Heart Conditions Atrial Fibrillation

Overview

Atrial fibrillation — usually called AF — is a heart rhythm problem. Your heart has four chambers, and the two upper ones are called the atria. In AF, those upper chambers quiver or wobble instead of squeezing in a steady beat. That makes your heartbeat fast and uneven. AF is not the same as a heart attack, and it is not always dangerous in itself. But it does raise your chance of a stroke, so it is important to get it checked and treated.

Yes. AF is the most common serious heart rhythm problem worldwide. It affects roughly 1 to 2 in every 100 adults, and the numbers rise with age — around 1 in 10 people over 80 have it. Many cases are never picked up, so the true figure is probably higher.

AF can affect anyone, but it is much more common over the age of 65, and slightly more common in men. You are more likely to develop it if you have high blood pressure, other heart problems, sleep apnoea (a condition where breathing stops and starts in sleep), an overactive thyroid, are very overweight, or drink a lot of alcohol. It can also happen in younger people, including athletes, and sometimes no cause is found.

Symptoms

Common symptoms

• Palpitations — a fluttering, racing, thumping or 'flip-flopping' feeling in your chest
• A pulse that feels uneven or irregular
• Feeling tired or low on energy, even when resting
• Shortness of breath, especially when active
• Dizziness or light-headedness
• Chest discomfort or a feeling of pressure
• Needing to pass urine more often, especially at night
• Finding exercise harder than usual
• No symptoms at all — AF is sometimes found by chance

Causes

Main causes

• A problem with the heart's electrical signals, which tell the heart when to beat
• Other heart conditions — high blood pressure, coronary heart disease, heart valve problems, heart failure or a weakened heart muscle
• An overactive thyroid gland
• Heavy drinking, especially binge drinking
• Sleep apnoea — breathing that stops and starts during sleep
• Infection, surgery or a serious illness
• Sometimes no clear cause is found — doctors sometimes call this 'lone' AF

Risk factors

• Being over 65
• High blood pressure
• Being overweight or obese
• Diabetes
• Sleep apnoea
• Thyroid disease
• Drinking a lot of alcohol
• Smoking
• A family history of AF
• Long-term lung disease
• Very strenuous endurance training
• Some medicines and remedies — ask your pharmacist, as some cold, flu and 'energy' products contain stimulants

When to see a doctor

See a doctor urgently if:

• The first time you notice a fast, uneven heartbeat that does not settle within a few minutes
• Palpitations with dizziness, breathlessness or chest discomfort
• Leg or ankle swelling that is getting worse, or breathlessness when lying flat
• Feeling faint or very tired along with an irregular pulse

Book a routine appointment if:

• You have noticed an irregular pulse at home, even if you feel well
• You feel more tired or breathless than usual during everyday activity
• A smartwatch or home blood pressure monitor has flagged an irregular rhythm
• You have risk factors such as high blood pressure or sleep apnoea and want a review
• A close family member has AF and you would like your pulse checked

Diagnosis

Your doctor will ask about your symptoms, feel your pulse and listen to your heart. The key test is an ECG (electrocardiogram) — a quick, painless heart tracing made with small sticky pads on your chest. Because AF can come and go, you may need to wear a monitor for a day or more, or use a small device at home, to catch an episode. Blood tests and an ultrasound scan of the heart are usually done too, to look for causes and to plan your treatment.

Tests that may be done

• Pulse check and physical examination
• ECG — a quick, painless tracing of your heart's electrical signals
• Ambulatory ECG — a monitor worn for 24 hours or longer, a small patch, or a hand-held event recorder
• Blood tests, including thyroid, kidney and blood count tests
• Echocardiogram — an ultrasound scan of the heart
• Chest X-ray
• Occasionally a small heart monitor inserted under the skin, or a recording from your phone or watch that your doctor can review

What to expect at your appointment

Most tests are quick and painless, and you can go home the same day. You may be asked to keep a diary of when symptoms happen, so the tracing can be matched to how you felt. Results usually come back within days to a few weeks, and your doctor will go through them with you and agree a plan. It helps to bring a list of your medicines and any recordings from your phone or smartwatch.

Treatment

Treatment has two main aims: protecting you from stroke, and helping your heart beat in a calmer, more comfortable way. What you are offered depends on your age, other health conditions, how often you have AF and how much it affects your daily life. Decisions should be made together with your healthcare team, and you can ask as many questions as you like.

Self-care at home

• Learn to check your own pulse — it takes about a minute
• Take any prescribed medicines exactly as directed, even when you feel well
• Keep a simple note of symptoms, possible triggers and how often they happen
• Cut back on alcohol and avoid binge drinking
• Ask your pharmacist before buying cold, flu or energy products, as some contain stimulants
• Stay active and work towards a healthy weight
• Get help to stop smoking
• Ask about treatment for snoring or pauses in breathing during sleep
• Keep blood pressure, cholesterol and diabetes well controlled
• Stay hydrated and rest when your heart feels fast

Medical treatments

Treatment usually falls into a few broad groups. Some medicines slow the heart rate so it feels calmer. Others help keep the heart in a normal rhythm, or are used for a short time to get you back into rhythm. A separate group of medicines — often called blood thinners — makes blood clots much less likely and greatly lowers the risk of stroke; these are advised for many people with AF, even when their heartbeat feels fine. Your doctor will weigh up the benefits and risks for you personally and explain the choices. Non-medicine options include cardioversion, where a controlled electric shock resets the heart rhythm, and catheter ablation, where a thin tube is guided to the areas of the heart causing the problem. Some people need a pacemaker.

When is surgery considered?

Procedures are more often used than open surgery. Cardioversion, catheter ablation or a pacemaker are the usual next steps if medicines are not working well. Open heart surgery is only considered in particular situations — for example, when a heart valve also needs repairing. Your heart team will explain the benefits and risks in your case.

Living with this condition

Most people with AF carry on with work, family life, travel and hobbies. A few habits make this easier: know how to check your pulse, keep any medicines in a routine you will not forget, and have a simple plan for when symptoms flare up — sit down, rest, breathe slowly, and seek help if the symptoms are severe or new. Tell any health professional you see that you have AF, and check the driving rules where you live, especially if you have fainted.

Lifestyle tips

• Keep alcohol within low levels and avoid heavy sessions
• Choose a heart-friendly way of eating
• Move more — regular moderate activity such as walking or swimming
• Aim for a healthy weight and steady, gradual weight loss if needed
• Get enough sleep and ask about sleep apnoea if you snore heavily or feel unrefreshed
• Manage stress with breathing exercises, hobbies or talking therapies
• Stop smoking, with support if you can
• Limit caffeine if you notice it triggers symptoms
• Keep up with routine check-ups for blood pressure and other conditions

Diet and exercise

A heart-friendly pattern of eating helps: plenty of vegetables, fruit, wholegrains, beans, nuts, fish and olive oil, with less salt, processed meat and sugary food. If you are carrying extra weight, losing even a modest amount can reduce how often AF happens. Moderate activity like walking, swimming or cycling suits most people with AF. If your heart rate is not well controlled, build up gradually and ask your team about very strenuous or endurance exercise.

Mental health and emotional wellbeing

AF can be worrying, and it is very common to feel anxious about your heart — especially at night when it races. Low mood and anxiety are treatable, and talking therapies help many people. Tell your doctor how you are feeling; it is part of your care, not a side issue. If you ever feel unable to cope, or have thoughts of harming yourself, get help straight away — contact your doctor, your local crisis support line, or your local emergency number.

Prevention

You cannot always prevent AF, but you can lower your chances. Looking after your blood pressure, weight, sleep and alcohol intake makes a real difference — and the same steps help you stay well if you already have AF.

Vaccines

There is no vaccine against AF itself. People with heart conditions are usually advised to have a yearly flu vaccine and to keep up to date with recommended vaccinations. Ask your doctor or pharmacist what is right for you.

Screening programmes

Most countries do not have a national screening programme for AF, but pulse checks are done at many routine appointments and health checks. You can check your own pulse at home, and some smartwatches and home blood pressure monitors flag an irregular rhythm — show any alerts to your doctor.

Complications

If left untreated

• Stroke — AF is one of the main causes, and treatment greatly reduces the risk
• Heart failure, when the heart becomes weak or stiff over time
• Worsening breathlessness, tiredness and reduced ability to exercise
• More hospital visits and admissions
• Memory and concentration problems in some people
• Low mood and anxiety

Long-term outlook

The outlook for people with AF is good. With the right treatment and a little self-care, most people live normal, active lives. Stroke risk can be cut substantially, symptoms can usually be controlled, and there is a lot you can do yourself to stay well. Keep in touch with your healthcare team, ask questions, and tell them if anything changes.

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