Too few Americans know they have atrial fibrillation

While several new treatments for atrial fibrillation have been developed over the past decade, recognition of the dangerous heart condition has not kept pace with the scientific discoveries.

Too few Americans know they are at risk for the condition and do not recognize symptoms of atrial fibrillation, says Dr. Robert Kim (left), an electrophysiologist at HCA Florida Memorial Hospital. The American Heart Association has designated September as Atrial Fibrillation Awareness Month to improve public awareness and potentially save lives.

“It’s an extremely common condition,” Kim says. “It’s the most common non-life-threatening rhythm condition. Just in this country, about three to five million people have AFib.”

HCA recently opened a freestanding, 24/7 emergency room in Yulee with a trauma bay and 10 private rooms. The facility provides free ambulance rides to HCA Florida Memorial Hospital in Jacksonville when patients in the ED require inpatient admission.

AFib is characterized by an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. It’s a major cause of stroke.

 “In some cases, people come in with a stroke as a first manifestation of this,” Kim says. “What I tell my patients is you’re not going to drop dead from the AFib. The arrhythmia itself is not going to hurt you, it’s the consequences — which is a fivefold increased risk of stroke.”

What makes AFib challenging is that so few people with the condition recognize they have it, and they can go months or years untreated. According to a new national survey from the American Heart Association, 62% of people diagnosed with AFib had no prior knowledge of the condition before the diagnosis.

The challenge for people is that symptoms can be vague or even nonexistent. The condition causes racing or irregular heartbeat, but many individuals don’t feel anything. Instead, symptoms often manifest as shortness of breath, fatigue, dizziness or fainting.

“The reasons why this goes undetected for a long time without being recognized has to do with how subtle these symptoms can be,” Kim says. “It never causes any kind of pain or discomfort. It’s a feeling of fatigue or getting out of breath with exercise. Getting tired and having to nap. There is a loss of energy. But older folks often attribute those symptoms to, ‘I’m getting older and slowing down.’”

In the early stages of AFib, the irregular heartbeat can occur sporadically before the heart returns to normal sinus rhythm. This is called paroxysmal AFib. When the irregular heartbeat becomes chronic, the condition is called persistent AFib.

Anyone who notices a worsening of energy levels and fatigue should consult a physician, Kim says. Another optimal way to detect the condition is to have a 12-lead EKG test performed on an annual basis. The quick and easy screening test is recommended for anyone age 40 and older. Most primary care offices provide the test.

Once detected, people with AFib will find they have several effective options for managing the condition and preventing stroke. Often, doctors will have their patients try medications, such as beta blockers or calcium channel blockers. If medications are insufficient to control the abnormal rhythm, patients undergo an outpatient procedure called radiofrequency ablation.

During this procedure, the physician will thread a tiny wire into the upper heart chamber and apply radiofrequency as a source of heat energy to cauterize some tissue in the heart. Studies have determined that a small group of cells are typically responsible for the irregular heartbeat and removing that tissue restores normal heart rhythm.

Late last year, the Food and Drug Administration approved a new ablative therapy technology called pulse field ablation (PFA). Instead of radiofrequency or another type of energy, PFA consists of bursts of energy called irreversible electroporation to remove the disruptive tissue.

Patients should discuss the range of treatment options with their healthcare provider and ask how much experience the provider has with a particular treatment, Kim says.

“Any therapy has to be individualized,” he says. “Treatment depends the patient’s age, comorbidities, paroxysmal or persistent, the severity of the episodes and patient preference.”

For more information on AFib, see the American Heart Association website.