New AFib diagnosis? Here’s some help to clear any confusion

Atrial fibrillation can cause confusion.

Most people with AFib, a type of irregular heartbeat, know nothing about it until their diagnosis. Learning that management can range from basic lifestyle changes to complex procedures doesn’t help.

To clear things up, Dr. José Joglar, director of the clinical cardiac electrophysiology fellowship program at UT Southwestern Medical Center in Dallas, answered questions about what people who just learned they have AFib need to know.

Joglar, who led the expert panel that wrote the American Heart Association guidelines for the diagnosis and management of AFib published in 2023, said that while some potential outcomes from AFib can be serious, there also are many ways to address it.

What is AFib?

AFib is the most common type of irregular heart rhythm, or arrhythmia. By 2030, more than 12 million people in the United States are expected to have it.

Some people have no symptoms. Others may experience a racing heartbeat, palpitations, shortness of breath, or lightheadedness or dizziness.

What’s causing those symptoms? Normally, an electrical signal in the heart’s upper chambers, or atria, triggers each heartbeat. “That electrical energy is converted into mechanical energy, and that’s the way the heart pumps blood,” Joglar said.

With AFib, “multiple, chaotic waves of electrical activity” spread through the atria, he said, which then quiver, or fibrillate, instead of pumping blood efficiently.

What are the risks of AFib?

AFib poses two main concerns, Joglar said.

When a heart is quivering, blood can pool inside the heart, and clots can form. Those clots can go to the brain and cause a stroke.

“That's one of the most fearsome complications,” Joglar said. Untreated AFib is associated with a fivefold increased risk for stroke.

If AFib episodes are prolonged, Joglar said, they also can weaken the heart muscle itself, leading to congestive heart failure.

How is AFib treated?

AFib is a progressive disease, Joglar said, and technology has changed how it is addressed. Early in his career, by the time someone sought care, their cases were usually advanced. Now, smartwatches are alerting people about AFib sooner.

What happens after AFib is detected will depend on how far along the continuum the case is. Your doctor can take all of your health factors into consideration to come up with a risk score that will guide treatment.

Although earlier care is better, Joglar said, if someone is having brief, isolated episodes, he wouldn’t be too worried. He’d start by addressing the risk factors for AFib, which are similar to those for overall heart health. High blood pressure, for example, is one of the strongest risk factors for AFib.

“Lifestyle interventions like weight loss, exercise training and alcohol moderation can go a long way” in mitigating AFib, Joglar said, and those lifestyle factors are important no matter how advanced someone’s AFib is or what other treatments they get.

Because of the stroke connection, blood thinners may also be prescribed to reduce the risk of clots.

As AFib progresses, steps might be needed to regulate heartbeats. That can be done through medications or a procedure called catheter ablation.

What is catheter ablation?

Using a catheter, or thin tube, inserted into a vein (usually in the groin), a specialist will go into the heart and find the source of the electrical signals causing the heart to misfire. Once the spot is located, the problematic cells are destroyed, or ablated.

It sounds intense, and Joglar acknowledged that any heart procedure carries risks. But catheter ablation works better than medications, he said. It also has gotten easier and faster over the years, he said. With modern technology, a typical procedure might take an hour or two, with patients usually going home the same day and able to be up and walking that night.

“Ablation is very successful at staving off AFib,” he said. But it might need to be repeated.

What else can be done?

Addressing lifestyle issues can increase the odds that ablation will help, Joglar said.

As people age, they and their health care team might decide to live with a certain amount of AFib and manage the heartbeats as best they can with medications. Some people will have a pacemaker implanted, he said, as a last resort.

Do smartwatches help with AFib?

Joglar expresses mixed feelings about wearable consumer devices that can detect AFib.

Thanks to that technology, people are learning about possible AFib earlier than ever, which can be helpful, he said. And in people whose diagnosis has been confirmed, a smartwatch can provide helpful information and track the effectiveness of different treatments.

But for the general population, in people who are at low risk of AFib, the watches can generate anxiety from false alarms. So he doesn’t recommend them across the board.

If your watch says you have AFib, go to the doctor to confirm it, he said.

Why is it important to have an ongoing conversation with your doctor about AFib?

AFib is a long-term issue, Joglar said. Procedures might need to be repeated, and treatments might overlap or need to evolve.

The most important thing for a person to understand is that AFib isn’t something like an infection, where “you treat it and it’s cured,” Joglar said. It’s a chronic condition, and that requires that the person be comfortable with and have faith in their doctor. “Because that’s a relationship that’s going to be there for years to come.”

Learn more about atrial fibrillation, including resources for AFib patients and professionals, at heart.org.