After eating lunch one day in 2019, Kathy Foster noticed her heart rate “started going crazy.” She initially brushed it off and thought, “Maybe I had too much caffeine.”
She’d never experienced anything like it, though. “It was pretty significant,” says the now 58-year-old, and she considered pulling over on her drive back to work. “But while it wasn’t getting better, it also wasn’t getting worse, and I thought I could manage through it and get back to my office.”
But then her Apple Watch alerted her that her heart rate was high. “I knew something was up,” she says. “It was a scary feeling.”
Foster made an appointment with her doctor immediately and was diagnosed with atrial fibrillation (AFib), a type of cardiac arrhythmia—that is, an abnormal heart rhythm—that occurs in the upper chambers of the heart, known as the atria.
AFib is the most common type of cardiac arrhythmia. It is a progressive disease; if left untreated, it worsens over time. When your heart beats irregularly, blood can’t move through the body as effectively. This can lead to a host of problems, like blood clots, stroke or heart failure.
While Foster was at genetic risk for AFib (her dad had the heart condition) and she previously had deep vein thrombosis (a type of blood clot) after having surgery, the diagnosis was still shocking, since she always tested normal on EKGs and saw a cardiologist regularly.
Across the globe, more and more people are developing AFib, so much so that it’s considered an epidemic in the making. Today, more than 50 million people worldwide are affected by AFib, and about one in four adults over 40 are at risk of developing the condition at some point in their lives. Additionally, AFib carries a fivefold increased risk of heart failure and a 2.4-fold increased risk of stroke.
That’s why innovation in AFib diagnostics and treatment is more important than ever. Among the latest AFib innovations, developed by Johnson & Johnson, are thin, flexible tubes called diagnostic catheters which allow doctors to visualize the heart’s interior, and ablation catheters that enable them to treat arrhythmias and help restore normal heart rhythm.
Continued advancements help physicians deliver safer, more effective procedures than in the past. This keeps AFib from progressing and ensures that people like Foster can enjoy a healthy quality of life. Here are five things to know about the disease, plus high-tech advances aimed at changing how AFib is diagnosed and treated.
1.
Many people don’t realize they have AFib
“AFib symptoms may vary depending on the person,” says Michael Porter, M.D., an electrophysiologist with Heart Care Centers of Illinois, who is a paid consultant for Johnson & Johnson and was not compensated for this article.
The most common symptom of AFib is heart palpitations, sometimes described as skipped heartbeats, butterflies in the chest, a pounding sensation, chest pain and a racing heart. Other symptoms include fatigue, shortness of breath, dizziness and anxiety.
Yet around 27% of people with AFib don’t feel any symptoms at all.
“AFib can fly under the medical radar,” says Brett Gidney, M.D., an electrophysiologist at the University of California, Los Angeles Health, who is a paid consultant for Johnson & Johnson and was not compensated for this article. “Often, people don’t know they have the condition until they see their doctor about another problem, such as experiencing a stroke.”
Women are more likely to experience vague symptoms like fatigue, weakness and anxiety when they have AFib, which may make it tricky to notice that something is wrong. And some patients may write off their symptoms as stress-related and might not seek treatment right away.
“Any heart rate fluctuations, shortness of breath or fatigue that come out of nowhere are warning signs that shouldn’t be ignored,” Dr. Gidney explains. “If you have any of these symptoms or have risk factors for AFib, it’s a good idea to get screened, and always stay up-to-date on your routine physicals.”
2.
There are four types of AFib
“Not all cases of AFib are the same: Irregular heartbeats associated with the disease can occur at different frequencies and last for varied lengths of time,” says Dr. Porter. “Some people only experience abnormal heart rhythms sporadically, while others experience them every day.”
Paroxysmal AFib refers to brief events that might come and go with or without symptoms. The events usually stop within 24 hours but may last up to a week. In some cases, the symptoms may go away on their own, but other patients may need treatment for paroxysmal AFib. Common treatments include cardioversion, catheter ablation, beta blockers and other medications.
When irregular heart rhythms last for more than a week, the condition is known as persistent AFib. If the heart rhythms don’t return to normal on their own, patients may need medication or, if medication proves to be unsuccessful, they may need catheter ablation. This procedure involves threading a catheter through a patient’s leg up to the heart and cauterizing the tissue in the heart that’s causing the AFib.
If a patient is experiencing abnormal heart rhythms that last more than a year without getting better, then they might have long-term persistent AFib. The condition is considered permanent AFib when irregular heart rhythms don’t improve, even after taking medication or getting a catheter ablation. Some treatments and lifestyle changes may slow symptoms and help patients manage the condition.
3.
There are many risk factors for AFib
Anyone can get AFib, but the risk increases after the age of 65. People are also at a greater risk if they have a family member diagnosed with AFib. In addition to age and genetics, certain lifestyle factors like drinking alcohol excessively, smoking and stress may also up the odds.
People with existing medical conditions, such as high blood pressure, sleep apnea, diabetes, obesity and coronary disease are also more likely to get AFib, since these health conditions may affect the structure of the heart and its functioning, making irregular heartbeats more likely. The good news is that “if you work to treat those underlying problems, a lot of times it reduces the risk for AFib or improves AFib symptoms,” Dr. Porter says.
Perhaps surprisingly, many elite athletes who participate in endurance sports like running and cycling are also at a higher risk for AFib. “We see people in their 20s who are incredibly fit with AFib,” Dr. Gidney says. While these athletes might have genetic risk factors, intense, prolonged exercise can change the structure of their heart and make some chambers larger. That structural change can put more demand on the heart and raise their risk of AFib.
“And some people who get AFib have no risk factors,” says Dr. Porter.
In certain cases, it’s possible to prevent AFib by adopting heart-healthy habits, including maintaining a healthy weight, lowering your blood pressure, limiting alcohol, quitting smoking, reducing stress and getting treated for sleep apnea.
4.
If not treated—or not treated properly—AFib can lead to serious health consequences
When AFib isn’t treated, it can get worse.
“AFib is a progressive problem,” explains Dr. Porter. Prolonged AFib can damage the structure of the heart and lead to blood clots in the heart, putting patients at an increased risk for stroke and heart failure.
AFib may also affect quality of life. The symptoms of fatigue, shortness of breath and limited physical ability may keep individuals from carrying out their daily responsibilities and other tasks, such as exercising or caring for loved ones.
After her AFib diagnosis, Foster tried multiple medications for about 10 months, but none of them helped her manage her symptoms. She says her normal heart rate is about 60 beats per minute, but it would jump to anywhere from 150 to 200 from one beat to the next.
Sometimes her heart would race during the night while she was sleeping and would wake her up. Foster remembers having to sit at an important work meeting for hours while “my heart was pumping out of my chest.”
AFib consumed her thoughts and everything she did. “I never knew when it was going to happen,” Foster says of dealing with the daily heart rhythm fluctuations. “It would stop me in my tracks.”
5.
Innovation in AFib treatment and diagnostics is more important than ever
With 5 million new AFib cases diagnosed each year and the disease’s progressive nature, innovation in diagnosing and treating AFib patients is crucial. Catheter ablation is a safe and effective procedure to restore the heart’s incorrect electrical signals, which cause an abnormal heart rhythm.
Before doctors can fix an irregular heartbeat with catheter ablation, they first have to find the trouble spots.
Regular X-rays can’t show the heart’s electrical signals, so specialists use a technique called electro-anatomical mapping. It builds a detailed, 3-D “live map” of the heart’s electrical activity, highlighting exactly where the faulty signals start and travel.
With this map, the specialist can see the problem areas clearly and precisely treat the tiny pieces of tissue causing the arrhythmia.
One key advancement in AFib treatment is Pulsed Field Ablation (PFA), a catheter-based technique that uses short, high-energy electrical pulses to treat recurrent paroxysmal AFib.
Johnson & Johnson is introducing a range of PFA solutions to meet different patient needs and support a variety of treatment approaches. These tools are designed to work seamlessly with the Carto™ 3 System, an advanced 3D mapping technology that helps doctors visualize the heart in real time with precision.
Among these innovations is Varipulse™, a PFA system that treats AFib. It uses a specialized catheter and mapping tools to precisely target the areas of the heart causing irregular rhythms—often with little or no need for X-ray imaging.
Another breakthrough is the Dual Energy ThermoCool SmartTouch™ SF Catheter. Currently approved for use in the EU and some Asia Pacific markets only (it’s still pending approval in the U.S. by the U.S. Food and Drug Administration), the catheter gives doctors the flexibility to use two types of energy—radiofrequency and PFA—in a single procedure.
This dual-energy approach supports more personalized treatment while maintaining precise control and full integration with the Carto 3 System.
The investigational Omnypulse™ Platform is currently being studied for its potential to deliver fast, accurate AFib treatment.
“Innovations in AFib diagnosis and treatment help reduce procedure times and patient risks,” says Dr. Porter. “Patients don’t need as much anesthesia, see less radiation exposure and often return to their daily routines the following day. It’s very gratifying to be able to give people their lives back.”
It’s something Foster can relate to.
After several months of taking medication and still experiencing symptoms, her cardiologist referred her to an electrophysiologist, who recommended catheter ablation.
“The idea of having a heart procedure was scary, but the reality is that it can be life-changing,” says Foster.
While she still visits her electrophysiologist once a year for a checkup, she says she hasn’t felt symptoms in the six years since she underwent the procedure. “It’s as if I never had it.”
This story, originally published on September 29, 2023, has been updated.
