Deck: Diagnoses of heart rhythm disorders are growing in adults younger than age 65, and the risk of developing one increases with age. Here’s what adults of all ages should know.
You’re taking a bike ride or playing with your grandchildren when you feel your heart suddenly skip a beat. Then it calms down. But a few days later, you’re taking a brisk walk, and it feels like butterflies are floating inside your chest. The feeling comes and goes. Should you call a doctor?
“Yes,” says Conor Barrett, MD, MBA, senior vice president and chief clinical officer for Heart and Vascular Services at RWJBarnabas Health. “Any awareness of your heart fluttering, skipping beats, taking extra beats or racing isn’t normal and should be examined.”
The cause could be atrial fibrillation (AFib), a type of irregular heartbeat that affects roughly 10.5 million Americans. AFib is more than just a fluttery feeling or pounding heartbeat—those who have it are five times more likely to have a stroke than those without the condition.
The vast majority of patients with AFib are older than 65 years of age. However, AFib is now being diagnosed more in younger adults. A 2024 study of more than 67,000 AFib patients found that 25% were younger than age 65, for example.
Dr. Barrett cites two reasons for the rising frequency of diagnosis in younger people. One is increased public awareness of AFib, stemming from coverage in the news and on social media as well as educational campaigns by local hospitals and national health groups. The other is the growing popularity of wearable devices that track heart rate and other vital signs.
“The diagnostics on many wearables are very good,” Dr. Barrett says. “We have seen patients come into the office and tell us that they went into AFib at 12:32 p.m. and stayed there for 97 minutes based on their wearable, and they’ll be exactly right.”
Symptoms and Risk Factors
While a racing heart or a skipped beat can be a telltale sign of AFib, younger people sometimes experience irregular heartbeats differently. Avid exercisers, for example, may feel palpitations when running or working out at the gym. They also might develop shortness of breath while exercising. Some people, however, have no symptoms at all.
“For some, symptoms can be mildly to very annoying,” Dr. Barrett says. “For others, they can be quite debilitating. And for a select few, they can be life-changing—even fatal.”
Many underlying health conditions can raise the risk of AFib, including uncontrolled hypertension, diabetes and pulmonary diseases, such as sleep apnea. People with congenital heart conditions and heart failure are more prone to developing rhythm disorders, as are people with inflammation of the lining of the heart sac (pericardium).
If you experience any of the symptoms of AFib, even if they’re brief, or if you receive an abnormal rhythm notification on a wearable device, you should notify your primary care provider (PCP) immediately. They can check the recording information on a wearable and run initial tests such as an electrocardiogram to assess your heart rhythm. If your PCP suspects AFib, you may receive a referral to see a cardiologist or an electrophysiologist who specializes in rhythm disorders.
“The first thing a cardiologist will do upon diagnosing AFib is an assessment to determine whether you’re at an increased risk for stroke,” Dr. Barrett says.
AFib, if uncontrolled, can also weaken the heart muscle, which can lead to heart failure. That’s why proper management is essential. Fortunately, most people can live a long, healthy life by managing AFib with lifestyle changes, medications and treatments.
How AFib Is Treated
Treatments may include medications designed to slow the heart rate (beta blockers or calcium channel blockers). Other medications or a cardioversion can be used to help restore a normal heart rhythm. Blood thinners are often very important and used to reduce the risk of a blood clot forming and traveling from the heart to the brain, causing a stroke. Discussing stroke risk with your doctor is important if you have a history of atrial fibrillation; the risk is also higher in women.
For people with symptomatic AFib or those who develop heart failure due to AFib, doctors may recommend cardiac ablation. It’s a minimally invasive procedure, performed through a catheter, that uses energy to target and eliminate the triggers causing an irregular heartbeat.
“Historically, ablation was reserved for symptomatic younger patients, but today it’s being performed in older patients with a high degree of success,” says Dr. Barrett.
For patients who can’t tolerate blood thinners, the WATCHMAN device offers an alternative way to reduce stroke risk. The small, parachute-shaped device is inserted through a catheter and implanted in the heart’s left atrial appendage. Once in place, the device seals off the appendage, preventing clots from traveling to the brain.
“Work with your doctor to find the type of treatment that works best for your AFib,” Dr. Barrett says. “Doing so can stop you from having a stroke and can potentially save your life.”
Reducing Your Risk
You can’t control your age and health history, but you can take steps to reduce your risk of developing AFib. “The first step is addressing all the underlying risk factors,” Dr. Barrett says. “Partner with your primary care provider to manage conditions like hypertension and diabetes. Get a sleep study to check for sleep apnea if you snore or feel tired during the day after a night’s sleep.”
The next step is to work a little more activity into your day. “Research shows that a daily 20-minute brisk walk can help reduce blood pressure, decrease the risk for cardiovascular disease and increase your mental well-being,” Dr. Barrett says. Workouts at home or in the gym with light weights and high numbers of repetitions can also be beneficial.
“The symptoms of AFib can be annoying and sometimes debilitating, but a stroke can be life-changing—even fatal,” Dr. Barrett says. “Listening to your doctor and controlling your risk factors can help you protect yourself from stroke and live a healthier, longer life.”
