Dear Savvy Senior: What can you tell me about atrial fibrillation? Every so often, I’ve noticed my heart starts beating rapidly for no particular reason. Is this something I should be worried about? — Anxious Annie
Dear Annie: Heart palpitations can be harmless if they are brief and infrequent. But if you’re experiencing an erratic heart rhythm, you need to get checked out by a doctor for atrial fibrillation, also referred to as AFib.
Atrial fibrillation — which is marked by rapid, fluttering beats — can lead to serious complications such as stroke, and heart failure when the weakened heart can’t pump enough blood to the rest of the body.
Normally, your heartbeat follows a steady rhythm as your heart contracts and relaxes. But when you have atrial fibrillation, the upper chambers of your heart (atria) beat rapidly and irregularly, sending blood to the lower chambers (ventricles) less efficiently. These episodes can last for minutes to hours or longer and can cause palpitations, lightheadedness, fatigue and shortness of breath. Over time, atrial fibrillation tends to become chronic.
Age is a common risk factor, and the condition affects roughly 10% of people older than 75. Other factors include genetics, obesity, diabetes, high blood pressure and alcohol and tobacco use. Atrial fibrillation has also been linked to viral infections, including COVID-19.
Get a diagnosis
If you’re experiencing symptoms of atrial fibrillation, see your doctor. The doctor will listen to your heart and likely recommend an electrocardiogram or a treadmill heart test, or you might wear a portable monitor for several weeks to find evidence of abnormal heart rhythms, to confirm a diagnosis of atrial fibrillation. Such tests can help distinguish atrial fibrillation from other conditions that can cause the heart to flutter, such as anxiety and stress.
Atrial fibrillation affects some 3 million adults in the United States, and that number is expected to quadruple in the coming decade as the population ages and risk factors such as obesity, diabetes and high blood pressure become even more common. The lifetime risk of developing the condition is greater than 20%, yet many people don’t even know they have it.
A growing body of research underscores the importance of lifestyle in tackling the condition, such as exercise, a healthy diet and limiting alcohol.
Depending on your age and symptoms, your doctor might prescribe drugs to help control your heart rate, with beta blockers such as metoprolol (Toprol XL), and anti-arrhythmics such as flecainide (Tambocor).
You might also need an electrical cardioversion, an outpatient procedure that delivers an electrical shock to the heart to restore a normal rhythm. You will be sedated for this brief procedure and not feel the shocks.
Catheter ablation is another outpatient treatment. It scars the small area of heart tissue that causes irregular heartbeats. This procedure is becoming more common since evidence shows it is safe and effective in normalizing the heart rhythm and easing symptoms. Ablations can be effective in people 75 and older, but medication may still be required.
If you’re at higher risk for stroke, you may be prescribed a blood thinner, too. In the past, Coumadin (warfarin) was the only such drug widely available, and it requires monitoring with regular blood tests. Newer anticoagulants, such as apixaban (Eliquis) and rivaroxaban (Xarelto), don’t have that requirement and have been shown to be just as effective at preventing strokes.
Jim Miller is a contributor to NBC-TV’s “Today” program and author of “The Savvy Senior.” Send your questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070; or visit savvysenior.org.