How to Take Control of Your AFib Journey, With Miguel Leal, M.D.

Miguel Leal, M.D.

Credit: American Heart Association

Atrial fibrillation (AFib) is the most common type of irregular heart rhythm, yet awareness about the condition remains surprisingly low. Many people don’t realize they have AFib until serious complications arise, such as heart failure or stroke. To shed light on this often-missed diagnosis, The Educated Patient spoke with Miguel Leal, M.D., American Heart Association (AHA) national volunteer expert and associate professor at Emory University School of Medicine. Leal explains why AFib is underrecognized, what symptoms patients should watch for, and how lifestyle changes and treatment options can help manage the condition and improve quality of life.

A recent survey conducted by the AHA found that most people with AFib had never heard of it before diagnosis. Why do you think awareness of AFib is still so low?

Miguel Leal, M.D.: In many cases, atrial fibrillation may present with subtle symptoms (palpitations, dizzy spells, heart fluttering or shortness of breath that may be slowly and insidiously progressive), and many patients adapt to these symptoms over weeks, months or even years. There are also situations when the disease is essentially asymptomatic, and the concern we have is that some of its most feared consequences (such as the progression to heart failure or the development of a clotting complication, such as a stroke) may be present before atrial fibrillation is formally diagnosed and adequately treated. There is a compelling need for increased awareness of this condition, which is very common (estimated to be present in one of its many forms in as many as 10% to 15% of adults worldwide, with an increased prevalence in the older age groups) and often unrecognized (with recent studies suggesting that more than 60% of the patients with atrial fibrillation may not be aware of their diagnosis).

What are the most common signs and symptoms of AFib, and how can someone tell whether what they’re experiencing might be AFib?

ML: Although there are many patients in whom atrial fibrillation is essentially subclinical (i.e., presenting with no apparent clinical symptoms), atrial fibrillation may present with symptoms such as palpitations (the sensation of skipping or pounding heartbeats), dizzy or lightheaded spells, a perception of heart fluttering, excessive fatigue, shortness of breath during the performance of activities that used to be well tolerated by the patient, fainting spells and, in some cases, chest pain or discomfort precipitated by excessive cardiac workload in the setting of irregular and fast heartbeats. The advent of wearable technologies (watches, wristbands, etc.) has helped identify more individuals with absent or mild clinical symptoms, which is important as early diagnosis will typically lead to more effective treatment strategies.

Once someone is diagnosed with AFib, what treatment options are typically available to help manage the condition?

ML: Treatment options are multiple and need to be tailored to each individual patient. They include lifestyle changes, antiarrhythmic medications (which may be taken on a regular basis or in response to a symptomatic event) and more invasive interventions, such as catheter ablation procedures (when catheters are advanced to the heart and target the sites typically associated with the origin of rapid and irregular heartbeats), as well as pacemaker implants in some cases. It is important to emphasize that other ancillary interventions, such as weight loss, treatment of sleep apnea (when present), stress management and moderation in alcohol consumption also play a pivotal role in the chronic management of atrial fibrillation.

How do lifestyle changes — such as diet, exercise or managing blood pressure — play a role in controlling AFib?

ML: Any lifestyle change that leads to a decreased cardiovascular risk — and many years of research have indicated the established role of a low-salt, low-fat diet, rich in fruits, vegetables and lean sources of protein, as well as 2 ½ hours of moderate or 75 minutes of vigorous physical activity per week for adults, smoking cessation and avoidance of excessive alcohol consumption — will contribute to a lesser chance of developing atrial fibrillation and, if the disease has already been diagnosed, to a lower frequency of arrhythmia episodes.

Living with AFib can feel overwhelming. What advice do you have for patients just starting out on their AFib journey?

ML: There are many available pathways of care, from lifestyle changes to more specifically targeted therapies, including antiarrhythmic medications, anticoagulants aimed to prevent strokes, and invasive interventions (cardiac ablation procedures, pacemaker implants, etc.). Each individual patient requires a customized approach to his or her condition, and consulting with a specialist (cardiologist and/or cardiac electrophysiologist) will ensure that care is delivered on a timely basis, avoiding both short- and long-term consequences of untreated cardiac arrhythmias, particularly atrial fibrillation.

Where can patients and caregivers find reliable resources or communities for support?

ML: Most professional societies (including the American Heart Association, the American College of Cardiology and the Heart Rhythm Society) have websites with patient-directed sessions, like the American Heart Association’s MyAFibExperience, that contain invaluable resources for a better understanding of this disease condition, and the necessary steps in its diagnosis and management. In addition, there are patient-led communities that have national and international reach, helping connect patients, families and clinicians, with the goal of achieving adequate treatment and preventing complications (such as heart failure and stroke), which have a significant personal societal burden in today’s world.