Have you ever felt your heart beat faster for no clear reason? Maybe it flutters for a few seconds, then settles back to normal. It might happen when you’re resting, watching TV, or walking to the train.
Most of the time, these moments are harmless. But sometimes, they can be a sign of a common heart rhythm condition called atrial fibrillation (AFib), where the heart beats irregularly and sometimes too fast.
AFib isn’t rare, and it doesn’t always cause obvious symptoms. That’s why it often goes unnoticed. Understanding what feels different for you makes it easier to recognise small irregularities in your heartbeat.
When the heart’s rhythm changes
Your heart usually beats in a steady rhythm, regular and coordinated, with the upper and lower chambers working together to pump blood efficiently.
In atrial fibrillation, that coordination is lost. The upper chambers (the atria) start sending rapid, irregular electrical signals, causing the heartbeat to feel uneven, sometimes fast, sometimes skipping a beat.
You might notice this irregular pulse when you’re at rest, reading, or walking up a short flight of stairs. Episodes can last a few seconds or several minutes before settling back to normal. Because these sensations pass quickly, most people don’t think much of them and simply just move on with their day.
Atrial fibrillation (AFib) differs in important ways between younger and older patients, and these differences shape how treatment plans are developed.
According to cardiologist Dr Walker, AFib in younger patients is often linked to lifestyle factors or underlying structural heart abnormalities, and it tends to present in a paroxysmal (intermittent) form. A stronger genetic component is also more common in this group. For those with a history of recurrent AF, ablation is frequently considered as a first-line therapy, as it can be particularly effective in restoring and maintaining normal rhythm.
In older adults, AFib is more likely to be persistent or permanent and is often complicated by other comorbid conditions. For patients over the age of 65 with either paroxysmal or chronic AFib, oral anticoagulation is generally recommended to lower the risk of stroke, unless significant bleeding risks are present. In such cases, left atrial appendage (LAA) closure may be considered as an alternative.
Another important consideration, especially in patients with a high ventricular rate or persistent symptoms despite therapy, is ablation of the atrioventricular (A-V) junction combined with the insertion of a permanent pacemaker. This approach can reduce the symptom burden and lower the risk of progression to heart failure.
Who is more likely to develop AFib
AFib can affect anyone, but some people are more prone to it because of age, lifestyle, or health conditions that place extra strain on the heart.
Age is the biggest risk factor. The likelihood of AFib increases steadily after 50 and becomes increasingly common after 65, as the heart’s electrical system naturally changes with age.
Prolonged pressure on the heart can make the atrial walls to thicken and lose flexibility, which may disrupt normal electrical signalling.
AFib often occurs alongside with other heart conditions, such as:
- Coronary artery disease
- Heart valve disorders, especially mitral valve problems
- Heart failure
- Past heart attack or cardiac surgery
An overactive thyroid (hyperthyroidism) can trigger AFib by speeding up the heart’s activity. Diabetes and obesity also raise the risk by promoting inflammation and structural changes in the heart over time.
Obstructive sleep apnoea, where breathing repeatedly stops during sleep, causes dips in oxygen levels and extra strain on the heart, which can increase the risk of AFib.
AFib episodes can be triggered by alcohol, sometimes called “holiday heart syndrome.” Binge drinking or regularly exceeding recommended limits, such as more than one drink a day for women or two for men, can increase the risk, especially over time.
While regular exercise protects heart health, very high levels of endurance training can have the opposite effect. Long-term, intense exercise, such as years of marathon running or triathlon training, may increase AFib risk by stretching the heart’s upper chambers. On the other hand, too little activity can also raise risk indirectly through conditions like obesity or hypertension.
Having a close family member with AFib slightly increases your own risk, suggesting a possible genetic link.
Chronic lung disease, kidney problems, or inflammatory disorders can increase AFib risk by causing ongoing strain and inflammation in the heart.
AFib is most common among older adults and people with hypertension, diabetes, or heart disease, but it can also occur in younger, otherwise healthy individuals. In these cases, episodes are sometimes triggered by factors such as acute illness, lack of sleep, heavy alcohol use, or periods of high stress.
Atrial fibrillation (AFib) can have a major impact on long-term heart health, raising the risk of complications such as stroke and heart failure. It’s the cause of about one-third of strokes and can also contribute to the development of heart failure. Chronic AFib may lead to structural changes in the heart, including left atrial enlargement, which further worsens the condition.
Steps to reduce risks
- Stroke prevention: The CHA₂DS₂-VASc score, available online, helps assess an individual’s risk. A score of more than 0 for men or more than 1 for women generally indicates the need to begin lifelong anticoagulation therapy. Anticoagulants significantly reduce the risk of stroke.
- Restoring rhythm and improving function: Returning suitable patients to normal sinus rhythm can improve cardiac function and reduce the burden of heart failure. Specific medications are also available that improve heart function, reduce symptoms, and support long-term survival.
- Lifestyle modifications: Regular physical activity, maintaining a healthy weight, following a heart-healthy diet low in sodium and rich in fruits, vegetables, and omega-3 fatty acids, and limiting alcohol intake all lower the risk of complications.
- Regular medical check-ups: Routine follow-ups are important to monitor heart health, manage co-existing conditions, and adjust treatment as needed.
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What AFib can feel like and when to see a doctor
AFib doesn’t always come with obvious symptoms. Some people barely notice anything unusual, while others simply feel their heartbeat isn’t quite right. The list below can help you spot signs worth discussing with your doctor.
How it might feel
You may notice:
- A fluttering or pounding sensation in the chest (heart palpitations)
- A pulse that feels irregular or unexpectedly fast
- Brief episodes where the heartbeat starts and stops on its own
- A sense that the heart “skips” or “thuds” against the chest
Sometimes, these sensations come with other changes in how your body feels:
Unusual tiredness or reduced stamina
Shortness of breath, even with light effort (known medically as dyspnoea)
Feeling faint or dizzy (sometimes called syncope if fainting occurs)
Chest discomfort or pain, especially if it occurs with activity (this can sometimes indicate angina)
A general sense of fatigue
No symptoms at all
Some people don’t notice any symptoms at all. AFib is often picked up only during a routine health check or when a smartwatch detects an irregular pulse.
Even if these episodes happen occasionally or mild, mention them the next time you see your doctor.
When to see a doctor
See a doctor if you notice any of the following changes:
These symptoms don’t always mean AFib, but they do deserve a proper check. Your doctor may suggest an ECG (a simple test that records your heart rhythm) or a Holter monitor, a small, wearable device that tracks your heartbeat continuously for 24 to 48 hours. If your symptoms occur intermittently, a longer-term event recorder may be used to capture irregular rhythms over several days or weeks.
Effective early intervention in atrial fibrillation (AFib) involves two aspects: the immediate management of an episode and the longer-term steps to prevent recurrence. Dr Walker explains that although the sudden onset of AFib is not usually a medical emergency, patients should not delay seeking treatment for more than 24 hours. The longer the heart remains in AFib, the harder it becomes to restore normal sinus rhythm.
In acute cases, he cautions that urgent cardioversion should not necessarily be the first step. Drawing on over 45 years of clinical experience, Dr Walker has found that immediate oral anticoagulation together with amiodarone 200 mg three times a day is often the most effective approach. If used early, between 80 and 90 percent of patients return to sinus rhythm within a few days. The dose is then tapered: one tablet twice daily for a week, then one daily, maintained for around two months before switching to a drug with fewer long-term toxicities. Amiodarone remains the most effective short-term agent for avoiding the risks linked to cardioversion.
While cardioversion is highly effective in restoring sinus rhythm, each shock causes some damage to the heart’s conduction system. Over time, this increases the risk of further AFib episodes and may eventually lead to the need for permanent pacing.
Once the acute episode has been stabilised, the focus must shift to prevention. Lifestyle and risk factor management play a decisive role. Research led by Prof Prash Sanders at the University of Adelaide has shown that weight loss and alcohol reduction significantly lower the recurrence of AFib. It’s also essential to exclude underlying causes such as cardiomyopathy, valvular disease, thyroid disorders, or anaemia.
Early intervention also relies on collaboration between patients and healthcare providers. This includes:
- Education and awareness: Patients need to recognise symptoms such as palpitations, fatigue, or dizziness and understand when to seek care.
- Regular screening: Particularly in people with hypertension, diabetes, or a family history of heart disease.
- Telemedicine and monitoring: Remote tools allow earlier detection and reporting of symptoms.
- Risk factor management: Addressing weight, smoking, alcohol intake, exercise, and conditions such as hypertension, or sleep apnoea.
- Shared decision-making: Actively involving patients in treatment choices to support adherence and long-term success.
AFib is best managed through a combination of timely medical treatment, lifestyle modification, and patient–provider partnership. Addressing both the acute episode and the risk factors driving recurrence offers the greatest chance of reducing complications over the long term.
How to describe your symptoms to your doctor
Explaining heart symptoms isn’t always easy, especially if the sensations occur intermittently. The following tips can help you describe what you’re feeling more clearly and communicate it effectively during your appointment.
Think about whether the irregular heartbeat appears during rest, light activity, or after something specific like caffeine, alcohol, or stress.
Describe the sensations in your own words. These details help your doctor tell AFib apart from other rhythm changes.
Even rough estimates are useful. They help your doctor understand whether the irregular rhythm is occasional or persistent.
Mention any dizziness, breathlessness, or weakness that occurs during these episodes. These details can give your doctor useful clues about what’s happening.
If you use a smartwatch or fitness tracker, show your pulse records or screenshots. Home blood pressure readings that display heart rate can also build a clearer picture.
Caffeine, alcohol, stress, and sleep all influence your heartbeat. Sharing these habits helps your doctor understand the patterns behind your symptoms. It’s about insight, not judgment.
Significant progress has been made in recent years in the treatment of atrial fibrillation (AFib), with advancements in both medical therapies and surgical interventions offering patients safer and more effective options. Dr Walker explains that novel anticoagulants, antiarrhythmic drugs, and minimally invasive procedures are now central to managing the condition.
Medical therapies
- Novel anticoagulants: Direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and dabigatran have transformed stroke prevention in AFib. They provide an alternative to warfarin with fewer dietary restrictions and less need for frequent monitoring.
- Antiarrhythmic drugs: Both newer and established antiarrhythmic medications remain important for maintaining normal rhythm or controlling heart rate.
Surgical interventions
- Catheter ablation: This minimally invasive procedure destroys small areas of heart tissue that trigger AFib. Advances such as cryoablation and radiofrequency ablation have improved long-term outcomes.
- Left atrial appendage closure (LAAC): For patients at high risk of stroke who can’t take anticoagulants, implantable devices such as the Watchman can be used as an alternative.
- Surgical options: In some cases, atrial fibrillation surgery may be performed alongside other cardiac operations, such as coronary artery bypass grafting (CABG).
Dr Walker also notes a word of caution: while ablation procedures can be highly effective, in patients over 65 they often require prolonged general anaesthesia, which has been linked to a higher risk of dementia in older adults. Careful consideration of patient age and overall health is therefore essential when selecting treatment options.
What happens if Afib is not treated
AFib isn’t usually life-threatening on its own, but over time the irregular rhythm can affect how efficiently your heart pumps blood.
When blood doesn’t flow smoothly, it can collect in parts of the heart, increasing the chance of clots and placing extra strain on the heart muscle.
If left unmanaged, AFib can lead to other health problems:
Irregular heartbeats can cause blood to pool and form clots, which may travel to the brain.
A constantly irregular rhythm can weaken the heart muscle, making it less able to supply oxygen to the body.
The heart’s reduced efficiency means the body doesn’t get the oxygen it needs during activity.
Over time, reduced blood flow and silent strokes linked to AFib can raise the risk of memory loss or vascular dementia.
With proper diagnosis and treatment, these risks can be greatly reduced.
People with atrial fibrillation (Afib) can take an active role in monitoring their heart health, and there are several practical ways to ensure a treatment plan is working effectively.
Monitoring techniques
- Home monitoring devices: Mobile ECG devices or smartwatches that track heart rhythm can help patients detect and record AFib episodes.
- Daily Symptoms Diary: Keeping a log of symptoms, possible triggers, and changes in heart rate provides valuable insight into patterns and treatment response.
Signs to monitor
- Palpitations or irregular heartbeats: Sudden or frequent changes may signal that management is not working as intended.
- Fatigue, dizziness, or shortness of breath: These could point to worsening heart failure or reduced blood flow.
- Lifestyle indicators: Monitoring weight, blood pressure, and adherence to medications is also crucial for maintaining overall heart health.
Follow-up care
Regular appointments for echocardiograms and other necessary tests remain essential. These visits allow healthcare providers to evaluate progress, adjust treatment, and prevent complications.
By paying attention to these aspects of AFib, patients and healthcare providers can work together to track progress, make timely adjustments, and support better long-term outcomes.
AFib can be quiet or obvious, brief or persistent. What matters is recognising when something feels off. If your heartbeat seems irregular, or you’ve noticed more fatigue or breathlessness than usual, mention it during your next doctor’s visit. A simple check can clarify what’s going on and help you stay ahead of potential problems.
Dr Ross G.T. Walker
Consultant, Cardiologist
Sydney Heart Health Clinic, Australia
LinkedIn: Dr Ross Walker
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