Rugby star Alun blamed coffee for his heart palpitations. In fact, he had a defective heart, but he dismissed the other telltale symptoms… and cases like his are on the rise among young people.

Having played professional rugby for almost two decades, former British Lions captain Alun Wyn Jones was used to pushing his body hard, so when three years ago he started occasionally getting out of breath and feeling As if his heart was pounding, he shrugged.

‘You can get a rapid heartbeat after drinking caffeine, so I thought it might be due to a strong cup of coffee,’ says Alun, 39, who lives near Swansea with his wife Anwen, a university lecturer, and their three daughters.

And Alun concluded that since ‘about 90 percent of my time was spent running around’, it was to be expected that I would lose my appetite after a match, even for him, the most capped international rugby player in the world, with 158 games for Wales.

However, medical checks he underwent before signing for a new team in the south of France last year showed his optimism was misplaced.

To Alun’s shock, checks revealed that he had a serious heart condition: atrial fibrillation or AF, which means his heart beats irregularly, putting him at significantly increased risk of stroke.

The condition affects around 1.4 million people in Britain – and the number of cases is increasing, even among fit, relatively young people.

Although the diagnosis was ‘a huge shock’, Alun said it was ‘actually a bit of a relief too’. “It joined all the dots: About eighteen months to two years before my diagnosis, I felt tired and wondered if I had chronic fatigue.

‘My sleep was disturbed and I had fleeting palpitations in my chest and felt a little out of breath. But my symptoms were so harmless that I dismissed them.’

Indeed, it is the harmless nature of the symptoms – which also include light-headedness – that causes so many cases to go undiagnosed; According to the British Heart Foundation, almost 300,000 people live with AF without knowing they have it. This is a concern because the condition puts them at five times greater risk of stroke.

In AF, the most common heart rhythm disorder, the heart beats irregularly and sometimes faster or slower than normal (the usual heart rate is between 60 and 100 beats per minute, but in AF it can go up to 200).

The condition is caused by abnormal electrical activity in the upper chambers of the heart (the atria). As a result, they do not contract fully, causing them to be out of sync with the two lower chambers. Although AF itself is not life-threatening, it increases the risk of blood clots. These can travel to the brain, blocking blood flow and leading to a stroke.

And the number of AF cases has risen dramatically, says Andre Ng, consultant cardiologist at Glenfield Hospital in Leicester and professor of cardiac electrophysiology at the University of Leicester.

“About 10 to 15 years ago we said it affects 1 to 2 percent of the population, but now it’s about 2 to 3 percent,” he says.

‘One of the driving forces for this is that we are living longer – one in ten people over 70 have AF – and as we get older we have more time to develop other conditions that can cause AF, such as diabetes, high blood pressure, heart disease and heart failure.’

Another driver in people of all ages is obesity – which can lead to inflammation in heart tissue. ‘But I also see many younger, sporty people with AF in my practice,’ he adds.

A 2021 review in the British Journal of Sports Medicine found that people under 55 who regularly participated in endurance and mixed sports were almost two and a half times more likely to develop AF than non-exercisers.

‘We know that exercise is good,’ says Professor Ng, ‘but too much exercise is not necessarily good for us – and excessive exercise, for example at a particularly competitive level and long endurance training, can put extra stress on the heart.’

That’s because it raises your blood pressure, “so the heart is under stress,” says Professor Ng.

“If you do that repeatedly, the extra stress can ‘stretch’ the cells in the heart and cause them to become excited and ‘fire’ electrically, creating extra heartbeats in the heart that cause AF.” I see many enthusiastic or competitive athletes, especially long-distance runners, who suffer from atrial fibrillation early in their careers.’

One reason more cases are being picked up among young people is the increasing use of “smart” watches, some of which can detect potential heart rhythm problems, he says. AF is diagnosed with an electrocardiogram (ECG), which records the electrical activity of the heart through small sensors attached to various points on the chest and body.

Alun had a normal ECG in 2021, but the ECG he received last July as part of his medical checks before joining French rugby club Toulon “immediately revealed that something was wrong,” he says. The doctor explained on the spot that he had AF, but he was lucky it was noticed – because it may not always be noticeable.

Professor Ng says once AF is diagnosed, any underlying cause, such as high blood pressure, which increases the risk of AF by putting stress on the heart, will be treated. Treating the cause can better control AF symptoms. “If there is no underlying cause, we try to reduce the long-term effects of AF, such as the risk of stroke and heart failure,” he adds.

AF that comes and goes – called paroxysmal AF – can be treated with medications such as beta blockers that slow the heart rhythm or blood thinners to prevent clots. Patients with more persistent AF may be offered cardioversion, in which an electric shock is administered to ‘reset’ the heart rhythm.

An alternative is catheter ablation, in which a thin, flexible tube is passed through a blood vessel in the groin to the heart and the area producing the wrong rhythm is destroyed by heat or freezing.

This causes a scar in the heart that the abnormal electrical activity cannot pass through. Alun was told cardioversion was best for him as his symptoms persisted.

“I knew I would get my treatment once my short-term contract expired, so I went out and played, focusing on the games,” said Alun, who joined Toulon from Swansea-based Ospreys in July 2023. ‘I carried on normally, but was more aware of my body.’

Alun played his last professional match last November: two weeks later he had the cardioversion. “It was like plugging in, that’s what the medical team told me,” says Alun.

‘After the cardioversion, the complaints – the palpitations and shortness of breath – disappeared and I was no longer so tired.’

Today he is not on any medications, but uses a KardiaMobile heart monitor, on which you can place your fingers to record the heart’s electrical activity in 30 seconds. The results are then sent to an app on your mobile phone.

“This device gave me peace of mind,” he says. “If I felt palpitations and wondered if that was indigestion or too much caffeine, I might take it out and use it.”

For example, he stays fit by swimming, running and cycling, and remains grateful that he had the medical examination at Toulon.

“I would have ended my playing career and never known about my atrial fibrillation, which would probably have put me in a worse position in the future,” he says. ‘By making the diagnosis when they did, it’s a good thing for me, and I’m now making others aware of it too.’

Alun has partnered with AliveCor’s Let’s Talk Rhythm campaign to raise awareness about atrial fibrillation.

Vitamin math

‘Vitamin B12 contributes to the production of red and white blood cells and platelets (important for blood clotting) and DNA,’ says dietitian Frankie Phillips. ‘B12 also helps keep hair, nails and skin healthy.

We get it from foods of animal origin – good sources include meat, fish, poultry, milk, eggs, fortified breakfast cereals and plant-based milks and nutritional yeasts.” Vegans may need to take a B12 supplement.