When Your Heart Skips Beats

How to know if it’s something serious—like AFib—and steps to take when it is

By Laura Entis

July 18, 2021

Illustration of a heart beating inside a person and skipping one beat.

Heart palpitations can be harmless if they are brief and infrequent. But it’s important to have an erratic heart rhythm checked out by a doctor because atrial fibrillation, or AFib—marked by rapid, fluttering beats—can lead to serious complications, such as stroke and heart failure, when the weakened heart can’t pump enough blood to the rest of the body.

Normally, your heartbeat follows a steady rhythm as your heart contracts and relaxes. When you have AFib, the upper chambers of your heart (atria) beat rapidly and irregularly, sending blood to the lower chambers (ventricles) less efficiently, says Robert Bonow, MD, a professor of cardiology at Northwestern University Feinberg School of Medicine in Chicago. Episodes can last for minutes to hours or longer, and can cause palpitations, lightheadedness, fatigue, and/or shortness of breath. Over time, AFib tends to become chronic.

Age is a common risk factor for AFib, which affects roughly 10 percent of people older than 75, according to Bonow. Other factors include genetics, obesity, diabetes, high blood pressure, and alcohol and tobacco use. The condition has also been linked to viral infections, including COVID-19.

Pinpointing the Problem

If you experience AFib-like symptoms, your doctor will listen to your heart and is likely to recommend an electrocardiogram (EKG), a test that records your heart’s electrical activity. A Holter monitor, a portable EKG device that is worn for 24 hours or longer, can reveal how often AFib episodes occur and how long they last.

But up to 25 percent of people with AFib may experience no symptoms, says Sumeet Chugh, MD, director of the Center for Cardiac Arrest Prevention at Smidt Heart Institute at Cedars-Sinai in Los Angeles, so it’s often diagnosed during an annual physical or a routine procedure, such as a colonoscopy, when your heart rate is being monitored.

What Works to Fix It

A growing body of research underscores the importance of lifestyle steps such as exercise, a healthy diet, and limiting alcohol for treating AFib (and even preventing it, for those at higher risk for the condition), Chugh says.

Depending on your age and symptoms, your doctor may prescribe drugs to help control your heart rate, like beta blockers such as metoprolol (Toprol XL); and/or rhythm, such as anti-arrhythmics like flecainide (Tambocor). You may also need an electrical cardioversion, an outpatient procedure that delivers an electrical shock to the heart to restore a normal rhythm.

Catheter ablation, an outpatient procedure that scars a small area of heart tissue that causes irregular heartbeats, is becoming more common, based on evidence of its safety and ability to normalize the heart rhythm and ease symptoms. Ablations can be effective in people 75 and older, but medication may still be required afterward.

If you’re at higher risk for stroke, you may be prescribed a blood thinner, too. “We treat the heart to protect the brain,” says Daniel Cantillon, MD, a cardiologist at the Cleveland Clinic. In the past, warfarin was the only such drug widely available; it requires monitoring with regular blood tests. But newer anticoagulants don’t have that requirement and have been shown to be just as effective at preventing strokes. These drugs—such as apixaban (Eliquis) and rivaroxaban (Xarelto)—are pricey, though: Out-of-pocket costs can be $500 per month or more. Coupons from websites like GoodRx can help defray costs.

Finally, keep in mind that most people who have AFib can continue to live normal, active lives “using a combination of lifestyle modification and medical treatment,” Chugh says.

Should You Use a Smart Device to Monitor AFib?

The Apple Watch, Fitbit, and AliveCor have been cleared by the Food and Drug Administration to help detect a bout of AFib and record heart activity. A smart device can’t be used to diagnose the condition but can help you determine how often you experience episodes and how long they last. “In our institution, we use [wearables] as a follow-up to measure the success of an ablation procedure,” says Daniel Cantillon, MD, of the Cleveland Clinic. Note that in some cases these devices can produce false positives, leading to anxiety and unnecessary medical visits, so discuss potential benefits with your doctor.

Editor’s Note: A version of this article also appeared in the August 2021 issue of Consumer Reports on Health.

Laura Entis

Laura Entis is a Brooklyn-based freelance journalist focusing on health, business, and science. In addition to Consumer Reports, her work has appeared in Fortune, The Guardian, Outside, and GQ, among other publications.