Atrial fibrillation

What is it?

In atrial fibrillation (AF), a problem with the heart's electrical system makes the heartbeat irregular, and sometimes much faster than normal.^2,1 The upper and lower parts of the heart stop working together, so the heart may not pump blood as well as it should.¹ It is one of the most common heart rhythm problems.¹ High blood pressure, narrowed heart arteries, other heart problems, an overactive thyroid, diabetes and sleep apnoea can all lead to it; sometimes the cause is not known.^2,1

Anyone can get it, but it is more likely as you get older, especially after 65, and in men.^2,1 Obesity, smoking, heavy drinking and some medicines raise the risk.^2,1 AF can run in families.¹

The first signs

Some people have no symptoms, and AF is found during a routine check-up or when tests are done for something else.^2,1

• an irregular pulse, or a fluttering or pounding heartbeat (palpitations);²
• a heartbeat faster than 100 beats a minute;²
• feeling very tired, or less able to exercise;²
• shortness of breath, dizziness or feeling faint;²
• chest pain or tightness.²

How doctors find out

If your family doctor thinks you have AF, you are sent to a heart specialist (cardiologist), who checks your heart rate.² Tests can include a heart trace (ECG), an ultrasound scan of the heart (echocardiogram), a chest X-ray and blood tests.² You may be asked to wear a heart monitor that records your heart's electrical activity.¹ The tests also look for other causes of your symptoms.²

Current treatment

The 2024 ESC guideline (AF-CARE) puts treating other conditions and risk factors first, then avoiding stroke, then easing symptoms with rate or rhythm control, and individualised reassessment over time.Source: ESC

Will it get worse?

AF may happen in brief episodes, or it may be permanent. Symptoms may start and stop on their own, or stop after treatment, or you may always have symptoms.^1,2 Without treatment it raises the risk of blood clots, stroke, heart failure and memory problems, which is why treatment aims to lower these risks.^1,2 The sooner it is found and treated, the better.¹

Medicines: what helps, and what to watch for

Medicines such as beta blockers control the heart rate and rhythm.² Anticoagulants (often called blood thinners) make blood clots, and so strokes, less likely.^3,2 They include warfarin and newer tablets such as apixaban, rivaroxaban, edoxaban and dabigatran.³ Treatment is often lifelong.³

Good to know:

• the main side effect of anticoagulants is bleeding too easily: watch for blood in your pee or poo, black poo, bad bruising, long nosebleeds, bleeding gums, or coughing or vomiting blood;³
• for most people, the benefit of an anticoagulant is bigger than the risk of bleeding;³

Exercise and healthy habits help too

• aim for at least 150 minutes of moderate exercise a week, like walking, bike riding or gardening, but avoid intense exercise and try not to exercise when you have symptoms of atrial fibrillation;²

Procedures and surgery, for some people

Electrical cardioversion uses low-energy shocks to reset your heart rhythm.^1,2 In catheter ablation, the heart tissue that sends the faulty signals is scarred on purpose by burning, freezing or high-energy pulses.^1,2 Some people have a pacemaker or an implantable defibrillator (ICD) fitted, or heart surgery (the Maze procedure).^2,1 For people who cannot take blood thinners, another procedure (left atrial appendage closure) may be an option.¹

Is there a cure?

Not yet.² Treatment helps manage the symptoms and lowers the risk of stroke and other problems.²

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Sources

Written in plain words by Frontlight from these pages:

1. MedlinePlus: Atrial Fibrillation
2. NHS: Atrial fibrillation
3. NHS: Anticoagulant medicines