Understanding Atrial Fibrillation: What You Need to Know

Atrial fibrillation (AFib) is the most common heart rhythm disorder, yet many people don’t know they have it. AFib can have serious health consequences, but with proper awareness, diagnosis, and treatment, many people can lead healthy lives. In this article, we’ll cover what AFib is, how common it is, how it’s diagnosed and treated, recent advancements, prevention strategies, and the latest guidelines for screening.

What is Atrial Fibrillation?

Atrial fibrillation is an irregular and often rapid heart rhythm that starts in the atria—the upper chambers of the heart. Instead of beating in a coordinated way, the atria quiver or "fibrillate," which can lead to poor blood flow, blood clots, stroke, heart failure, and other complications.

How Common is AFib?

AFib is a growing public health concern. According to the Centers for Disease Control and Prevention (CDC), an estimated 6 million people in the United States—and 6.8 percent of Californians—have atrial fibrillation. This number is expected to rise to 12.1 million by 2030 as the population ages. While AFib is more common in older adults, it can occur at any age.

How Do People Develop AFib?

AFib occurs when the electrical signals that coordinate the heart’s upper chambers become chaotic, causing the atria to quiver instead of beating effectively. Several factors and underlying conditions can increase a person’s risk of developing AFib, including:

• High blood pressure (hypertension): The most significant risk factor.
• Heart disease: Such as coronary artery disease, heart failure, heart valve problems, or previous heart surgery.
• Age: Risk increases as you get older.
• Thyroid disorders: Especially an overactive thyroid.
• Obesity: Excess weight raises risk.
• Diabetes: Increases the likelihood of AFib.
• Sleep apnea: Strongly linked to AFib.
• Chronic kidney disease
• Alcohol consumption: Especially binge drinking (“holiday heart syndrome”).
• Family history: Genetics can play a role.
• Other factors: Lung diseases, viral infections, and certain medications or stimulants.

Sometimes, AFib can occur without any identifiable cause, known as “lone atrial fibrillation.”

Symptoms of AFib

Symptoms can vary. Some people experience:

• Palpitations (irregular, rapid heartbeat)
• Fatigue
• Shortness of breath
• Dizziness or lightheadedness
• Chest discomfort

However, some people may have no symptoms at all, making AFib difficult to detect without screening.

How is AFib Diagnosed?

Diagnosing AFib typically involves:

• Medical history and physical exam
• Electrocardiogram (ECG or EKG): The primary tool for detecting AFib.
• Holter monitor or event recorder: Portable devices worn for 24 hours or longer to catch intermittent episodes.
• Echocardiogram: An ultrasound to assess heart structure and function.
• Blood tests: To rule out other causes, such as thyroid problems.

How is AFib Treated?

Treatment aims to restore normal rhythm, control heart rate, and prevent stroke. Options include:

• Medications: To control heart rate (beta-blockers, calcium channel blockers), restore normal rhythm (antiarrhythmics), and prevent blood clots (anticoagulants like warfarin, apixaban, rivaroxaban, or dabigatran).
• Cardioversion: An electrical shock to the heart to restore normal rhythm.
• Catheter ablation: A minimally invasive procedure that destroys small areas of heart tissue causing abnormal signals.
• Watchman heart implant: A minimally invasive implant designed to reduce the risk of stroke with AFib by closing off the left atrial appendage. This treatment lowers the risk of stroke without blood thinners.
• Other surgical procedures: Such as the Maze procedure, for select patients.

Recent Advancements

There have been several important advancements in AFib management in recent years. Newer anticoagulants, known as direct oral anticoagulants (DOACs), have largely replaced warfarin for many patients, providing similar or better protection against stroke with fewer dietary restrictions and less frequent blood monitoring. Improvements in catheter ablation techniques—including enhanced mapping and ablation technology—have significantly increased the success rates and safety of these procedures. Wearable technology, such as smartwatches and fitness trackers with ECG capabilities, is also making it easier to detect AFib earlier, especially in people who may not have noticeable symptoms but are at risk.

Prevention Strategies

While not all cases of AFib can be prevented, you can reduce your risk by:

• Managing Blood Pressure: Regularly monitor your blood pressure, take medications as prescribed, and reduce salt intake.
• Maintaining a Healthy Weight: Achieve and maintain a healthy weight through balanced nutrition and regular physical activity.
• Exercising Regularly: Engage in moderate aerobic exercise most days of the week.
• Limiting Alcohol Consumption: Limit your alcohol intake—or avoid it altogether.
• Avoiding Stimulants: Limit or avoid caffeine and over-the-counter stimulants.
• Quitting Smoking: Quitting smoking benefits your overall cardiovascular health.
• Managing Sleep Apnea: If you snore loudly or feel excessively tired during the day, talk to your healthcare provider about screening and treatment.
• Controlling Diabetes: Keep your blood sugar levels within target ranges.
• Reducing Stress: Practice mindfulness, meditation, yoga, or other relaxation techniques.
• Eating a Heart-Healthy Diet: Follow a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.

New Guidelines for Testing and Screening

In 2022, the U.S. Preventive Services Task Force (USPSTF) reviewed evidence on screening for AFib in asymptomatic adults. While routine screening in the general population is not yet universally recommended, targeted screening in older adults (age 65 and up) and those with risk factors is increasingly supported, especially with the availability of wearable ECG devices. The American Heart Association (AHA) and American College of Cardiology (ACC) recommend screening for AFib in patients over 65 during routine healthcare visits, using pulse checks or ECGs.

Atrial fibrillation is a common and potentially serious heart rhythm disorder. Early detection and treatment are key to reducing the risk of complications like stroke. With recent advancements in diagnosis and treatment, and growing awareness of prevention strategies, there’s never been a better time to take charge of your heart health. If you have concerns about your heart rhythm or risk factors for AFib, talk to your healthcare provider about screening and prevention. For expert care and the latest in cardiovascular treatment, reach out to the cardiovascular specialists at El Camino Health. Visit us online at elcaminohealth.org/heart to learn more or to schedule an appointment.

This article first appeared in the September 2025 edition of the HealthPerks newsletter.