When Your Heart Skips Beats
How to know if it’s something serious—like AFib—and steps to take when it is
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.
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.