Arrhythmia: The heart of a big matter

When Tom James and his rowing teammates took to the podium to receive their gold medals during last year's Olympics, the 29-year-old was the picture of health.

Just months earlier, though, he'd been diagnosed with a heart rhythm disorder called atrial fibrillation (AF) which almost resulted in him missing out on the team selection.

"The symptoms started about seven months before the Olympics, so it wasn't great timing," James recalls.

"I'd just come back from a training camp in Spain where things had gone really well. But after getting home, I got up one morning feeling pretty terrible, went to training and couldn't do more than a couple of minutes on the rowing machine without feeling completely exhausted."

Initially, James put his fatigue down to a virus that had been doing the rounds. But the symptoms didn't clear and he noticed his pulse rate was also abnormally fast and irregular, and he couldn't climb a flight of stairs without becoming very breathless.

"A doctor looked at my heart rate and I was sent to see a cardiologist in London who quickly diagnosed AF," says James. "An ECG [electrocardiogram - which measures the rhythm and electrical activity in the heart] picked it up."

AF, which occurs when the heart's upper chambers stop working properly due to chaotic electrical activity, causing the pulse to become erratic, results in the heart not being able to pump as efficiently.

Luckily for James, once he was diagnosed drug treatment quickly restored his normal heart rhythm. He needed five weeks' rest while the effects of the AF wore off, but was then able to return to training - just in the nick of time.

"If it had been a couple of weeks later I probably would have missed the selection rounds," he says. "It would have been a very different outcome."

There's a high chance James will experience further episodes of AF in the future. But for now it's not causing him any problems, and certainly not hindering his fitness.

However, his experience should be a lesson for us all. There isn't much awareness of atrial fibrillation but it's actually the most common arrhythmia - the medical term for abnormal heart rhythm.

It can affect anybody, even the young and super-fit, but the condition is more prevalent with age, and is far more likely to occur in people with existing problems like high blood pressure, heart disease and valve diseases.

According to the AF Association, around 10% of people over 65 are affected by it, and it's believed that half of them aren't even aware of it.

Not everybody with AF experiences noticeable symptoms, and those who do might not realise that they require treatment.

Indeed, a recent Bupa survey revealed that a quarter of people would wait until they'd experienced an irregular heartbeat four times or more before going to see their doctor.

"AF is the commonest form of arrhythmia seen in humans," says Bupa specialist cardiologist Dr Tushar Salukhe. "We see it in all walks of life and all age groups, even young children, but it's more common the older you get. For over 80s, it's very common.

"The symptoms are highly variable. Some people can be exquisitely sensitive to AF and experience palpitations, breathlessness, dizziness, sometimes fainting, and, to the other extreme, some people may not experience any symptoms at all."

He stresses that palpitations aren't always a sign of a serious arrhythmia. In fact, while they can be very alarming, palpitations are very normal.

Concern arises when palpitations don't quickly return to normal and go on for extended periods of time and, in the case of AF, when the pulse is irregular.

"But when the pulse is racing particularly fast, it can be quite difficult to tell whether it's regular or not," Dr Salukhe adds.

The only way of diagnosing AF for certain is through an ECG. This can be tricky, as the ECG needs to be performed while AF is happening. For many people, episodes come and go - known as paroxysmal AF.

Often AF will be picked up during a routine medical, and not because the sufferer has been referred due to symptoms.

Dr Salukhe points out that, particularly in younger people, it's not uncommon to experience a one-off episode of AF - especially following a heavy night out and binge drinking.

However, if AF persists - with the attacks lasting for seven days or more - without appropriate treatment, it can develop into a chronic long-standing or permanent problem.

This can have a big impact on a person's general wellbeing and quality of life. Crucially, it also significantly increases the chances of stroke, one of the leading causes of death and serious disability.

"What happens with AF," Dr Salukhe explains, "is that in the heart's top chambers, where the pace setters are, instead of contracting and squirting blood into the main pumping chambers, they just tend to wobble like a bag of worms, and this causes blood to pool. And when blood pools, it can clot, and that can cause strokes."

For this reason, blood-thinning drugs are sometimes considered as a treatment option for AF patients.

If picked up early - as in James's case - treatment to restore the normal rhythm can be very effective. Sometimes a surgical procedure called an ablation may be suggested.

Dr Salukhe explains that how AF is treated depends largely on the individual, as the condition can vary greatly.

The important thing is that it's diagnosed as early as possible.

James was lucky but other members of his family who have AF, including his father and uncle, didn't have their condition picked up so quickly. His uncle now has ongoing problems with it.

The double Olympic gold winner has teamed up with Bupa to launch a new section of their website highlighting AF and other arrhythmias.

Dr Salukhe adds: "If a person's worried about their pulse - if it's particularly fast or irregular, or their heart's racing when it shouldn't be racing, that is an indication to go and see your GP.

"If you're feeling breathless along with palpitations, especially if you lose consciousness, that's the time to present yourself to casualty."