older woman with hand on heart in a park

Atrial Fibrillation: When Heart Palpitations Are Cause for Concern

February 21, 2024

Your heart starts pounding and skips a beat or two. You think you are just excited, but you could have atrial fibrillation. Atrial fibrillation (Afib) is a condition with irregular or rapid heartbeats caused by abnormal electrical impulses that interfere with the natural rhythm and affect the upper chambers of the heart, called the atria. With Afib, the atria beat irregularly and out of sync with the lower chambers, known as the ventricles.  

Typically, the average heart beats and contracts at a steady, coordinated pace, but the heart's electrical signals become disorganized, which can create blood clots that cause strokes. Eventually, Afib can also weaken the heart muscles and can progress to heart failure. 

Are you at risk for Afib? 

There are several risk factors associated with Afib, but the most common is age, as it is more prevalent in people over 60, with the risk doubling after the age of 50. Other factors include heart disease, high blood pressure, diabetes, thyroid problems, sleep apnea, lung or chronic kidney diseases, obesity, and a family history of the condition. Additionally, excessive alcohol and caffeine consumption and smoking can increase the risk of developing Afib.  

“Patients often ask why they developed Afib. Often times there isn’t an exact correlation between something a patient did and Afib, but rather a combination of risk factors that leads to Afib. That is, often times we don’t necessarily know exactly why someone develops Afib. Nevertheless, a strategy of addressing the Afib itself, as well as its risk factors, increases the chances of successful treatment,” says Angelo Biviano, MD. Dr. Biviano is a cardiac electrophysiologist and a professor of Medicine at CUIMC. 

What are the signs of Afib? 

While Afib has a range of symptoms, keep in mind most of them can be easy to miss, dismiss, or take lightly. Common symptoms of Afib may include: 

  • Irregular heartbeat: Heart rate can vary and may exceed 100 to 175 beats per minute, faster than the average resting heart rate between 60-100. 
  • Heart palpitations: A rapid or fluttering sensation in the chest.  
  • Irregular pulse: The pulse may have an irregular rhythm. 
  • Fatigue or shortness of breath: Especially during exertion or while lying flat.  
  • Dizziness or lightheadedness: Reduced blood flow to the brain due to irregular heart rhythms can cause dizziness, lightheadedness, or fainting. 

How Do Doctors Diagnose Afib? 

Various methods and diagnostic tests can detect Afib. Doctors commonly use tests like electrocardiograms (ECGs), Holter monitoring, or an implantable loop recorder, but recently smartphone apps have become an option.  

Dr. Biviano explains, “With the recent explosion of wearable monitors, including watches, for arrhythmia diagnosis, the recognition that patients are having Afib is increasing, which leads to improved care for those patients.”

What can you do about Afib? 

If you are concerned about your risk of developing Afib, there are several things you can do to reduce your risk. These include regular exercise, maintaining a healthy weight, avoiding excessive alcohol and caffeine consumption, quitting smoking, and managing conditions such as heart disease and high blood pressure. 

The goal of Afib treatment is to control the heart rate, restore a normal heart rhythm, and lower the risk of complications such as stroke or heart failure. If you do develop Afib, there are several treatment options available. Common treatments include antiarrhythmic medications to try to keep patients out of Afib, including flecainide, propafenone, amiodarone, and sotalol. Beta-blockers or calcium channel blockers are used to slow down the heart rate, which can help regulate the heart rate and prevent blood clots. The use of blood thinners to reduce the risk of stroke is also considered. In some cases, surgery may be required to correct the abnormal heart rhythm. 

“While the management of Afib can be relatively straightforward for some patients, it can be challenging for others, including the combined use of medications and ablation(s), as well as monitoring for recurrence of the Afib. It is important to maintain a continuing relationship with your healthcare providers to make sure that you are being treated as effectively as possible,” advises Dr. Biviano. 

If you experience any symptoms, it's essential to see your doctor. Early detection and management of Afib can help reduce the risk of complications. 


Angelo Biviano, MD, is a cardiac electrophysiologist and professor of medicine at CUIMC.