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When to worry about AFib

UC Davis cardiologist sheds light on a common cause of stroke and heart failure

Uma Srivatsa

UC Davis heart specialist Uma Srivatsa has spent her career treating arrhythmia. For Atrial Fibrillation Awareness Month, she discusses the symptoms, causes and treatments for this common type of arrhythmia, also known as AFib.

(SACRAMENTO) — UC Davis heart specialist Uma Srivatsa has spent her career treating arrhythmia. For Atrial Fibrillation Awareness Month, she discusses the symptoms, causes and treatments for this common type of arrhythmia, also known as AFib.

Atrial fibrillation (also known as AFib) is a type of irregular heart beat — or arrhythmia — linked with heart failure and stroke. It affects millions of Americans but, because symptoms can be hard to detect, many don’t know they have the condition.

To encourage understanding of AFib, Uma Srivatsa, a UC Davis Health specialist in arrhythmia treatment, answers questions about the disease for Atrial Fibrillation Awareness Month (September).


AFib occurs when the right and left atria beat out-of-sync, reducing the heart’s ability to pump efficiently.

What is AFib?

Srivatsa: AFib occurs when electrical activity in the heart goes haywire, causing the two upper chambers, or atria, to beat out-of-sync. Without a regular rhythm, the heart can’t efficiently pump blood throughout the body.

Why is this a problem?

Srivatsa: AFib is a common reason for emergency department visits and hospitalizations. It’s also a significant cause of heart failure and disabling strokes that occur when clots form in pooled blood in the left atrium and travel to the head.

What are the causes?

Srivatsa: The reasons for the disease are not known, however basic scientists, including a remarkable team led by Nipavan Chiamvimonvat at UC Davis Health, are identifying the cell-signaling systems that lead to AFib. Aging, persistent high blood pressure, coronary artery disease, heart failure, diabetes, obesity, sleep apnea or emphysema can eventually damage the heart’s electrical system and lead to arrhythmias, making it important to treat these conditions early and aggressively. I also have seen an increase in arrhythmia among those who have a combination of unhealthy weight, stress and respiratory illness.

How does stress play a role in AFib?

Srivatsa: Stress is one of the most important AFib risk factors, especially now with COVID-19 and wildfires adding so much uncertaintly to our lives. Stress triggers fight-or-flight hormones and nerve growth in the heart that can lead to irregular rhythms. I encourage daily stress management, including meditation, to reduce the emotional reactivity that can contribute to arrhythmia.

Can it be prevented?

Srivatsa: Like most heart disease, AFib is often preventable with healthy lifestyle practices. Limiting alcohol consumption, maintaining a healthy weight, eating a heart-healthy diet and exercising every day have been shown to reduce the likelihood of AFib or help alleviate symptoms once it is diagnosed. We have published research on the benefits of meditation on patients at risk for heart failure and AFib. I encourage people to use smart phone apps that help monitor eating and exercise habits. Walking is an excellent way to get daily physical activity.

Who gets AFib?

Srivatsa: It is most common among Caucasian men over age 65. However, I am seeing more women and patients of all ages, races and ethnicities with AFib, so no one is truly “in the clear.” People with diabetes or who are obese are more likely than others to get AFib.

What are the symptoms?

Srivatsa: A common symptom is heart palpitations or the sense that the heart is beating out of control. AFib can cause extreme fatigue or exercise intolerance, which is what drives most patients to seek treatment. Some people unfortunately do not have noticeable symptoms until they have a stroke. I am a big fan of new smartphone and smartwatch technologies that record EKGs. They provide immediate access to knowledge about your heart rhythm and great information to share with your physician.

What do you do as a cardiac electrophysiologist?

Srivatsa: I conduct catheter-based electrophysiology studies that offer real-time maps of the heart in action and that can identify arrhythmias along with their specific sources. During those exams, I can apply targeted energy to affected tissue, often permanently restoring normal heart rhythm and reducing the need for medications. This treatment is useful for simple and complex arrhythmias.

What changes have you seen in AFib treatment during your career?

Srivatsa: Treating AFib has undergone tremendous improvements in the past two decades. Medications, catheter-based interventions or heart surgery can restore normal heart rhythm. Advances in mapping and ablation techniques of the heart have enhanced the precision of my work. Newer drugs that require less monitoring and devices that trap blood clots have greatly reduced strokes. Recent research from UC Davis Health clinicians also shows that current weight-loss surgery techniques can significantly reduce AFib symptoms in those who are obese. Our team also has published research on the benefits of ablating the pulmonary venous portion of the atrium to improve outcomes for our patients.

When should I see a heart specialist for AFib?

Doctor Patient

Changes in heart rate, energy level or ability to exercise are symptoms to discuss with a physician.

Srivatsa: Everyone should receive heart rhythm evaluations during routine physical exams and check his or her own pulse regularly. For adults, a normal pulse rate is between 60 and 100 beats per minute. A noticeable rapid or slow heartbeat, worse-than-normal tiredness or an inability to complete a regular exercise routine should lead to a referral to a cardiac specialist and treatment if AFib is diagnosed. Managing AFib is a journey, and no single approach works for everyone. But the condition definitely needs to be monitored and controlled, and stroke prevention absolutely needs to be addressed. Be aware of your symptoms, discuss with your doctor the criteria for an emergency room visit and what to do if your heart suddenly becomes irregular, and stick with your treatment plan.