Silent AFib Can Raise Stroke Risk Fivefold, Warn Doctors

HYDERABAD: Atrial fibrillation (AFib), the most common heart rhythm disorder, is increasingly becoming a concern in India as people live longer and lifestyle‑related conditions such as obesity, diabetes and hypertension rise, experts said.

Prof. Dhiraj Gupta, a globally recognised expert in AFib and cardiac electrophysiology from the UK, and Dr C. Narasimhan, director and HOD, electrophysiology services, AIG Hospitals, told Deccan Chronicle AFib often goes undetected because its symptoms can be mild or absent.

Prof. Gupta said AFib had existed for a long time, but growing awareness of its complications and increasing life expectancy had brought greater attention to the condition. Unlike a heart attack, AFib generally develops gradually over days, months or even years.

“Patients may think they are feeling tired or breathless because they are getting older or are less fit. They may not realise that they have a heart rhythm problem,” he said.

AFib occurs when the upper chambers of the heart, called the atria, do not contract normally. This can reduce the heart’s pumping efficiency and cause symptoms such as breathlessness, dizziness, fatigue and palpitations.

Dr Narasimhan said India had a distinct risk profile, with many people having sarcopenic obesity, where muscle mass is low but fat accumulates around the abdomen. This, along with high blood pressure and diabetes, increases the risk of cardiovascular problems.

He said rheumatic heart disease also remained a significant cause of AFib in India. While hypertension is the leading risk factor globally, rheumatic valve disease still accounts for around 40 per cent of AFib cases in some Indian patient groups, compared with a much smaller proportion in Western countries.

The experts said AFib could increase the risk of stroke by about five times. It can also lead to heart failure and, over the long term, may increase the risk of dementia. In some patients, a stroke may be the first indication that they had AFib.

A simple 12‑lead ECG can detect AFib, but doctors need to suspect the condition early. As AFib can be intermittent, prolonged monitoring for two or three weeks or smartwatches with AFib detection features may help identify cases missed during a routine consultation.

The experts said treatment options had also improved significantly. Catheter ablation, particularly newer pulsed‑field ablation technology, has made treatment faster and safer. Newer blood‑thinning medicines have also made stroke prevention easier compared with older drugs such as warfarin.

They stressed that AFib treatment should not focus only on the heart rhythm. Controlling blood pressure, diabetes, obesity and other lifestyle‑related risk factors is equally important.

Prof Gupta said patients should choose centres with experienced electrophysiology teams and high procedural volumes, as experience can improve the safety and effectiveness of procedures.

The doctors also called for greater awareness among primary‑care physicians so that patients with diabetes, hypertension or previous heart disease who report palpitations, fatigue or breathlessness are properly screened instead of having the symptoms dismissed as anxiety or ageing.