Atrial fibrillation: The Science and Seriousness

You may have heard of someone having a heart condition called arrhythmia, which is characterised by the heart beating too fast, too slowly, or in an irregular fashion. The most common type of arrhythmia is atrial fibrillation (AFib), a heart disorder which is caused by the abnormal beating of the heart’s upper chambers (atria).

Normally, your heart’s natural pacemaker — the sinoatrial node — generates regular electrical signals, which in turn make the heart chambers contract and pump blood. But when these electrical signals are fired irregularly, the upper heart chambers (atria) also contract haphazardly. The upper and lower chambers (ventricles) do not work in a coordinated way, and blood cannot be efficiently pumped to the rest of the body.

If you have AFib, managing your condition is crucial to prevent life-threatening strokes (block of blood flow to the brain). AFib patients are five times more likely to suffer from a stroke. In India, stroke is a highly prevalent cardiovascular disease, and is one of the two conditions responsible for more than 80% of heart disease-related deaths. Global AFib research shows that the number of people with AFib is lower in India than in other high-income countries. But the true AFib burden is likely to be underestimated due to the lack of well-designed studies in the Indian population. AFib may be undetected in a large number of Indians, which makes these people vulnerable to serious complications.

So, understanding more about the manifestations of AFib and lifestyle-related changes to prevent or manage the condition can help in timely detection and effective treatment.

Types of Atrial Fibrillation

Depending on the pattern of abnormal heart rhythm episodes in patients, AFib can be classified into four types

  • Paroxysmal AFib – The episodes of irregular heart rhythms are brief and can last for seconds or even up to a week. The symptoms in patients may not even be present or may be too obvious. The episodes stop without any treatment. Triggers for these recurrent episodes vary from patient to patient and can include caffeine, stress, alcohol, smoking, certain medications, and exercise.
  • Persistent AFib – The episodes can last for more than a week. Treatment is needed to stop the heart’s abnormal beating and normalize the heart rhythm.
  • Long-standing persistent AFib – The abnormal heart rhythm episodes last for more than a year.
  • Permanent AFib – If the irregular heart rhythm episodes do not respond to treatment, your AFib is then considered permanent.

Signs and Symptoms of Atrial Fibrillation

AFib manifests differently in different people. Some patients have described their symptoms as “a sudden thud in the chest”, “banging against their chest wall”, and “flip-flopping of the heart”. The episodes of irregular heart rhythms can cause the following symptoms:

  • Shortness of breath
  • Dizziness or lightheadedness
  • Pounding or fluttering of your chest due to heart palpitations
  • Extreme fatigue and tiredness
  • Chest pains
  • Changes in heart rate (below 60 beats per minute or above 100 beats per minute)

Risk Factors of Atrial Fibrillation

AFib can be associated with many causes, some of which are listed below:

  • Older age – Older people are at a higher risk of developing AFib, especially those over 65 years.
  • Family history – There may be a genetic element to AFib. So, if someone in your family has AFib, chances are you might develop it as well.
  • Hypertension – High blood pressure, or hypertension, has been shown to be behind about 1 in 5 AFib cases.
  • Unhealthy habits – Behaviours like smoking and high alcohol consumption can increase your risk of AFib.
  • Underlying heart conditions – If you already have a pre-existing heart disorder like coronary heart disease, heart failure, or structural heart disease, you may be more likely to also develop AFib.
  • Other medical conditions – There are certain conditions that may increase your likelihood of AFib like diabetes, chronic kidney disease, obstructive sleep apnea, and thyroid problems.

As you can see, the various AFib risk factors are related to lifestyle, genetics, and medical history. It is important to be vigilant about the possibility of developing AFib if you relate to one or more of these factors.

Diagnosis of Atrial Fibrillation

If you frequently experience some of the symptoms linked with AFib, then it is best to consult your doctor. To confirm an AFib diagnosis, your doctor will ask you questions about your symptoms, medical history (if they don’t already have it), and lifestyle. Here are some tests your doctor may ask you to take:

  • Blood test – This may be done to rule out problems related to potassium and thyroid levels in the body.
  • Echocardiography – This produces moving pictures of the heart and provides information about any structural abnormalities and blood clots in the heart.
  • Electrocardiogram (ECG) – This test assesses the electrical activity in your heart. The recordings of the electrical signals appear as moving line tracings on a strip of paper or digitally on a screen. But because of the infrequent nature of AFib episodes, your doctor may ask you to wear a Holter monitor, which is a portable ECG device, to capture AFib episodes while you go about your day-to-day activities.
  • Stress test/Exercise stress test – This test helps evaluate your heart’s function during exercise.

Your doctor may use a combination of these tests to make an informed diagnosis and a suitable treatment plan.

Managing Atrial Fibrillation

You may be afraid that AFib episodes could possibly strike at key moments like during a job interview, during an examination, during a big presentation at work, or while taking care of your toddler. You may also think an AFib diagnosis needs dramatic lifestyle changes. It is reassuring to know that many AFib patients are still able to go about their daily lives, but with a few precautions. Although AFib is not usually life-threatening, it does need constant monitoring and effective management to prevent the risk of stroke.

Adhering to the medications prescribed by your doctor is of utmost importance. These medications help in normalizing your heart rhythm and rate (antiarrhythmic medicines and beta-blockers) and preventing blood clots (blood thinners). Sometimes, doctors may advise procedures like “cardioversion” (giving the heart electrical shocks to restore normal electrical activity) or “catheter ablation” (destroying heart tissue that is responsible for the abnormal rhythms).

If you have AFib or are at an increased risk of AFib, remember that you can still control the condition rather than letting it control you. Lifestyle changes can be immensely beneficial in helping you manage or prevent AFib. Some simple tips you can follow are below:

  • Quit unhealthy behaviours like smoking and high alcohol consumption as these can be triggers for AFib episodes and also make you more vulnerable to developing the condition.
  • Adopt healthy dietary habits to manage AFib risk factors like diabetes and hypertension. Reducing your salt and refined sugar consumption, avoiding foods high in saturated and trans fats, and eating more fresh fruits and vegetables can go a long way.
  • Manage your stress as it can also be a trigger for AFib episodes. You can do this by meditating, maintaining social interactions with friends and family, and engaging in physical activity. Consult your doctor about a suitable exercise regimen for your AFib condition.

Monitoring your AFib episodes has become much easier now with the introduction of smartphone-enabled ECG devices like AliveCor’s KardiaMobile. This FDA-cleared device allows you to record a medical-grade ECG by placing your fingers on pocket-friendly electrodes. Your real-time ECG appears on your smartphone, which can then be easily emailed to your doctor.

Thus, AFib is a manageable condition with the right lifestyle choices and a sound treatment and monitoring plan. Don’t let AFib take over your life, and don’t take it easy with your heart health!


#1. Which disease generally occurs as a result of AFib?