Catheter Ablation For Atrial Fibrillation (AFIB)
Atrial Fibrillation Isn't Just an Older Person's Problem
You might think an afib heart condition strikes only senior citizens. That's a myth.
By Madeline R. Vann, MPH
Medically Reviewed by Farrokh Sohrabi, MD
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On Aug. 3, 2013, Melissa Duncan woke up “feeling a little bit funny.” At 38, she considered herself a healthy adult. Despite previous bouts of anxiety, she had no reason to think she'd have a heart problem. But, sensing something was wrong, she went to the emergency room.
That's where she learned about atrial fibrillation, or afib, as it's known — an irregular heartbeat and the most common type of arrhythmia.
“I had no idea what atrial fibrillation was,” Duncan says. Doctors explained that her heart was unable to keep its normal rhythm. They gave her aspirin, screened her heart using EKGs and a heart monitor. They then gave her stronger medications to stabilize her heart rhythm, and admitted her to the hospital. By the next morning her heart rate had returned to normal.
“To be honest, I was scared to death,” she recalls.
She returned to her home in Bowling Green, Ohio, with few answers. She had no risk factors that could trigger atrial fibrillation, such as medical conditions, heavy alcohol consumption, or being an endurance athlete. And her doctors had found no structural problems with her heart that could cause afib. They suggested that the stress of an after-hours robbery at her workplace might have caused the episode.
But a few months later, in November, she had another episode. This time her heart returned to its normal rhythm on its own. Her doctor ordered a sleep study, thinking that perhaps sleep disturbance could be the explanation.
The study revealed obstructive sleep apnea, and she started using a device at night to regulate her breathing. Still, she had more afib episodes. They were increasingly frequent but always when she woke up in the morning and always over within a few hours.
Duncan researched her options and decided to have an ablation — a procedure that uses electrodes to destroy parts of the heart that may be causing the afib episodes. But Duncan said her doctors still have no explanation for what caused her afib episodes.
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When Atrial Fibrillation Remains a Mystery
In fact, it's not uncommon for doctors to be stumped when a healthy, young adult has an irregular heartbeat and is diagnosed with afib. In such cases, including Duncan's, the patients are sometimes described as having "lone afib" — a type of atrial fibrillation that develops in people younger than 60 who have no obvious risk factors.
Though the term lone afib has been used for more than a half-century, improvements in diagnostic technologies, an increasing list of differentiated heart diseases, and an explosion in the understanding of afib pathophysiology mean fewer and fewer instances have mystery causes, according to research published in theJournal of the American College of Cardiologyin May 2014.
Other experts have come to similar conclusions. For instance, a report in theInternational Journal of Clinical Practicenoted that better screening tests and a more in-depth understanding of the genetic risks and biology of afib led to doctors finding more explanations for cases in young people.
“These seemingly normal people come up with afib, and when you do an evaluation you can’t find a sign of heart disease,” explains John Mandrola, MD, a cardiologist with Louisville Cardiology Group in Kentucky. “The more we do MRI scans of the heart, the harder we look, and the more detailed questions we ask about recent infections, exercise habits, and alcohol, the more we find there is some sign of underlying heart disease or other possible factor.”
Dr. Mandrola himself experienced atrial fibrillation at age 48, most likely related to his intense training schedule for competitive cycling and something he describes as "an utter shock."
"It was a moment of wondering, how can this be happening to me?” Mandrola recalls. But like other people younger than 60 who have lone afib, he found himself temporarily on medication to stabilize his heart rhythm. Now he has made some changes in his life to reduce physical stress.
Though Duncan chose to have an ablation, some — like Mandrola — opt for more conservative treatments.
He says that the increasingly fast pace of life today with high stress, little sleep, and unhealthy diets, is probably behind some afib cases that are otherwise hard to explain. “If your heart is doing this, there’s a reason,” he says.
What to Do If You're Young and Have Afib
Ultimately, both Mandrola and Duncan say, the most important thing that you can do if you are younger than 60 is to see your doctor right away if you have signs of atrial fibrillation. Seek care even if you think you're too young to have the condition.
Atrial fibrillation symptoms can include:
- Shortness of breath
- Heart palpitations
- An irregular heartbeat
- A rapid heartbeat
- Unusual tiredness during workouts
Mandrola notes that the long-term risk of untreated atrial fibrillation includes more afib episodes. An important risk to be aware of is the increased chance of having a stroke. He says that as a doctor, he makes decisions about treating afib based on age, overall health, treatment risks, and other factors, not just the risk for stroke.
Figuring out what’s behind afib and how to respond is like untangling a mystery, he says.
Duncan advises, "Get your answer.
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