Atrial fibrillation explained

What is atrial fibrillation?

Atrial fibrillation (AF) is when the upper chambers of your heart (atria) do not beat in a regular rhythm. Any irregular heart beat can be called an 'arrhythmia'. The irregular heart beat is often too fast, but sometimes is normal, or too slow.

It can go away on its own, but if it is not treated it increases your risk of blood clots, having a stroke, heart failure, and other heart-related conditions.

There are three main types of AF, these are:

• Occasional or paroxysmal - symptoms come and go suddenly and usually stop without treatment.

• Persistent - lasts longer than seven days and usually requires treatment.

• Permanent – lasts long-term. Treatment can help bring the heart rate back down, but the rhythm remains irregular.

Causes of atrial fibrillation

AF can be caused by several factors, including heart disease, health conditions, and lifestyle. For some people there is no apparent cause.

The main causes of AF include:

• Heart disease – such as heart attack, heart failure and coronary heart disease.

• Other health conditions - such as high blood pressure and diabetes.

• Medicines you take for your health conditions – such as asthma inhalers.

• Lifestyle – such as drinking too much alcohol or living with obesity.

Your chance of having AF can also increase due to factors outside your control such as your age, sex, or having a family history of the condition.

Symptoms and signs of atrial fibrillation

Some people who have AF say it feels like their heart is fluttering or pounding hard. Many have no symptoms at all and may only find out when they are having other tests, or their heartbeat is being checked.

Symptoms usually start suddenly - the main ones include:

• Heart fluttering, thumping or pounding more than usual (palpitations) - this may last for several seconds or hours.

• Chest pains (angina) or a feeling of chest tightness.

• Irregular heartbeat.

• Feeling very tired

• Feeling short of breath, dizzy or faint.

How long your symptoms last will depend on the type of AF you have.

How atrial fibrillation is diagnosed

To diagnose AF, your doctor or health care professional will check your pulse and ask questions about your general health and symptoms. They will then arrange for a heart tracing (ECG) to accurately record the rate and rhythm of the heart. If they think you have AF you may be offered a consultation with a specialist for further tests and treatment.

These tests include:

Echocardiogram

Similar to a pregnancy scan, sound waves show how blood is flowing through your heart as well as looking at the valves and structures of the heart.

Electrocardiogram (ECG)

An ECG is the main test for diagnosing AF. Electrodes are stuck onto your chest, arms and, legs to record your heart rate and rhythm and its electrical activity.

Other types of ECG tests include:

Implantable loop recorder – a small device is placed under the skin and records your heartbeat continuously for up to 3 years. It's also called a cardiac event recorder.

Continual ECG recording - also called a Holter monitor. This small portable device records your heart’s electrical activity for one to seven days, while you go about your day-to-day activities.

Exercise ECG – records your heart activity while you're walking on a treadmill or pedalling an exercise bike to show how your heart reacts to exertion. If you have difficulty exercising, you may be given medicine that increases your heart rate as though you were.

You may also be offered blood tests and a chest x-ray to look for any other health conditions affecting your heart.

Treatment for atrial fibrillation

Sometimes AF does not require treatment. If treatment is necessary, the options open to you will depend on factors such as the type of AF you have and your general health.

The main treatments include:

Medicines

You may be offered medicines – such as beta blockers - to help slow down and regulate your heartbeat. You may also be offered medicines to help prevent related conditions such as blood clots or stroke (anticoagulants).

Surgery

There are different types of surgery that you could be offered, the most common are:

• Ablation – burns or freezes part of your heart to deactivate the area that's causing the AF.

• Electrical cardioversion – uses electricity to reset your heartbeat to a regular rhythm.

• Pacemaker – implanted in your chest to regulate your heartbeat after some forms of ablation.

If your AF is caused by another health condition, then that will be treated and should help ease the symptoms.

Living with atrial fibrillation

As well as any treatment you may receive for AF, there are several lifestyle changes you can make to help keep your heart healthy and reduce the chances of further complications. These include:

• Eating healthily.

• Keeping your weight at healthy levels.

• Exercising regularly.

• Looking after your mental wellbeing.

• Taking your medicines when you should.

• Drinking within safer alcohol limits.

• Not smoking.

• Managing your blood sugars.

• Managing high blood pressure.