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Be Heart Smart! 5 Things You Should Know about Atrial Fibrillation

Atrial fibrillation (AF) is one of the most common heart arrhythmias affecting at least 1% of the population. Studies show that people with atrial fibrillation have a 3 to 5 times greater risk for ischemic stroke, with increased chances of heart failure.

Read on to learn the warning signs of Afib,  the reasons behind it, along with a spotlight on its occurrence in athletes, and how continuous monitoring can be useful to understand and track episodes. 

1. What does an Afib Episode feel like? 

  • You may notice a skipped heartbeat and then feel a thud or thump, followed by a racing heartbeat for some time after. 
  • You may experience palpitations or a fluttering sensation in your heart
  • You may sweat or experience chest pain, similar to a heart attack.
  • Your pulse is erratic or weak.
  • You may feel dizzy, weak, tired, or breathless.
  • You may not have any symptoms and have an episode of silent AFib.

If you have experienced symptoms like these, it is essential to tell your doctor about them and ask about tests to determine if you have atrial fibrillation or any other cardiac arrhythmia. 

2. Why does Atrial Fibrillation occur? 

The atria are the heart's collecting chambers. Regular electrical signals help push blood efficiently from the atria into the lower pumping chambers (the ventricles). From the ventricles, blood is pumped to the rest of the body. In Afib, the electrical signals are fast and disorganised, with impulses ranging from 300 to 600 beats per minute.

This causes a rapid and irregular heartbeat, and the heart may not pump as efficiently.

While AFib can appear in a structurally normal heart, it can also be a sign of underlying cardiac conditions. 

3. What are the different types of AFib?

Atrial fibrillation is known to occur for varying lengths in different people. They may be categorized as: 

  • Paroxysmal AF: This type of AFib usually lasts more than a day but less than a week. Symptoms can feel mild or severe and suddenly start and then stop.
  • Persistent AF: Symptoms last more than a week at a time
  • Longstanding persistent AF: Symptoms last longer than one year
  • Permanent AF: Symptoms occur all the time and do not entirely go away. 

4. Who is at risk for AFib?

Atrial fibrillation can occur at any age, but your chance of developing it increases as you grow older. As a result, AFib is most common in people over 60. Other risk factors include high blood pressure, previous heart disease or heart surgery, chronic medical conditions like hyperthyroidism, kidney disease or lung disease, moderate to heavy alcohol use, obesity or obstructive sleep apnea. 

5. Does Afib occur more in athletes? 

There seems to be a unique relationship between exercise and AF. Studies show that people who exercised moderately seem to have a lower risk of developing  Atrial fibrillation. On the flip side, those who participated in intense endurance sports had a slightly increased risk of Afib episodes. 

Exercise-induced AF is usually seen in middle-aged athletes who have practised very intense endurance sports like marathon running, cycling or cross-country skiing for more than ten years. 

A large UK based study, published in the British Journal of Sports Medicine,  involving ​​ 70,478 participants, including 63,662 controls and 6,816 athletes, showed that the risk of AFib was 2.46 times higher among athletes than non-athletes. 

Another study, from the European Society of Cardiology, observed that athletes were 5 times more likely to experience Afib than others in the study population. 

 What causes this increase in numbers in athletes? 

Athletes who train vigorously can have dynamic fluid shifts in the body, causing dehydration and changes in pH. Electrolytes like sodium, potassium and magnesium may fall below normal levels, contributing to AFib. 

After many years of high-intensity physical exercise, their heart muscles also undergo material changes that make them more susceptible to rhythm disorders. Stretching and remodelling of the heart, with dilation of the atrial chambers, and inflammation and fibrosis of the heart muscle are permanent changes that cause irregular conduction of the signals leading to irregular heartbeats. 

How is atrial fibrillation diagnosed?

The most widely used method of diagnosing Afib is an ECG. This may be through a standard 12 lead ECG, though it may not be the most effective as you must be undergoing an episode of Afib at the time of the ECG for it to be picked up. This method works well for patients in persistent or longstanding persistent atrial fibrillation.

However, if your episodes are intermittent, like in paroxysmal atrial fibrillation, they probably won't be recorded on the standard 12 Lead ECG. Instead, doctors may use a small portable electrocardiogram device, a Holter Monitor, for 24–48 hours to try and capture an Afib episode on the graph. In some cases, these abnormal heart rhythms may be so sporadic that they may be missed on both. In these cases, long term ambulatory ECG recordings can help capture rare instances of irregular rhythm. 

If it can't be caught the conventional way, many people wonder, “How can I check for Afib at home?” 

A regular heart monitor that captures only heart rate will not be adequate. Since the frequency of episodes of atrial fibrillation may increase on physical activity or exercise, a resting ECG probably won't fit the bill either. Continuous monitoring of ECG using ECG wearables may be the perfect solution!


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