially has become a pandemic in this country,” says Mario Pascual, M.D., an electrophysiologist with Baptist Health Miami Cardiac & Vascular Institute. “It’s a serious medical condition that requires proper treatment.”

When you have atrial fibrillation, you might notice a skipped heartbeat, followed by your heart racing. Or you might feel heart palpitations, fluttering or jumping of your heart. But you also might feel nothing. Atrial fibrillation may be so subtle that you don’t detect a change in your heartbeat, although you find you’re sometimes dizzy, weak, tired or breathless.

Even if you’re not sure if you have experienced aFib, you should discuss your risk with your physician. Dr. Pascual is concerned that because the symptoms can be common, people might dismiss them. “I think many times patients don’t realize from their symptoms that they’re in atrial fibrillation.”

What’s Behind aFib?

A normal, healthy heartbeat involves a regular contraction of the heart muscle. A contraction happens about once per second to push blood from the heart’s atria, the two upper chambers, to the ventricles, the two lower chambers. The ventricles then contract and push the blood to the lungs or to the rest of the body.

In a person with aFib, faulty electrical signals make the heart’s upper chambers beat chaotically and irregularly — causing them to be out of sync with the lower chambers. Because the heart is not working efficiently, blood can pool in the atrium, which may lead to clots. If a blood clot breaks free from the heart area, it can travel to the brain and cause a life-threatening stroke.

“People with atrial fibrillation have a five times greater risk of stroke,” Dr. Pascual says. “That is significant. One of the first things we address is how we can prevent that stroke, prevent that blood clot formation.”

AFib that causes the lower chambers to beat too quickly can also cause heart failure, Dr. Pascual notes. This can result from being in aFib for too long, especially with a high heart rate. The heart becomes enlarged and ineffective, making it unable to pump oxygenated blood throughout the body.

“AFib is a big contributor to recurrent hospitalizations due to heart failure exacerbations,” Dr. Pascual says. “AFib is not a heart attack, but it certainly has significant consequences.”

What You Should Know

Atrial fibrillation is a progressive condition, which means that if left unaddressed, the condition can grow worse over time.

If you have intermittent atrial fibrillation that starts and stops, you may feel drained after an episode. But if your heart is in continuous atrial fibrillation, you may not realize it and be aware only that you don’t have as much energy as usual.

“A lot of times aFib symptoms can be very subtle. So things that used to be normal — let’s say cutting the grass, going up a flight of stairs, walking around the grocery store — all of a sudden patients might notice these things are more difficult to do,” Dr. Pascual says.

“Instead of reaching out to a physician to determine why, many people just cut back their activity. If they’re used to walking at a certain pace, they'll slow down. If they’re used to cutting their lawn in one session, now it takes them two sessions. If they’re used to using the stairs, they’ll change to the elevators.”

Dr. Pascual estimates that 60 percent of patients with atrial fibrillation experience such hindrances without realizing the cause.

“There’s certainly some portion of patients who will have very severe and very obvious symptoms such as palpitations, severe shortness of breath, episodes of passing out,” he says. But addressing more subtle symptoms with your physician can lead to an earlier diagnosis and more effective treatment, Dr. Pascual adds.

“It only gets more and more difficult to treat as time goes on,” Dr. Pascual says. “That's an important message.”

Understanding What to Do Next

The risk of atrial fibrillation increases as you grow older. Other health conditions may increase your risk such as high blood pressure, diabetes, untreated sleep apnea, being overweight and inactive, and some other heart conditions.

Certain kinds of arrhythmias can be very dangerous for sport participation and can increase the risk of sudden cardiac arrest.

Because arrhythmias and their treatment can differ, it’s important to be properly diagnosed — which can be tricky. In some cases, arrhythmias can be diagnosed using a routine electrocardiogram, or EKG. But because that test provides only a quick snapshot, it might not always catch aFib. Your physician may ask you to wear a portable heart rhythm monitor for 24-48 hours, or even longer. The extra time provides a better opportunity of detecting an abnormal heart rhythm. You may also be prescribed additional imaging tests such as an echocardiogram, magnetic resonance imaging (MRI), or CT scan.

Arrhythmias, including aFib, are definitely preventable, Dr. Pascual says. Most people can prevent aFib by focusing on healthy lifestyle choices, such as striving for an optimal weight, getting regular exercise, avoiding excessive alcohol consumption and not smoking. Most important, if you think you may have a problem, address it with your doctor — sooner rather than later.

“AFib is progressive, aFib is chronic, and we know that the sooner we offer therapies such as ablation or medication, the better our long-term outcomes are,” Dr. Pascual says. “If we leave aFib alone and don’t treat it for several years on end, outcomes really suffer in those patients. Earlier treatment of atrial fibrillation leads to better long-term outcomes.”

See an animation by the American Heart Association of how atrial fibrillation occurs.