When your heart starts racing, your chest feels constricted, and you’re overcome by an intense feeling of foreboding, you may be experiencing atrial fibrillation (AFib) or a panic attack — or both.

Atrial fibrillation is one of the most common forms of irregular or atypical heart rate, otherwise known as a heart arrhythmia.

When you live with AFib, the top two chambers of your heart (the atria) contract and relax irregularly, hindering blood flow into the lower chambers (the ventricles).

An AFib episode can have a number of physical symptoms, but it can also be an emotionally stressful event. For some people, the symptoms of AFib closely mimic those of a panic attack, and it can be difficult in the moment to know which one you’re experiencing.

You can experience AFib and panic attacks simultaneously, in close succession, or independently of one another.

While both conditions can share symptoms and generate a fear or anxiety response, there are some fundamental differences between the two.

Underlying mechanisms

AFib is a cardiac condition. Altered electrical signaling occurring in the top chambers of the heart creates atypical contraction function, while structural changes and nervous system dysfunction may impact rhythm regularity.

Panic attacks are an emotional experience with origins in the brain, often presenting with physical symptoms.

While the exact causes behind panic attacks aren’t well understood, the underlying mechanisms may be related to altered neurotransmitter levels or structural changes in the brain.

Emotional component

While AFib can be distressing for some people, emotion isn’t always a factor.

If you’ve lived with an AFib diagnosis for some time, you may be accustomed to the feelings and symptoms of this condition.

You can experience AFib without any emotional response. In fact, it’s possible for AFib to occur without noticeable symptoms, physical or emotional.

Panic attacks, on the other hand, are characterized as emotional experiences.

AFib symptoms

You may not always experience symptoms when living with AFib. Common signs of this condition include:

  • heart palpitations, including fast or irregular heart rate
  • fatigue
  • dizziness, fainting, or lightheadedness
  • chest pain or pressure
  • shortness of breath
  • low blood pressure
  • exercise intolerance
  • emotional distress

Panic attack symptoms

Panic attacks tend to have noticeable symptoms when they occur, including:

  • accelerated heart rate
  • sweating
  • trembling
  • chest pain or pressure
  • sensation of choking or breathing constriction
  • nausea
  • chills or hot flashes
  • intense sense of dread or foreboding
  • anxiety
  • fear
  • tingling sensations
  • feelings of detachment from reality or self

Panic attacks are characterized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) by sudden, overwhelming fear or anxiety, regardless of whether or not other physical symptoms emerge.

There are currently no studies that indicate AFib directly causes panic attacks. However, if AFib is particularly distressing for you, panic attacks may be possible.

For instance, the symptoms of atrial fibrillation may be uncomfortable and frightening, which can contribute to a feeling of anxiety.

Can panic attacks cause AFib?

The role of anxiety disorders as a risk factor for AFib hasn’t been largely studied. In 2019, however, a review paper into AFib triggers found reasonable cause for anxiety to be considered an independent risk factor.

Authors noted that anxiety could potentially increase AFib occurrence by promoting the autonomic nervous system changes that could impact heart function.

Similar symptoms may make you wonder if you’re experiencing AFib or panic attacks, but treatment for these conditions is very different.

Treating AFib

Atrial fibrillation can be identified through diagnostic testing, particularly through the use of electrocardiogram (ECG), which maps the performance of your heart over time.

If AFib is present, your healthcare team will likely recommend a variety of lifestyle, medication, and procedural approaches, depending on the severity of the condition and other underlying medical conditions.

Lifestyle changes aim to address controllable aspects of daily life that may increase the progression or severity of AFib. Lifestyle changes can include:

  • weight management
  • physical exercise requirements
  • reduction or elimination of alcohol intake
  • treatment for substance misuse
  • dietary changes, like salt intake reduction
  • smoking cessation

AFib treatment may require the use of medications that slow the heart rate or act as antiarrhythmics, such as:

You may also benefit from medications that help manage other conditions linked to AFib, such as stroke, high blood pressure, diabetes, or high cholesterol.

If AFib is severe or poses significant concerns, your healthcare professional may recommend one of the following surgical procedures:

Treating panic attacks

Unlike AFib, panic attacks are primarily treated through psychological interventions with the use of medication to complement cognitive behavioral therapy (CBT).

During CBT, your mental health care professional focuses on helping you reconstruct patterns of thinking, behaving, and reacting that may be contributing to panic attack episodes.

Psychological treatment involves developing new coping mechanisms, building stress-reduction skills, and discovering relaxation methods, while at the same time exploring the underlying causes of your feelings.

While many people experience panic attack relief from CBT alone, medication can help reduce symptoms more quickly while CBT is underway.

Medications commonly used to help treat panic attacks include:

If panic attacks are frequent and cause significant impairment to your daily life, you may be living with panic disorder.

Atrial fibrillation is a type of heart arrhythmia that can present with symptoms like palpitations with irregular heart rate, fatigue, shortness of breath, and possibly emotional distress.

While very similar to the experience of a panic attack, AFib directly involves the heart, whereas panic attacks are rooted in brain circuitry and emotional experience.

It is possible to live with both conditions, and experiencing one may contribute to the other. However, no direct cause-and-effect relationship exists between the two.