Flutter or Skipped Beat? What to Know After 50

Medically Reviewed By: Nikhil P Warrier, M.D., FACC, FHRS, medical director, Electrophysiology, MemorialCare Heart & Vascular Institute, Orange Coast Medical Center

As people age, the risk of heart disease rises—often without obvious symptoms. After age 50, natural changes in the body begin to affect how the heart and blood vessels function, including how the heart beats. These changes can increase the likelihood of developing conditions such as atrial fibrillation (AFib), an abnormal heart rhythm that becomes more common with age.

As the body ages, blood vessels can become less flexible, and risk factors like high blood pressure, cholesterol and stress can increase the likelihood of heart disease, including heart attacks, stroke and abnormal heart rhythms.

The encouraging news is that it is never too late to take control of your heart health. Even small, consistent steps can make a meaningful difference. 

Understanding Atrial Fibrillation as We Age

AFib is closely linked to aging. AFib is uncommon before age 65, affecting fewer than 2% of adults, but roughly 9% of people age 65 and older are living with it. About one in three people will develop AFib at some point in their lifetime, with risk climbing sharply after 65.

AFib can increase the risk of serious complications, particularly stroke, if left untreated. Because AFib can develop without noticeable symptoms, it is important to stay current on routine healthcare visits and talk with your doctor if you have concerns about your heart rhythm.

When Should You Talk to Your Doctor About AFib?

Because AFib can be silent, it is important to know when to talk with a doctor about heart rhythm concerns.

Consider talking with your doctor if you:

• Are over age 50, especially with a history of high blood pressure or heart disease
• Notice a fluttering, racing or irregular heartbeat
• Experience fatigue, dizziness or shortness of breath
• Have a history of stroke or family history of heart rhythm conditions
• Feel your heart “skipping beats,” even occasionally

If something does not feel right, get checked. Early detection can help prevent serious complications and expand treatment options.

If You Are Diagnosed with AFib, You Have Options

If you are diagnosed with AFib, treatment is not one-size-fits-all. The right approach depends on your symptoms, overall health, stroke risk and how long you have had the condition.

Age alone should not limit your choices. Decisions are based on your symptoms and overall health, not your birthdate, and evidence now shows that restoring a normal rhythm earlier in the course of the disease leads to better outcomes.

A cardiac electrophysiologist—a cardiologist who specializes in heart rhythm disorders—can help ensure you understand the full range of treatment options available.

Treatment options may include:

Medications

• Medications can help control heart rate and rhythm. Separately, blood thinners lower stroke risk by roughly two-thirds in patients who need them, and aspirin is sometimes not an equivalent substitute. For some patients, medication alone may effectively manage AFib.

Catheter Ablation

• Catheter ablation treats the areas of the heart responsible for abnormal electrical signals. It may be considered when medications are ineffective or poorly tolerated—and, for some patients, as an initial rhythm-control treatment.
• Traditional ablation uses heat or extreme cold to create small areas of treated tissue that interrupt abnormal signals. A newer approach, called pulsed field ablation (PFA), uses targeted electrical pulses instead. Because its effects are relatively selective for heart-muscle cells, PFA may reduce injury to nearby structures such as the esophagus.

Left Atrial Appendage Closure

• Some patients cannot tolerate long-term blood thinners, have bleeding concerns or have an appropriate reason to seek an alternative. Devices such as WATCHMAN close off the left atrial appendage, the area of the heart where most AFib-related blood clots form, helping reduce stroke risk without the need for lifelong blood-thinning medication in appropriately selected patients. Short-term blood-thinning therapy is still typically needed for a period after the device is implanted.

Healthy Habits That Support Heart Health at Any Age

Whether you're looking to prevent AFib or manage it, healthy lifestyle habits remain essential for heart health.

Stay Active

• Aim for at least 150 minutes of moderate activity each week. Walking, gardening, taking the stairs and light strength training can all support heart health.

Eat for Heart Health

• Focus on fruits and vegetables, whole grains, lean proteins and healthy fats while limiting sodium, sugary drinks and highly processed foods.

Ask About Sleep Apnea

• Untreated obstructive sleep apnea is one of the strongest and most treatable drivers of AFib. If you snore, wake up unrested or have been told you stop breathing at night, ask your doctor about a sleep study.

Watch Alcohol and Weight

• Cutting back on alcohol reduces how often AFib returns, and losing excess weight can reduce both the frequency and severity of episodes.

Prioritize Sleep and Manage Stress

• Chronic stress can contribute to inflammation and high blood pressure, while poor sleep has been linked to an increased risk of heart conditions, including irregular heart rhythms. Establishing a consistent sleep routine and making time for relaxation can have a lasting impact on overall health.

A Proactive Approach to Aging Well

Heart disease and conditions like AFib may become more common with age, but they are not inevitable. With advances in care, the focus is shifting toward prevention and personalized treatment. By combining preventive care, healthy lifestyle habits, early detection and access to advanced treatment options, adults over 50 can take meaningful steps to protect their heart health and continue doing the things they enjoy most.

About the Author

Dr. Nikhil Warrier is the medical director of Electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center. A board-certified cardiologist and cardiac electrophysiologist, he specializes in the diagnosis and treatment of complex heart rhythm disorders, including atrial fibrillation. He performs a high volume of AFib ablations each year, including pulsed field ablation, and treats patients with pacemakers, defibrillators and left atrial appendage closure devices. Dr. Warrier also serves as principal investigator at Orange Coast Medical Center for several national and international clinical trials in atrial fibrillation and stroke prevention.