By Robin Stoloff
It usually doesn’t start with a dramatic moment. More often, it’s a small, strange sensation we brush off because life is busy and we feel fine otherwise.
Maybe it happens while you’re unloading groceries, walking the dog, or sitting in traffic. Or maybe it shows up in the middle of a pickleball game or a tennis match, right after a long rally, when you pause at the baseline and feel your heart doing something you can’t quite describe. A flutter. A quick pounding. A few beats that feel out of step. You take a sip of water, blame it on caffeine or stress, and keep going.
Sometimes that’s all it is. But sometimes it’s atrial fibrillation, better known as AFib, one of the most common heart rhythm problems and one of the easiest to miss.
AFib starts in the upper chambers of the heart, the atria. Instead of beating in a steady, coordinated pattern, the electrical signals become disorganized. The heartbeat can become irregular, too fast, or both. When the heart isn’t beating in a normal pattern, blood can pool and form clots. If a clot travels to the brain, it can cause a stroke. That’s why AFib is more than an inconvenience. It’s a health issue worth paying attention to.
According to Dr. Michael Link, AtlantiCare Electrophysiologist, “AFib can cause strokes and heart failure, and it can make people feel terrible. We say it can make you an old man or old woman prematurely. For general heart health and to reduce rhythm issues, focus on diet, exercise, and weight loss. Obesity and being overweight are epidemics. Sleep apnea is an emerging risk factor, along with high blood pressure, thyroid issues, smoking, and stress. Blood clots in the legs or lungs can also trigger it. And unfortunately, the most important risk factor is age, the one we can’t do much about, so as we get older, it’s something to pay even more attention to.”
What makes AFib tricky is how different it feels from person to person. Some people notice it immediately. They feel their heart racing, skipping, or flipping around in their chest. Others feel short of breath, unusually tired, lightheaded, or unable to exercise the way they normally do. And some people feel absolutely nothing. No pounding, no warning, no symptoms, just an irregular rhythm discovered at a routine visit or after a smartwatch notification.
AFib sometimes announces itself on the court. Pickleball, basketball and tennis are stop-and-go sports. A burst of effort, a quick recovery, another burst. That constant shift can make an irregular heartbeat easier to notice, especially if you’re dehydrated or running on too little sleep. Alcohol, stress, and excess caffeine can also trigger palpitations in some people, and winter indoor dryness can leave us more dehydrated than we realize.
If you notice palpitations during play, the goal is to respond calmly and smartly. Stop for a moment. Breathe. Hydrate. See if the feeling passes. If it becomes a pattern, it’s time to get checked.
There are clear situations where you should seek medical care right away such as chest pressure or pain, fainting or near-fainting, severe shortness of breath, or a feeling that you might pass out. Of course, stroke warning signs require emergency help: sudden weakness, facial drooping, trouble speaking, confusion, or a sudden severe headache.
Even without emergency symptoms, recurring palpitations deserve attention. A helpful approach is to notice the pattern. Did it happen during exercise or after you stopped? How long did it last? Did you have more caffeine than usual, drink alcohol, take a decongestant, miss a meal, or sleep poorly? Bring those details to your provider. The description often helps guide next steps.
This is also where wearable devices can be both helpful. Many smartwatches and fitness trackers can detect an irregular rhythm. That information can be useful to share with your clinician, especially if the rhythm comes and goes, but wearables have limits. They can miss episodes you have when you’re not wearing the device, and motion during sports can create inaccurate readings. A smartwatch alert is a reason to follow up, not a diagnosis by itself.
Diagnosing AFib often starts with an EKG. If the rhythm problem is happening during your appointment, it may show up immediately, but AFib can be intermittent, so many people need to wear a monitor at home for several days or even weeks. The goal is to capture the rhythm and understand how often it happens.
Once AFib is confirmed, treatment depends on your symptoms and your overall health. The plan is usually built around a few key goals: lowering stroke risk, controlling the heart rate, and improving how you feel.
Stroke prevention is a major focus with AFib. Some people need a blood thinner to lower stroke risk, especially if they also have high blood pressure, diabetes, heart failure, or a history of stroke. Others may not. It’s a personalized decision to talk through carefully with your provider.
Another goal is rate control. If your heart runs too fast during episodes, medications can slow it down, easing symptoms and protecting your heart over time. For others, the priority is restoring and maintaining a normal rhythm. That may involve medication, and sometimes a controlled “reset” called cardioversion.
Catheter ablation is also an option for some patients. During this procedure, a specialist targets the areas triggering AFib to reduce episodes and improve quality of life, especially when symptoms continue despite medication.
The bottom line is that AFib is common and treatable, but it’s easy to miss because it can be subtle. If your heart feels “off,” especially during activity, don’t shrug it off. Pause, pay attention, and get it checked. When it comes to AFib, the goal is simple: Protect your heart and keep the beat.
Robin is a former television reporter for NBC News 40. She currently hosts a podcast and radio program called Living Well with Robin Stoloff. It airs Sundays at 10 AM on Lite 96.9. You can email Robin at livingwellwithrobin@gmail.com
