I developed palpitations and AFib. Can it return to normal?

Question

Hi doctor,

I am 68 and was recently found to have atrial fibrillation after experiencing sudden palpitations and lightheadedness. My ECG showed irregular rhythm, and the echo was normal. My concerns are:

I am now on Apixaban and Metoprolol. Is it safe to take both long-term?
Can AFib revert to a normal rhythm without a procedure?
Does high stress or caffeine increase the risk of another episode?
My doctor mentioned something called cardioversion. Is that done under anesthesia?
I sometimes feel my pulse skipping even when calm. Does that mean it is still not under control?
Should I avoid heavy walking or light exercises until the rhythm stabilizes?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Atrial fibrillation (AF) is an abnormal heart rhythm where the upper chambers beat fast and irregularly. This can cause palpitations, breathlessness, fatigue, and anxiety.

Because the upper chambers do not contract properly, blood can pool and form clots, which may travel to the brain (causing a stroke) or to the limbs.

Common triggers that worsen AF include:

Infections.
Dehydration.
Excess caffeine or alcohol.
Stress.
Lack of sleep.

Managing these helps maintain a stable heart rate. Once the heart rate is controlled, light to moderate exercise is safe.

AF may be paroxysmal (comes and goes) or persistent, and often requires long-term medication. Blood thinners are recommended based on your stroke risk using scores like

CHA₂DS₂-VASc (if more than 3, anticoagulation is strongly advised). Bleeding risk is assessed with the HAS-BLED score. If the bleeding risk is low, anticoagulation is considered safe.

Metoprolol helps control heart rate. If you still feel skipped beats, a 24-hour Holter monitor can check rate variability and guide dose adjustment. Apixaban is a safe long-term anticoagulant that reduces stroke risk.

It is essential to look for underlying causes such as hypertension, coronary disease, thyroid issues, or electrolyte imbalance.

Treatment pillars include:

• Heart rate control.

• Rhythm control.

• Anticoagulation.

• Treating underlying causes.

• Procedures like cardioversion or ablation, if needed.

Ablation can be effective, but some patients may still need beta-blockers and blood thinners afterward.

I hope this clarifies your concerns. Feel free to ask if you have more questions.

Thank you.