Understanding atrial fibrillation, or AFib


In this article: 

  • Atrial fibrillation, or AFib, is the most common heart rhythm disorder in the United States, causing your heart to pump too slowly, too fast or with an irregular beat. 

  • A newly released study shows more people are getting AFib at a younger age than before, increasing their risk of stroke, heart failure and heart valve issues. 

  • A cardiologist at Swedish explains why the numbers for AFib are on the rise and offers tips to help you protect yourself.

Atrial fibrillation, or AFib, is the most common heart rhythm disorder in the United States, causing more than 450,000 hospitalizations and contributing to around 158,000 deaths a year. And the average age of people affected by this widespread condition is younger than it used to be, according to a study from the American Heart Association.

Traditionally, people younger than 65 have not been considered to be likely candidates for AFib. However, the recently published research shows “an increasing number of patients with atrial fibrillation are aged under 65 at presentation.”

That means more people are at risk of stroke, congestive heart failure and heart valve problems at a younger age, according to John Chen, M.D., a cardiologist at Swedish. We talked to Dr. Chen about why AFib is becoming more common in people under 65, the health challenges that presents and what you can do to lower your risk. Here’s what he shared.

What is AFib?

“AFib is an irregular heart rhythm caused by a chaotic electrical signal in the top chamber of the heart that causes the heart to beat irregularly,” says Dr. Chen.

Your heart has two upper chambers called atria and two lower chambers called ventricles. When beating normally, your heart circulates blood from the upper to the lower chambers and into your body with a steady rhythm. When you have AFib, your heart’s upper and lower chambers don’t work together properly. The lower chambers don’t fill completely and may not pump enough blood to fill your body’s needs.

Although some people with the disorder don't experience warning signs, others fight extreme fatigue and an irregular heartbeat on a regular basis. In either scenario, the health problems associated with AFib can have a significant impact on your health.

“There are several health problems associated with AFib,” says Dr. Chen. “One is that it causes symptoms, and some people don’t feel good when they go into AFib.”

“The other problem is stroke,” he adds. “The top chambers are not squeezing with every heartbeat. They’re just sort of quivering or fibrillating. Blood doesn’t move through smoothly and small clots can form in the atria, in this spot called the left atrial appendage. If you have a clot that forms in your heart and then it becomes dislodged, that clot can cause a stroke.”

Other health complications may include: 

  • Heart failure.
  • Sudden cardiac arrest.
  • Dementia and cognitive impairment.

A spectrum of symptoms

The symptoms of AFib vary widely from person to person and treatment is based on each patient’s unique situation and needs, according to Dr. Chen.

“On one end of the spectrum, we have patients who are in AFib all the time. We call that permanent AFib. They don't typically have any symptoms. We make sure that their heart rate is controlled and that their stroke risk is mitigated,” he explains. “On the other end of the spectrum, we have patients who are rarely in AFib but they’re very symptomatic when they are. That’s called paroxysmal AFib. We try to keep them off AFib using medications, procedures such as ablation and controlling their risk factors.”

When present, symptoms of AFib may include:

  • Excessive fatigue.
  • Heart palpitations such as fluttering, rapid heartbeat, beating too fast or too slowly.
  • Difficulty breathing, especially when exercising or lying down.
  • Chest pain.
  • Low blood pressure.
  • Faintness or dizziness.

No cookie-cutter solutions

The most effective AFib treatment is based on your personal health history and needs.

“Every person with AFib is a little bit different. Depending on how long you’ve been in AFib and how symptomatic you are, there are different strategies. It’s not a one-size-fits-all issue. Depending on the patient – what other health problems they have and how old they are – we approach it differently,” says Dr. Chen. 

Treatment may include:

  • Medication to thin your blood and prevent blood clots.
  • Medication to control your heart’s rate and rhythm.
  • Lifestyle changes such as heart-healthy eating, managing stress and quitting smoking.
  • Cardioversion procedure that uses low-energy shocks to your heart to restore its rhythm.
  • Catheter ablation to block the abnormal signals.
  • Pacemaker.
  • Surgery.

Understanding the facts behind the figures

Is AFib actually more common in younger people or is the bump in numbers caused by earlier diagnosis?

“Probably both,” says Dr. Chen. “We’re detecting it more often. It’s not uncommon for people to come into our clinic after having diagnosed themselves with AFib on their Apple Watch,” he explains. “It’s also possible that AFib is more common in younger patients because more people have risk factors like obesity and sleep apnea. If that continues, we can expect to see higher rates of AFib even in younger folks.”

And that can greatly affect your health.

“We usually say that AFib begets more AFib. So the longer you’re in AFib, the harder it is to keep you out of AFib,” says Dr. Chen. “Being in AFib for a long period of time can cause additional problems. Some people get congestive heart failure if their heart rate is not well controlled.

“With prolonged AFib, the top chambers of the atria tend to stretch out and become really dilated. The valves can become leaky if the heart stretches out and the valve’s leaflets don’t close as well. We frequently have to do valve repair procedures on people who have very leaky valves as a result of AFib,” he adds.

Factors that can increase your risk include:

  • Sleep apnea.
  • High blood pressure.
  • Obesity.
  • Lung disease.
  • Thyroid disorders.
  • Diabetes.
  • Heart failure.
  • European ancestry.
  • Heart valve disease.
  • Family history and genetics.
  • Moderate to heavy alcohol consumption.

Getting help

How do you know if it’s time to call your doctor or just time to get a new watch?

“If you’re having new or first-time symptoms, you need to see a cardiologist. If it’s a known diagnosis, and a person is already a patient in the cardiology clinic, then, you should contact your cardiologist to let them know that you’ve gone back into AFib,” says Dr. Chen.

Learn more and find a physician or advanced practice clinician (APC) 

If you have atrial fibrillation, it can be difficult to get an accurate diagnosis and personalized treatment plan. The Swedish Comprehensive AFib Network and Clinic features the expertise of a multidisciplinary team and care options including weight loss programs, sleep apnea screening and medication management.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.

Information for patients and visitors

Related resources 

For heart health, small changes make a big difference

Stroke: Symptoms, risk and other tips from a Swedish expert

Wearable and personal heart monitors are increasingly popular 

This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

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About the Author

The Swedish Heart & Vascular Team is committed to bringing you many years of expertise and experience to help you understand how to prevent, treat and recover from cardiovascular diseases and conditions. From tips to eating better to exercise and everything in between, our clinical experts know how to help you help your heart.

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