Key takeaways

Atrial fibrillation (afib) is a common irregular heartbeat affecting 2.7 million Americans and can lead to serious health issues if left untreated, but it’s often asymptomatic and can be managed with proper care.
Diagnosis of afib involves an EKG and possibly wearing a Holter monitor for extended heart activity tracking, as afib episodes can come and go without notice.
Managing afib may include medications like blood thinners to prevent strokes and heart rate-controlling drugs, alongside lifestyle changes such as reducing caffeine and alcohol intake, managing stress, and exercising.
Living with afib entails regular monitoring, potentially adjusting lifestyle habits to reduce episodes, and staying informed about the condition to prevent serious complications or to manage episodes when they occur.

My heart has always seemed to flutter every now and then. But, at my annual physicals all of my tests always came back normal. I felt fine otherwise. Until last summer, during the pandemic, my heart seemed to be skipping more beats than usual. Although I had no pain or shortness of breath, I figured it couldn’t hurt to get checked out at my nearby urgent care center. It was a good thing, too. Just minutes later, the healthcare provider who examined me said her reading of my electrocardiogram (EKG) showed I had atrial fibrillation.

What is afib?

Atrial fibrillation, often referred to as afib, is an irregular heartbeat. It’s common, affecting 2.7 million Americans, according to the American Heart Association. My urgent care provider reassured me that an episode of afib is not dangerous, but leaving it untreated is—that is why I was lucky to have found out when I did. Uncontrolled atrial fibrillation can lead to stroke, heart failure, chronic fatigue, or other heart rhythm problems. As soon as I got home, I called a cardiologist recommended to me and was lucky enough to get an appointment for that afternoon.

Diagnosing afib

“Everyone is different in how afib affects them,” explains Jeffrey Levisman, MD, chair of cardiovascular Medicine at Mountainview Hospital, in Las Vegas, Nevada. An EKG is the most reliable way to diagnose the condition. My second EKG of the day, this time at the cardiologist’s office, was normal. It’s common for people to have heart rhythms that vacillate between atrial fibrillation and normal sinus rhythm. An EKG is just a quick snapshot of the heart’s activity.

To gather more information about my heart, for the next two weeks, my provider asked me to wear a Holter monitor—a small, portable, battery-run device with electrodes that records a continuous EKG. This keeps tabs on the heart’s activity over a longer period than an EKG can, more like a movie than a quick photo. During that time, the Holter monitor recorded another afib episode. Afib is asymptomatic at times, so people can flip in and out of atrial fibrillation without noticing.

Your physician may want to run additional tests to diagnose and treat risk factors for afib, such as high cholesterol, overactive thyroid, high blood pressure, or heart disease. Or, to perform an echocardiogram (an ultrasound of the heart) to assess your heart’s strength and function.

Medications for afib

There are two main types of medication given to people with afib.

1. Blood thinners

“Everyone with afib is at an increased risk of stroke because of the blood clots that may form in the heart as a result of the irregular heartbeat,” says Dr. Levinsman. “For the risk of stroke, we prescribe blood thinners.”

There is a calculation called the CHA2DS2-VASc score that estimates your risk that afib will cause a blood clot. Since I am over 65 and female—both risk factors for complications from afib—the cardiac protocol called for me to be on a blood thinner immediately. Commonly prescribed blood thinners are prescribed include:

2. Heart rate-controlling medications

In many cases, an episode of afib may also be accompanied by a rapid heartbeat, also called atrial fibrillation with rapid ventricular response. Patients who have this feel like their heart is racing and may be more aware of their irregular rhythm than those that have atrial fibrillation with a heart rate of less than 100. For this, says Dr. Levisman, “the main medications used to slow the rapid responses are beta blockers and calcium channel blockers.” Some examples include:

Beta blockers

Calcium channel blockers

These medications, Dr. Levisman says, keep the heart from working too hard. My heart rate was not rapid on the Holter monitor, so my cardiologist did not prescribe any of these medications.

Lifestyle changes

The next step for me was figuring out what lifestyle changes I could make to reduce my afib episodes.

Limit caffeine

I love coffee but I knew too much often gave me an irregular heartbeat. So I started brewing my coffee using half regular and half decaf. I also cut back on my overall consumption, from 5 or 6 cups a day to 2 or 3, and I didn’t drink any caffeine after noon. And much to my surprise, I found an herbal tea that I really came to like.

Cut back on alcohol

I thought alcohol could cause an irregular heartbeat, but I enjoyed a glass or two of wine at dinner. I didn’t give up wine, but I wondered if less wine would mean fewer flutters. So, I stopped having wine every night, and when I did have wine, I kept it down to one glass. The flutters didn’t stop, but I had fewer of them.

What triggers my episodes may trigger them in others as well. “It can be after ingestion of things that increase the adrenaline in the body, such as coffee or stimulants, like alcohol,” says Shephal Doshi, MD, director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, California. And, if you take blood thinners, alcohol can intensify the effect and make you bleed too much.

Reduce stress

And then there’s stress….There’s no real way to avoid stress. However, “there is definitely a correlation between stress and atrial fibrillation, and studies have shown that yoga, for example, can reduce the amount of atrial fibrillation,” says Dr. Doshi

Add exercise

When I’m under stress, vigorous exercise makes me feel better. During the pandemic, my gym was closed and I had to settle for a daily five mile walk. When my gym reopened, my treadmill and I had a reunion. Staying active helps control weight, improve sleep, and strengthen your heart—all positive effects for someone living with afib.

Living with afib

It’s more than a year since I was diagnosed with afib, and I keep an eye on episodes the same way I keep an eye on my weight or my calorie count. Some people have phone apps that allow them to do an immediate EKG, which gives them important information. That was more data than I wanted, but I do carry an oximeter in my purse—a small, inexpensive battery-run device that goes on one’s finger and that measures pulse as well as oxygen level. If I think I might be having an episode, rather than a single flutter, I can get more information with my oximeter. If I’m sitting quietly and my pulse is pretty steady, it means I’ve had a random flutter, but if I’m sitting quietly and my pulse jumps up or down 10 or 20 points, I probably am having an episode. At that point, I sit quietly and breathe in and out slowly.

“Most new episodes will terminate on their own, usually within a few minutes or a few hours,” says Dr. Doshi. “Staying calm and resting can often help.” Staying calm during an afib episode is good advice, but I’ve come to think that staying calm about afib itself is a good idea. I’m grateful that I learned about my afib when I did and could finetune my lifestyle to reduce the likelihood of serious consequences. I see my primary care physician and cardiologist regularly. And if my afib advances? There are other helpful medications and interventions available.