Overview
The heartbeat is normally set by regular electrical signals passing through the heart. In these signals become disorganised, so the two upper chambers, the atria, quiver rather than contract properly.
The result is a pulse that is irregular and often fast. Because the atria are not emptying fully, blood can pool inside them and form a clot. If that clot travels to the brain it causes a stroke, and this is the main reason atrial fibrillation is treated. In some people episodes come and go; in others the rhythm stays abnormal. Both need assessment.
Symptoms
Symptoms vary a great deal and may include:
- Palpitations, a fluttering, thumping or racing heartbeat
- A pulse that feels irregular at the wrist
- Tiredness and less energy for everyday activity
- Breathlessness
- Dizziness or light-headedness
- Chest discomfort
Many people have no symptoms at all, and the rhythm is found at a routine check, before surgery, or after a stroke.
When to see a doctor
See a doctor within a few days if the pulse feels irregular, if palpitations keep coming back, if there is new breathlessness or tiredness, or if a blood-thinning medicine has run out.
Causes
usually appears in a heart strained or changed by another condition: high , coronary artery disease, heart failure, valve disease or previous heart surgery.
It is also linked with an overactive thyroid, chest infection, diabetes, kidney and lung disease, and sleep apnoea. A heavy bout of alcohol or some stimulant drugs can set off an episode. In some people no cause is found.
Risk factors
- Older age
- High
- Coronary artery disease, heart failure or valve disease
- Diabetes
- Being overweight
- Obstructive sleep apnoea
- An overactive thyroid
- Long-term kidney or lung disease
- Heavy or binge drinking, and smoking
- A family history of
Complications
- Stroke, the most important complication
- Blood clots travelling to the leg, arm or other organs
- Heart failure, when a fast irregular rhythm continues
- Tiredness and reduced ability to exercise
- Problems with memory and thinking
Prevention
- Keeping within the doctor's target
- Treating diabetes, thyroid disease and sleep apnoea
- Keeping to a healthy weight and staying active
- Cutting down alcohol, and avoiding binge drinking
- Not smoking or chewing tobacco
- Limiting strong tea, coffee and energy drinks if they bring on palpitations
- Taking prescribed medicines regularly, especially those that prevent clots
Diagnosis
An irregular pulse felt at the wrist is often the first clue. The diagnosis is confirmed with an , which records the heart's electrical activity and shows the disorganised rhythm.
If episodes come and go, a recording over 24 hours or longer with a portable monitor may be needed. Other tests look for a cause: blood tests including thyroid function, an , and sometimes a sleep study.
Treatment
Treatment has two aims. The first is to reduce the risk of stroke. The doctor works this out from age and conditions such as high , diabetes, heart failure and any previous stroke, and prescribes a blood-thinning medicine when the risk is high enough.
The second aim is the rhythm. Some people are given medicines that simply slow the heart rate. Others are offered treatment to restore a normal rhythm: medicines, a controlled electric shock under sedation called cardioversion, or catheter ablation, in which the heart tissue sending faulty signals is treated through a thin tube.
Treating the underlying condition matters as well, whether that is blood pressure, thyroid disease, sleep apnoea, excess weight or alcohol. A few people need a pacemaker.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“My heart flutters only now and then, so it cannot be serious.”What is true?
Fact
Atrial fibrillation often comes and goes at first, and short episodes still let blood pool in the heart. The rhythm settling on its own does not remove the need for assessment, because the risk of stroke is worked out from age and other conditions, not from how often the palpitations are felt.
Myth“Palpitations are just gas, acidity or nerves.”What is true?
Fact
Anxiety, caffeine and indigestion really can cause the feeling of a thumping heart. But an irregular pulse can also be atrial fibrillation, and the only way to tell is an ECG, which is a quick and painless test.
Myth“If I feel fine, I do not have a rhythm problem.”What is true?
Fact
Atrial fibrillation can be completely silent, which is one reason it is sometimes found only after a stroke. Feeling well does not rule it out, and a doctor or a simple pulse check can pick it up.
Myth“Blood thinners are dangerous, so it is safer to stop them or to swap them for a home remedy.”What is true?
Fact
Blood-thinning medicines are prescribed because they greatly lower the chance of a stroke, which is the most serious thing that atrial fibrillation causes. They do raise the risk of bleeding, and that is why the dose and any blood tests are supervised. Starting, stopping or changing them should only be done by the doctor who prescribed them.
Myth“Once my heartbeat is back to normal, the treatment is over.”What is true?
Fact
The rhythm can return to normal by itself or after treatment, and still slip back into atrial fibrillation later, sometimes without symptoms. Medicines to prevent clots are usually continued according to the overall stroke risk rather than according to how the heart feels on a given day.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How can I check my own pulse?
Rest your hand palm upward, place two fingers of the other hand on the thumb side of the wrist, and press lightly until you feel the beat. Count for a full minute and notice whether the beats come at even intervals. An irregular or very fast pulse is worth reporting, even if you feel well otherwise.
Is aspirin enough to prevent a stroke if I have atrial fibrillation?
Aspirin and the blood-thinning medicines used in atrial fibrillation work in different ways and are not interchangeable. The choice of medicine is based on your calculated stroke risk and is made by your doctor. Do not swap, add or stop a medicine on your own, and take the prescription you were given as directed.
Will my heartbeat go back to normal for good?
Sometimes it does, especially when a trigger such as a thyroid problem, an infection or heavy alcohol use is corrected, or after cardioversion or ablation. In many people the rhythm returns at times, often without symptoms. That is why treatment to prevent clots is usually continued based on overall risk.
Can I still exercise and travel?
Most people with well-controlled atrial fibrillation can exercise and travel normally. Ask your doctor what level of activity suits you, carry a list of your medicines when you travel, and take enough supply with you. Seek help wherever you are if you develop chest pain, severe breathlessness or signs of a stroke.
