AFib and panic attacks can have overlapping symptoms, but there are some key differences. Here’s how to tell them apart.

Atrial fibrillation (AFib) 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 rapidly and irregularly, causing an irregular heartbeat and impairing the flow of blood to the lower chambers.

Episodes of AFib can trigger a variety of physical symptoms, but they can also be emotionally unsettling. For some people, the sensations of an AFib episode can feel very similar to those of a panic attack, making it challenging in the moment to tell which one is happening.

Understanding the differences between the two can help you respond appropriately and seek the right care.

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

Although they share some symptoms and can both trigger feelings of fear or anxiety, they stem from different causes and affect the body in distinct ways.

Underlying mechanisms

AFib is a heart rhythm disorder caused by rapid, irregular electrical signals that cause the heart’s upper chambers to quiver, resulting in an uneven or fast heartbeat.

In contrast, panic attacks originate in the brain as emotional responses that can produce strong physical sensations.

Although their exact cause isn’t fully understood, panic attacks may be linked to changes in brain chemistry or structure that affect how the body responds to stress.

Emotional component

While AFib can feel unsettling, emotion isn’t always involved. Many people with AFib become familiar with its sensations or may even experience episodes without noticeable physical or emotional symptoms.

In contrast, panic attacks are strongly tied to emotion and often include intense fear, anxiety, or a sense of impending doom.

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 are characterized in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) by the sudden onset of intense fear or discomfort accompanied by at least four of the following symptoms:

  • palpitations, pounding heart, or accelerated heart rate
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • feelings of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, lightheaded, or faint
  • chills or heat sensations
  • paresthesias (numbness or tingling sensations)
  • derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • fear of losing control or “going crazy”
  • fear of dying

Research from 2019 suggests that anxiety, which includes a diagnosis of panic disorder, is a potential risk factor for developing AFib.

Additionally, a 2022 review paper indicates that AFib and stress share a bidirectional relationship, meaning stress can trigger AFib episodes while AFib itself can increase psychological distress and anxiety symptoms, such as panic attacks.

Stress and anxiety influence heart rhythm through the autonomic nervous system (the part of the nervous system that automatically controls functions like heart rate and breathing) and hormonal pathways (the body’s system of chemical messengers that regulate stress responses), which may contribute to AFib onset or worsening.

Together, these findings highlight a complex connection between emotional stress, anxiety, and heart rhythm disturbances.

Because AFib and panic attacks can feel similar, it’s easy to confuse the two. However, they have very different causes, and each requires its own approach to treatment.

Treating AFib

Atrial fibrillation can be identified through diagnostic testing, particularly through the use of an electrocardiogram (ECG), which shows the heart’s electrical activity.

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:

Afib increases the risk of stroke, and blood thinners are often prescribed to lower the risk of stroke.

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

Treating panic attacks

Unlike AFib, panic attacks are mainly treated with psychological interventions, often complemented by medication. Cognitive behavioral therapy (CBT) helps you identify and change patterns of thinking, behavior, and reactions that contribute to panic episodes.

Treatment focuses on building coping skills, reducing stress, practicing relaxation techniques, and exploring underlying emotional causes.

While CBT alone can be effective, medications such as antidepressants, anti-anxiety drugs, or beta-blockers can help relieve symptoms more quickly. Although beta-blockers are not FDA-approved for anxiety, a doctor may prescribe them to address related physical symptoms.

Frequent, severe panic attacks that interfere with daily life may indicate 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 they share some symptoms, 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.