Atrial fibrillation or AFib starts with an abnormal heart rhythm that originates in the top chambers of the heart. The word itself refers to the fact that the two upper chambers, or atria, are no longer beating in the regular, coordinated manner. The electrical activity of the atria becomes disorganized and this may cause a sensation of rapid or irregular heartbeat.
Symptoms of atrial fibrillation may not always be apparent. While one person may clearly feel that something is wrong, another person may not feel a racing heart or any kind of fluttering sensation at all. A person can remain unaware of having AFib until a routine examination or heart rhythm test.
It can be difficult to distinguish between minor irregularity and full-blown AFib and feeling well does not always mean that you are not experiencing AFib. When there are recurring symptoms, or other heart irregularities occur alongside symptoms, a medical evaluation can help to determine the precise cause.
What Happens to the Heart During Atrial Fibrillation?
The normal electrical pattern in healthy heart tissue allows the chambers of your heart to open up and close in unison. In AFib, the electrical signals in the atria are out of sync.
As a result:
• The atria may begin to quiver or fibrillate instead of beating normally.
• The heartbeat may become irregular in rhythm, too fast, or both.
• Blood pumping from the atria may become less efficient.
• Blood may pool in the atria, which can lead to clot formation.
AFib (or atrial fibrillation) also increases clot and stroke risks, so it’s essential that physicians not treat the condition based on particular symptoms.
Early Signs of Atrial Fibrillation?
A Fast or Irregular Heartbeat
For many people, the first sign of AFib will always be related to the heartbeat. You may suddenly feel like your heart is:
- Racing
- Fluttering
- Pounding
- Thumping
- Beating unevenly
- Skipping or changing rhythm unexpectedly
Some people describe this sensation as feeling like their heart is fluttering. Others are more likely to notice a pounding sensation, like someone is knocking on their chest.
However, palpitations have many other causes. Caffeine, stress, medications, skipped heartbeats, other rhythm problems and a number of other causes can all contribute to this sensation. Only an ECG can confirm whether an abnormal rhythm is actually due to AFib.
Breathlessness During Everyday Activity
Shortness of breath can accompany AFib. You may feel breathless:
- While walking at a comfortable pace
- Climbing stairs
- During physical activity
- Doing everyday tasks
- Occasionally, even while resting
You may not always realize that you are experiencing breathlessness unless the change is dramatic. You may go from being able to walk for 20 minutes without stopping to being unable to stand up from a chair without feeling exhausted.
Shortness of breath can occur for other reasons besides atrial fibrillation as well. Pulmonary conditions, anemia, heart disease and several other causes can contribute to this sensation. The additional symptoms and your personal medical history play a crucial role in determining the cause.
Unusual Tiredness
Fatigue is another nonspecific symptom that can potentially accompany AFib.
You may find that things that used to be easy now cause you to feel excessively tired. You may feel low energy levels even when you have received a sufficient amount of sleep or find that you are unable to maintain your usual level of physical activity.
AFib may reduce the efficiency of the heartbeat, especially when the heart rate is too fast, but on its own, fatigue is not a sign of an abnormal heart rhythm. Thyroid conditions, sleep deprivation, anemia and several other causes can also contribute to this sensation of tiredness.
Dizziness or Feeling Lightheaded
If AFib affects your heart's normal rhythm, you might feel dizzy or lightheaded.
The sensation may be similar to:
- Feeling slightly off balance.
- Feeling like you are about to faint.
- Your head is floating.
- Your knees feel weak.
The world may appear strange or confusing.
Palpitations or irregular heartbeats with dizziness should be discussed with a doctor.
Extreme dizziness, fainting or feeling faint, and lightheadedness with other neurological symptoms should be considered an emergency and patients should immediately go to the ER.
Reduced Ability to Exercise
Sometimes the change is less dramatic. You may find that your ability to engage in physical activity has declined. For example:
- You may notice that you become out of breath more quickly than before.
- You may also need more rest when you are physically active.
- Stairs suddenly become an enormous challenge.
- Your heart begins to race sooner than before.
- You feel breathless sooner than you used to.
A change in physical performance has many potential causes. If these symptoms appear suddenly or last for a long time, it is important to seek medical checkup to find out the underlying cause.
Weakness
Weakness may be a symptom of AFib. It tends to accompany rapid heartbeat sensations. However, weakness can also vary greatly in terms of presentation. You may feel that your body is not working normally in general, or that one side of your body is suddenly weaker than the other.
There is a major difference between weakness and numbness or sudden weakness affecting one side of the body. The latter can be a sign of stroke and requires emergency medical attention.
Chest Discomfort
Chest discomfort should never be ignored.
People with AFib may also experience a sensation of heaviness or of pressure on the chest. This sensation is also commonplace for those having a heart attack, or, for that matter, any of a variety of cardiovascular ailments.
Chest pain could be a sign of a heart attack. The American Heart Association advises taking chest pain seriously, particularly if it is accompanied or characterized by shortness of breath, sweating, nausea, or pain radiating to other areas of the body.
Can You Have Atrial Fibrillation without Knowing?
Yes. This is one of the reasons AFib can be so concerning. A person may not realise that they have had an episode at all. In other cases, AFib may only present intermittently.
In some cases, the individual may have the sensation of palpitations followed by a brief period of irregular rhythm, but the heart reverts to normal just before the individual reaches the hospital.
It doesn’t mean nothing is happening. This is exactly why recognizing the signs of atrial fibrillation early, even when an episode is brief or mild, matters more than waiting for something extreme to happen.
When symptoms are occasional, longer-term heart rhythm monitoring can sometimes be more useful than a short ECG.
Why Do AFib Symptoms Come and Go?
Not everyone who has AFib will experience constant, irregular heartbeats.
Paroxysmal AFib, for example, occurs in episodes that often come and go on their own and may be stopped using treatment. Many people may experience episodes that are irregular or infrequent, while others may experience more regular episodes. Persistent AFib, on the other hand, rarely goes away and may need to be treated with medication or procedures.
So, this explains why somebody might get an hour of irregular heartbeats and then a normal rhythm. AFib episodes should still be investigated by a medical professional even if they stop before you reach the hospital.
What Can Trigger or Contribute to AFib?
AFib can have many different causes. Sometimes the cause is unclear. In other cases, AFib can occur alongside other health problems or conditions.
Some of the key risk factors for AFib include:
• Hypertension
• Heart disease
• Coronary artery disease
• Heart valve problems
• Diabetes
• Sleep apnea
• Obesity
• Smoking
• Drinking alcohol
• Heart attack
• Aging
• Family history of AFib
In some cases, thyroid disorders and heart surgeries are also possible.
Although having a risk factor does not necessarily mean that you have AFib, it may help your doctor better understand your symptoms and guide you in terms of which treatment is most appropriate for your case.
When Should You Get Your Heart Rhythm Checked?
A medical evaluation is always a good idea in cases of regularly occurring irregular heartbeats and strange symptoms.
The following are among the most common signs of atrial fibrillation worth raising with a doctor if they occur regularly:
• Palpitations
• Unexplained breathlessness
• Recurring dizziness
• Fatigue
• Reduced ability to exercise
• A pulse that feels irregular
• A wearable device repeatedly reporting an abnormal rhythm
But it’s not necessarily the intense or presenting symptoms that should be causing you to seek immediate care. If you are experiencing the occasional palpitations or fatigue for no known reason, you still need to schedule an appointment to have your heart checked out.
How Is Atrial Fibrillation Diagnosed?
Symptoms may make you wonder if you have AFib.
The simplest test to diagnose AFib is an ECG, which records the electrical activity of your heart. If AFib is the cause of the symptoms, but you experience the episodes irregularly, your doctor may suggest longer-term heart rhythm monitoring.
Common Diagnostic Tests Include:
-
ECG
An ECG is a diagnostic procedure that records the electrical activity of the heart. It is usually a brief procedure and is frequently the first test used to investigate AFib. -
Holter Monitor or Other Wearable Monitors
At TheHeart.ae, this kind of extended monitoring is commonly used to confirm a diagnosis in patients whose symptoms come and go unpredictably. -
Smartwatch or Other Wearable Device Data
Smartwatch data can be helpful in identifying an abnormal heart rhythm, but it should not be used to diagnose AFib. -
Echocardiogram
An echocardiogram can help to assess the structure and function of the heart. It may be recommended as part of the diagnostic process.
Why Should AFib Be Diagnosed Early?
AFib is an irregular heartbeat. When you are in AFib, your atria are not beating regularly or strongly enough to move blood efficiently through your heart.
The blood clot could also dislodge and move to the brain, which might result in a stroke. AFib also raises the chance of stroke more than other people who don’t have AFib. For this reason, stroke prevention should always be a concern when it comes to AFib.
Not all AFib patients have the same risk of having a stroke. Doctors will determine their patients’ risk based on how old they are, their blood pressure, if they have diabetes, their ethnicity, history of stroke, a transient ischemic attack (TIA) and several other risk factors. Addressing these risk factors is important in treating AFib.
How Is Atrial Fibrillation Treated?
There is no one-size-fits-all approach to AFib treatment. AFib treatment typically entails a mix of medication and lifestyle modification plus procedures.
The primary goals of treatment typically include:
• Slowing down the heart rate
• Restoring or maintaining a normal heart rhythm
• Reducing the risk of blood clots
• Managing existing conditions
• Controlling risk factors
• Preventing future episodes
Drugs form a significant part of AFib treatment, but other treatments such as cardiovascular procedures may also be recommended based on the type and severity of AFib.
What Is Atrial Fibrillation Ablation?
Atrial Fibrillation ablation is a cardiovascular procedure used to treat AFib. The electrophysiology team accesses the heart with thin tubes or catheters and then utilizes radiofrequency or cryotherapy energy to modify the tissue responsible for the abnormal heart rhythm.
There are three common approaches to AFib ablation:
• Radiofrequency ablation: Radio waves are used to modify the heart tissue.
• Cryoballoon AFib ablation: Cryotherapy energy is used to modify the heart tissue
• Pulsed Field Ablation (PFA): The latest non-thermal energy source to destry the tissue
The modified tissue prevents irregular heart signals from being sent. This can reduce the risk of further episodes of AFib.
The AFib ablation procedure is not always indicated even if a person is diagnosed with AFib. In some cases, medication forms of treatment or other non-invasive procedures may be recommended instead. For some people, AFib ablation may be an effective treatment for AFib symptoms.
When Might Atrial Fibrillation Ablation Be Considered?
The decision to pursue atrial fibrillation ablation depends on your personal circumstances and medical history. A specialist will always take this into account before recommending any treatment.
Atrial Fibrillation ablation may be considered if:
• AFib episodes are particularly frequent.
• AFib significantly impacts your quality of life.
• AFib symptoms persist despite medication.
• You have an increased risk of stroke.
• You have additional cardiovascular conditions.
• Your heart function is abnormal.
• You are experiencing significant AFib-related complications.
• You are interested in a minimally invasive procedure for AFib.
There is no particular point when the ablation of Atrial Fibrillation becomes mandatory. You should consult a cardiac electrophysiologist to discuss your options and decide whether to have Atrial Fibrillation ablated.
Specialists at The Heart.ae routinely guide patients through exactly this kind of decision, weighing symptom severity against stroke risk and overall heart health.
What Happens During Atrial Fibrillation Ablation?
During the procedure, you will be under constant supervision as the electrophysiology team accesses your heart with special catheters.
The procedure typically involves:
• Accessing the heart through a blood vessel.
• Guiding specialised catheters into the heart.
• Mapping electrical activity.
• Identifying areas associated with AFib.
• Delivering radiofrequency energy or controlled cooling, depending on the technique.
• Checking the electrical response before completing the procedure.
At The Heart.ae, Dr Moutaz El Kadri’s expertise has potential to give you appropriate treatment via cardiac electrophysiology and catheter ablation, including radiofrequency and cryoballoon techniques.
Does Ablation Eliminate the Need for Follow-Up?
No. Even after successful AFib ablation, you should continue to follow up with your doctor. Ablation is not always a permanent solution and AFib episodes can return. It is important to monitor your stroke risk and cardiovascular health. You may need medication to reduce your stroke risk, particularly if you have additional risk factors such as high blood pressure.
Follow-up appointments may involve:
• Reviewing your symptoms
• Checking your heart’s rhythm
• Reviewing your medications
• Checking for evidence of AFib
• Monitoring your blood pressure and cardiovascular health
• Discussing further treatment if necessary
AFib treatment often changes over time and the American Heart Association recommends a comprehensive approach to managing AFib based on your personal risk factors and symptoms.
What Should You Do if You Notice an Irregular Heartbeat?
The most important thing you can do is to pay close attention to any irregular heart sensations or symptoms. If you can, try to record some relevant details such as:
• When the irregular sensation occurred
• How long it lasted
• Whether the heartbeat was fast or slow
• Whether you felt unwell during the episode
• Whether you felt any other symptoms such as breathlessness
• Whether you could measure your heart rate and, if so, what it was
• What your smartwatch or wearable device said, if you have one
This information can be incredibly valuable to your doctor.
When Is an Irregular Heartbeat an Emergency?
There are a number of symptoms that should always be taken seriously.
Seek emergency medical attention if an irregular heartbeat is accompanied by:
• Chest pain or pressure
• Severe breathing difficulty
• Fainting
• Sudden confusion
• Sudden difficulty speaking
• Sudden loss or change in vision
• Sudden weakness or numbness, especially affecting one side of the body
• Severe dizziness with other neurological symptoms
Noticing a racing heartbeat, breathlessness or unexplained tiredness? Book a consultation with Dr Moutaz El Kadri at The Heart.ae for a proper heart rhythm check.
Schedule an appointmentFrequently Asked Questions
What are the typical symptoms of AF?
Can atrial fibrillation come and go?
You may have times when you go for a while without any episodes of atrial fibrillation. Atrial fibrillation episodes can cease (resolve) without treatment or with treatment. But the episodes should be checked by your doctor.
