Why are my atrial fibrillation episodes increasing?

Question

Hello doctor,

I am 56 years old and have atrial fibrillation. Sometimes, I wake up in the middle of the night with my heart racing for no obvious reason. It usually settles after a while, but it leaves me feeling really shaken.

I keep wondering, can atrial fibrillation episodes become more frequent over time? I take my medication every day, so I am really confused about why this keeps happening. I do not know if I should be worried about permanent heart damage or if these episodes are expected. It is becoming really stressful because I never know when the next one will happen.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Yes, atrial fibrillation (AF) can become more frequent over time in some people, even when they are taking their medications as prescribed. AF is often a progressive condition, and episodes that are occasional at first may gradually become more frequent or last longer due to changes in the heart's electrical system, aging, or contributing factors such as high blood pressure, obesity, obstructive sleep apnea (OSA), alcohol consumption, stress, thyroid disorders, or other medical conditions.

Waking up at night with a racing heart is a common way AF can present. However, it is important to discuss these episodes with a cardiologist, as the treatment plan or medications may need to be adjusted.

The underlying cause depends on treatment, including rate-controlling medicines such as Metoprolol, Bisoprolol, or Diltiazem, rhythm-controlling medicines such as Flecainide or Amiodarone, or anticoagulants (blood thinners) when indicated to reduce the risk of stroke.

These episodes do not necessarily mean that permanent heart damage is occurring, especially if the heart rate is well controlled and heart function remains normal. However, recurrent AF should not be ignored because it reduces the quality of life and increases the risk of complications, particularly stroke and, in some cases, heart failure if left uncontrolled.

A cardiologist may recommend ambulatory heart rhythm monitoring, such as a Holter monitor, to determine how often the episodes occur and whether additional treatment, including medication adjustments or catheter ablation, would be appropriate.

In the meantime, continue taking the prescribed medications regularly, avoid known triggers such as excessive alcohol, dehydration, and excessive caffeine intake, maintain a heart-healthy lifestyle, and attend regular follow-up appointments.

Seek immediate medical attention if an episode is accompanied by severe chest pain, fainting, significant shortness of breath, or symptoms suggestive of a stroke, such as sudden weakness, facial drooping, difficulty speaking, or vision changes.

I hope this information is helpful. Please feel free to ask if you have any further questions.

Thank you.