Atrial fibrillation is an irregular and often fast heart beat that can cause poor blood flow. Usually known as AFib, it is becoming more common. In addition, this condition may affect people at younger ages.
In this Q&A, Georgios Syros, MD, a cardiologist and Director of Arrhythmia Services at Mount Sinai Queens and Mount Sinai Brooklyn, explains the symptoms of AFib, why it is important to see a doctor, and how something as simple as an Apple watch can help.
Georgios Syros, MD
Why are more people diagnosed with AFib?
More people are being diagnosed with AFib these days for a couple of reasons. First, the population is aging, and the older you are, the greater the chance you have of developing AFib. Second, we are seeing increasing rates of obesity and diabetes, and these conditions can also lead to an irregular heartbeat. Third, there is more public awareness of AFib. People know that when they feel symptoms, such as heart palpitations, they should seek medical help immediately.
And why more young people?
With young people, there is an additional reason for the increased rates of diagnosis: technology. More young people are wearing devices like the Apple watch, which help us diagnose AFib earlier, often before there are any symptoms. All of this is to the good. The earlier we diagnose AFib, the easier—and more effective—the treatment.
What are the most important symptoms I should look for?
There are a lot of symptoms of AFib. The most common is having a sense of a fast, fluttering heartbeat, which we call heart palpitations. You might also feel dizziness, fatigue, chest pain, shortness of breath, weakness, lightheadedness, or an inability to exercise. Some people who have AFib don’t notice any symptoms. In fact, if we tell them they have AFib, they respond, “But I feel fine.” That usually just means we are catching it earlier than if we waited until they felt symptoms or, unfortunately, a stroke.
Why is it important to see a doctor if you think you might have AFib?
The main issue with AFib is that it can cause a stroke. AFib is responsible for about one in four strokes among people over 80 years old. If AFib is untreated, it can also lead to other problems, including heart failure, blood clots, and even dementia. But if we diagnose and treat AFib early on, there is a greater chance we can get it under control.
What causes AFib?
There are a number of causes of AFib. They include:
- obesity
- genetics
- consuming too much alcohol
- increasing age
- high blood pressure and high blood sugar
- structural heart disease
- sleep apnea
How can I avoid developing AFib?
You can’t do anything about age or genetics, but there are some things you can do to avoid getting AFib. Obesity is a major cause of AFib, and it has been proven that weight loss and exercise can be a powerful combination to help people prevent the incidence of AFib. Another cause of AFib is sleep apnea. Treating sleep apnea, either with lifestyle changes such as weight loss, or with a continuous positive airway pressure machine, also called a CPAP, can help decrease the incidence of AFib. Another cause of AFib is excessive alcohol, so cutting down your drinking of alcohol can lower your chances of developing this condition as well. Stopping smoking can help. It is also a good idea to eat a heart-healthy diet. That means cutting down on salt, saturated fats, transfats, and cholesterol. You can also talk to your doctor about managing your high blood pressure.
How do you diagnose AFib?
We diagnose AFib with an electrocardiogram, known as an EKG or ECG. We may also do blood tests to see if there are any other issues that might be causing the arrhythmia. But the definitive test is the electrocardiogram. To do this test in our office, we put sticky patches or electrodes on your chest and sometimes arms and legs. The electrodes are connected to a computer, which shows us how your heart is beating. We can also use other types of electrocardiograms, including a wearable device called a Holter monitor, an at-home machine, or a smart watch.
How do you treat AFib?
One approach is with medications. We use several types of medications. Blood thinners prevent blood clots, which cause strokes. Calcium blockers and beta blockers slow the rate at which your heart pumps blood throughout the body. Other medications can restore a regular heartbeat. But all of these approaches come with side effects.
Another method, if it is appropriate for you, is an electrophysiology procedure called an ablation, a procedure in which small, malfunctioning spots in the heart are targeted and eliminated, and this can improve symptoms. The latest form of this procedure is pulsed field ablation, or PFA. This approach was approved by the U.S. Food and Drug Administration in January 2024. It uses short bursts of high energy (rather than heat or cold, which are the older approaches). The bursts of energy let us precisely target the cells that are causing AFib and render them inactive. This approach is faster than the others, which means you are under anesthesia for less time. It is also safer. Depending on the situation, we may even likely be able to do the PFA as an outpatient procedure, meaning you can go home after the operation rather than spend the night in the hospital. The fact that the approach is faster also means we can treat older patients than we used to be able to. If you develop AFib these days, we’re much better position to help you now than we were 20 years ago.
