KNOW WARNING SIGNS OF AFIB AND GET TREATMENT EARLY
When considering problems with the heart, you might first think of clogged arteries that lead to heart attacks. But the heart has an electrical system, which guides how it beats, that can separately go haywire. When that happens, the heart can’t pump in a rhythmic manner and blood flow to organs may be compromised. If this arrhythmia goes undetected or isn’t managed properly, it can cause strokes, heart failure and death.
The most common – and frequently undiagnosed – arrhythmia is atrial fibrillation (AF), also known as AFib. An estimated 3 million to 6 million Americans have it, and studies show that the number will balloon to 12.1 million by 2030 as the population gets older. Recent studies also found that people who had COVID-19 have a higher risk of AFib and other heart diseases, even among those without a prior history of heart problems. And there is growing evidence that AFib significantly increases the risk of cognitive impairment and dementia. That is why it’s important to know the warning signs of atrial fibrillation and to get treatment early: It could save a person’s life.
WHAT IS ATRIAL FIBRILLATION?
Our hearts have four chambers. The two upper ones are the right and left atria, and the lower two are the ventricles. The heart’s electrical activity (via tissues that create electrical impulses) starts in the right atrium and spreads quickly to the left, allowing the atria to squeeze blood forward into the ventricles. Then, the electrical activity spreads to the ventricles, allowing them to contract and push blood throughout the body.
“Normally, the heart has a regular rhythm – like the ticking of a clock,” explained Geoffrey S. Pitt, a cardiologist at Weill Cornell Medicine and director of Cornell’s Cardiovascular Research Institute. “But when someone experiences AF, the irregular [electrical] activity causes the atria to quiver instead of maintaining coordinated pumping. The ventricles still continue to contract but lose their regular clocklike rhythm.”
Quivering of the atria and thwarted blood flow allow blood to pool and form clots in the upper heart chambers. These clots can then dislodge, travel through the bloodstream and obstruct other vessels, including those that supply the brain – causing strokes and sudden death. Studies show that strokes associated with atrial fibrillation can be more severe than strokes from other causes.
WHAT DOES AFIB FEEL LIKE?
Most commonly, patients feel palpitations, a sensation of racing heartbeats, shortness of breath, lightheadedness, weakness and fatigue, said Michael Honigberg, a cardiologist and researcher at Massachusetts General Hospital. Some people may also go on to experience heart failure and symptoms such as weight gain, difficulty breathing, and swelling in the belly and feet.
But some people may be completely asymptomatic. In fact, for 1 in 5 people who have a stroke associated with atrial fibrillation, stroke is the first sign that they even have the condition. Otherwise, AFib might be incidentally discovered during a routine doctor visit.
WHEN SHOULD YOU SEE A DOCTOR?
People experiencing palpitations, shortness of breath, fatigue and lightheadedness should see a doctor, Pitt said.
With the help of electrocardiograms and implanted devices such as loop recorders, physicians can then determine whether the palpitations are from atrial fibrillation or something else. These include generalized anxiety and panic disorder symptoms, medications such as decongestants and asthma inhalers, or overconsumption of substances like caffeine, nicotine and stimulant drugs.
Pay attention to AFib alerts from smart devices, which could provide warning signs to otherwise asymptomatic individuals. “The Apple Watch, Fitbit and AliveCor Kardia can monitor heart-rhythm irregularities and suggest a possible AF diagnosis, but it should be confirmed by a health-care professional,” said Honigberg.
WHAT MIGHT A DOCTOR ADVISE?
There are several treatment options depending on the extent of disease, stroke or bleeding risk, and how well patients can tolerate medications.
“Treatment typically includes a blood thinner to protect against stroke, plus medication to control heart rate or maintain normal heart rhythm,” said Honigberg.
If medications aren’t effective, doctors might advise catheter ablation or cardioversion. In an ablation, the tip of a catheter is used to destroy areas of heart tissue that are the source of irregular heartbeats.
Cardioversion is done by sending shocks through electrodes placed over the chest that can quickly restore a normal heart rhythm.
An “under-discussed” part of managing AFib is lifestyle changes, said Honigberg: “Weight loss and alcohol moderation can be very helpful for reducing or preventing AF episodes.”
Honigberg also pointed out racial and ethnic disparities in AFib treatment and results.
“Data consistently show that white individuals are more likely than other groups to undergo electrical cardioversion or an ablation procedure to prevent AF, and non-white individuals may have worse outcomes – for example, higher rates of stroke,” he said.
Awareness of these disparities and proactively advocating for care are needed to make treatment more equitable.
WHAT CAN INCREASE CHANCES OF AFIB?
Some conditions that contribute to atrial fibrillation are outside our control, while others we can potentially change. It is often associated with high blood pressure and congenital heart disease. One study found that AFib is the most common arrhythmia reported in people hospitalized with COVID-19, with 1 in 10 patients having developed it newly.
Traditional cardiovascular risk factors apply to AFib, including obesity, diabetes and smoking. Some studies show that people with diabetes have a 25% greater risk of developing the condition, and obesity increases the risk by nearly 50%.
Alcohol consumption can also be a factor, with recent studies showing that even a single drink can raise the risk of having an AFib episode.
WHO IS MORE LIKELY TO HAVE AFIB?
Age: In children and healthy adults, atrial fibrillation is rare: Less than 1% adults of adults younger than 55 have it. But as we get older, prevalence nearly doubles with every decade of life. And by the time we are 80, nearly 1 in 10 people have it.
Race and ethnicity: “Research suggests that AF incidence may be highest in white individuals and lowest in Black individuals,” said Honigberg. He cautions, however, that “this may reflect differences in diagnosis rates related to access to health care rather than true differences in AF rates across groups.”
Gender: “While men are more susceptible to developing AF, more women overall have it because women tend to live longer,” said Leslie Cho, director of the Cleveland Clinic’s Women’s Cardiovascular Center. “Also, if you look at all patients with AF, women are at a much higher risk of having a stroke than men, and their stroke symptoms are a lot more severe.”
SHOULD AFIB SCREENING BE ROUTINE?
The main reason to screen for AFib is to identify more individuals with silent atrial fibrillation and start them on blood thinners to prevent strokes. Most doctors screen for the condition only if a patient is symptomatic or has significant family history of AFib. Said Honigberg: “Some people envision AF screening like a routine blood pressure measurement as part of vital signs in an office medical visit.”
But in January, a panel of experts concluded that “current evidence is insufficient to assess the balance of benefits and harms of screening for AF.” The potential harms include anxiety from falsepositive test results and misdiagnoses that lead people with low stroke risk to start anticoagulation therapy that may cause bleeding complications.
Scientists and healthcare professionals are still working out the cost-effectiveness of AFib screening and the details of who would most benefit.
Honigberg said that it may be reasonable to screen older adults with strong risk factors such as high blood pressure, obesity, family history of AFib, or heavy alcohol use.
He also noted that smartwatches and other devices that monitor one’s health are “a net good thing, if we can determine how to best use them so that they increase diagnoses of silent AF and help prevent strokes.”