A-fib enigma: Why are younger adults developing this common heart condition?

Doctors typically diagnose atrial fibrillation with an electrocardiogram while factoring in a patient's medical and family history. Photo / Andrew Renneisen, The New York Times

Atrial fibrillation, a common cardiac condition that raises the risk of stroke, is increasingly affecting the health of people younger than 65.

For years, experts thought that A-fib, a type of irregular heartbeat, primarily occurred in people age 65 and older, and that younger people with the condition most likely wouldn’t develop other cardiac issues, said Dr Aditya Bhonsale, a cardiac electrophysiologist at the University of Pittsburgh Medical Center.

But in new research published last week, Bhonsale and his colleagues examined data on more than 67,000 patients with A-fib who were treated at the centre, nearly one-quarter of whom were younger than 65. Those patients had an increased risk of death, compared with people without the condition. They also often had risk factors for A-fib like high blood pressure, obesity and sleep apnea, which could make cardiovascular health issues worse.

What is A-fib?

In A-fib, the upper and lower chambers of the heart are not coordinated as they should be, which makes the heart beat chaotically — sometimes too slow, sometimes too fast, often just irregularly. People with the condition can experience a fluttering heartbeat and palpitations.

Dr Geoffrey Barnes, a cardiologist and vascular medicine specialist at University of Michigan Health, said that he frequently saw patients who say, “I felt like my heart was racing away,” or “I felt like it was skipping beats.” People with A-fib can also experience shortness of breath and chest discomfort. Some people have occasional episodes; others will continuously experience an irregular heartbeat. People often have no symptoms and don’t even realise they have the condition, Barnes said.

Increasingly, doctors said, patients are seeking care because their smartwatches have detected an irregular heartbeat. That might help explain why more younger people are being diagnosed, said Dr Hugh Calkins, a professor of cardiology at Johns Hopkins Medicine. “The more you screen, the more you’re going to find,” he said.

Doctors typically diagnose atrial fibrillation with an electrocardiogram while factoring in your medical and family history. They will sometimes give patients a portable monitor to wear for up to a month to look for an irregular heartbeat.

A-fib can cause clots to form in the heart that can travel to the brain and lead to strokes, even in younger patients, Bhonsale said. The condition may also raise the risk of cognitive decline and dementia, as well as heart failure. In the study, researchers found that people with A-fib who were younger than 65 were at a significantly higher risk of hospitalisation for heart failure, stroke and heart attack compared with people without A-fib.

What’s driving the increase in younger adults?

Atrial fibrillation may also be increasing among younger adults because many of the risk factors for the condition — including preexisting heart disease and diabetes — are on the rise in that age group, too, Bhonsale said.

Nearly 1 in 5 people in the study who had A-fib also had obstructive sleep apnea, which is a significant risk factor for the condition. People with sleep apnea stop and restart breathing in the night; they struggle to get sufficient rest. The condition, which often goes undiagnosed, is tied to a range of cardiovascular issues.

There is also a correlation between how much alcohol people consume and the likelihood they will develop A-fib, said Dr Bradley Knight, medical director of electrophysiology at the Northwestern Medicine Bluhm Cardiovascular Institute. Smoking cigarettes and vaping are also linked with a greater risk of A-fib, Barnes said.

While exercise in general is associated with a lower risk of cardiac conditions, extreme endurance exercise, like marathons and triathlons, are linked with a higher risk of A-fib, Calkins said.

How is A-fib treated?

Doctors work with patients to address factors that make A-fib more likely to occur, such as by making sure someone with sleep apnea is using a CPAP machine or by helping patients quit smoking. Sometimes, particularly for younger patients, physicians will recommend a procedure called catheter ablation, which doctors use to get rid of tissue in the heart that may be causing an irregular heartbeat.

Doctors may also prescribe blood thinners to reduce stroke risk, as well as other medications to manage symptoms. These include drugs that can help regulate heart rate and rhythm, Knight said. While medications can help reduce the frequency and duration of A-fib episodes, “they rarely eliminate the A-fib”, he added. He tells patients that the disease is like high blood pressure: it must be continuously managed.

“If you are diagnosed with A-fib at any age, but in particular at a younger age, you have been given a great opportunity to now say, OK, what things can I do to help better manage my health and reduce the chance of having a problem later in life?” Barnes said. “I almost think of it like a wake-up call.”

This article originally appeared in The New York Times.

Written by: Dani Blum

Photograph by: Andrew Renneisen

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