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Atrial fibrillation

Atrial fibrillation is a condition in which your heart beats in an irregular rhythm (arrhythmia) which may often be too fast. It’s one of the most common types of long-lasting (sustained) arrhythmia.

Your heartbeat is controlled by electrical signals (impulses), which travel through your heart making it contract. The signals travel from the atria (the upper chambers of your heart) to the ventricles (the lower chambers) through an area called the atrioventricular (AV) node. The AV node helps to synchronise the pumping action of your heart. 

Atrial fibrillation occurs when the electrical signals in your atria become disorganised, overriding your heart's normal rate and rhythm. This causes your atria to contract irregularly (also known as fibrillation).

Atrial fibrillation affects around 800,000 people a year in the UK. It can affect anyone at any age, but it’s more common in people aged 55 and over.

Types of atrial fibrillation

There are three types of atrial fibrillation. Atrial fibrillation can change from one type to another over time.

  • Paroxysmal atrial fibrillation. This type of atrial fibrillation comes and goes for a few minutes or hours at a time. It can last for up to seven days (but usually only lasts one or two days). Your heartbeat may return to normal by itself or you may need medicines to return your heartbeat to its normal rhythm.
  • Persistent atrial fibrillation. This type of atrial fibrillation can last for longer than seven days. You will need medical treatment, such as cardioversion, to restore your heart to its normal rhythm (see Treatment section for more information).
  • Permanent atrial fibrillation. This type of atrial fibrillation is when your heartbeat is permanently affected, and doesn’t return to its normal rhythm even after medical treatment.
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Different types of heart arrhythmia
Arrhythmia is a disturbance of the normal electrical rhythm of the heart
Image showing the electrical impluses in a normal heart and a heart with atrial fibrillation

Details

  • Symptoms Symptoms of atrial fibrillation

    You may have atrial fibrillation but not have any symptoms at all; or just have mild symptoms that don’t cause you any problems.

    If you have symptoms of atrial fibrillation, these may include:

    • palpitations – when you're aware of your heart beating faster or in an irregular way
    • chest pain or discomfort
    • finding it difficult to exercise
    • shortness of breath
    • feeling dizzy or light-headed

    If you have any of these symptoms, see your GP straight away.

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  • Diagnosis Diagnosis of atrial fibrillation

    You may not be aware that you have atrial fibrillation, and it may only be discovered by chance if your GP or nurse checks your pulse for some other reason. However, if you experience any symptoms or have any concerns about your heart rhythm, see your GP. He or she will ask about your symptoms and examine you.

    Your GP will check your blood pressure, listen to your heartbeat and take your pulse. If your pulse is irregular, you’re likely to have a test called an electrocardiogram (ECG). This records the electrical activity of your heart to see how well it’s working.

    If your GP suspects you have atrial fibrillation, he or she may refer you to a cardiologist – a doctor who specialises in identifying and treating heart and blood vessel conditions. He or she may suggest you have other tests including the following.

    • Blood tests.
    • An echocardiogram. This is an ultrasound scan that produces a clear image of your heart muscles and valves to check the structure of your heart and how well it's functioning.
    • Ambulatory ECG. This takes a recording of your heartbeat while you carry on with your usual activities for 24 hours or more.

    If you have symptoms that have come on suddenly, such as chest pain or shortness of breath, your GP may refer you to hospital immediately to have these tests.

  • Treatment Treatment of atrial fibrillation

    There are many treatment options available for atrial fibrillation. Your treatment will be tailored to you, and will depend on your symptoms, the type of atrial fibrillation you have and what is causing it.

    Your treatment may aim to control your heart rhythm and stop the arrhythmia, or it may aim to control your heart rate and reduce your risk of having a stroke. If your symptoms are mild, you may not need any treatment at all.

    Your doctor will discuss your treatment options with you.

    Medicines

    There are several different types of medicine that are used to treat atrial fibrillation. Your doctor may prescribe you a combination of medicines or try one type first before trying another. You may need to take them for a short time to control your heartbeat, or you may need to take them for several months or years to manage your condition.

    Medicines to control your heart rate

    You may be given medicines to control how fast your heart is beating. This means you will still have atrial fibrillation, but your heart will beat more slowly and effectively. These medicines include digoxin, beta-blockers and calcium-channel blockers.

    Medicines to control your heart rhythm

    You may be given medicines to control your heart rhythm. These are called antiarrhythmic medicines and include flecainide and beta-blockers.

    If your atrial fibrillation has come on suddenly (usually within 48 hours), you may also be given antiarrhythmic medicines in hospital as tablets or through a vein in your hand or arm to try to get your heart rhythm back to normal (this is called pharmacological or chemical cardioversion).

    If you have paroxysmal atrial fibrillation (the type that comes and goes), your doctor may give you an antiarrhythmic medicine to take only when you have symptoms. This is known as the ‘pill in the pocket’ approach. Examples of medicines used for this treatment include flecainide and propafenone.

    Medicines to reduce blood clotting

    As atrial fibrillation increases your risk of stroke, your doctor may give you medicines to try to prevent a blood clot forming. These are called anticoagulants and include heparin, warfarin and aspirin. You may be given these in addition to medicines to control your heart rate or if you’re having a procedure called electrical (DC) cardioversion (see below).

    Hospital treatment

    Your doctor will usually only recommend further treatment if medicines haven't controlled your atrial fibrillation. Options include electrical (DC) cardioversion and catheter ablation. All these procedures are carried out in hospital by a cardiologist, usually under local anaesthesia and sedation.

    Electrical (DC) cardioversion

    DC cardioversion is a procedure that involves giving a controlled electric shock to restore your heart's normal rhythm. You may be offered DC cardioversion straight away if your atrial fibrillation started less than 48 hours ago and medicines haven’t helped, or if you are very unwell. If your symptoms have lasted more than 48 hours, you may be prescribed medicines such as anticoagulants to take first, before having DC cardioversion about four to six weeks later. You may also need to have a transoesophageal echocardiogram before having a cardioversion, to check for any blood clots in your heart. DC cardioversion is less likely to work if you have had arrhythmia for over a year. For more information on cardioversion, see Related topics.

    Catheter ablation

    Ablation means freezing or burning your heart tissue. Catheter ablation can be carried out to destroy the areas of your heart that are sending out the irregular signals (known as atrial fibrillation ablation).

    Your cardiologist will insert catheters (thin flexible tubes) into a vein in your groin and pass them up into your heart. The affected area is then ablated using very high or low temperatures. This procedure may not be suitable for everyone, and sometimes you may need a repeat procedure to control your atrial fibrillation. See our frequently asked questions for more information about catheter ablation.

    If you're unable to have atrial fibrillation ablation or the procedure hasn't worked for you, you may be able to have another type of catheter ablation procedure, called AV node ablation. This destroys the AV node, preventing irregular signals being passed through your heart, so that your heart rhythm is kept regular. You will also be fitted with a pacemaker – a small device that controls your heart beat. This may be done as a separate procedure.

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  • Causes Causes of atrial fibrillation

    Many conditions that affect the heart or blood circulation can cause atrial fibrillation, including:

    • high blood pressure
    • heart valve disease
    • heart muscle disease (cardiomyopathy)
    • coronary heart disease
    • congenital heart disease (heart problems that you’re born with)
    • inflammation of your heart (pericarditis)
    • overactive thyroid and underactive thyroid
    • lung cancer and chest infections
    • a blood clot in your lung (pulmonary embolism)

    Certain other factors can also trigger atrial fibrillation, including:

    • drinking too much alcohol or caffeine
    • being overweight
    • taking certain medicines
    • emotional or physical stress
    • having surgical procedures

    About one in 10 people develop atrial fibrillation without having any known underlying cause. This is called lone atrial fibrillation.

  • Complications Complications of atrial fibrillation

    If you have atrial fibrillation, you may be up to five times more likely to have a stroke than someone who doesn’t have the condition. This is because your blood doesn't flow through your heart properly, so a blood clot can form. The blood clot can then travel to your brain where it can block your blood supply and cause a stroke. However, your risk of having a stroke will depend on many aspects of your health, such as your blood pressure and cholesterol level, and whether you have diabetes. Take our stroke risk assessment to find out your risk of stroke.

    If you have atrial fibrillation and your doctor thinks you’re at risk of a stroke, he or she may prescribe you an anticoagulant medicine, such as warfarin, to prevent a blood clot forming. If you can't take anticoagulant medicines, you may be prescribed aspirin or clopidogrel instead, but these aren’t as effective. For more information, speak to your doctor.

  • FAQs FAQs

    Are palpitations always caused by atrial fibrillation?

    Answer

    No, there are many other causes of palpitations (where you become aware of your heart beating more rapidly or more forcefully).

    Explanation

    Most people experience palpitations at some time – including people without atrial fibrillation. While they can be unpleasant and distressing, these palpitations are normally harmless and go away on their own. Palpitations can be triggered by factors, including:

    • fear
    • anger
    • stress
    • physical activity
    • fever
    • stomach upsets
    • drinking alcohol or caffeine
    • smoking tobacco
    • taking certain medicines, especially if they contain caffeine or phenylephrine, such as cough, cold and flu medicines

    You may also feel that your heart has skipped a beat or there is an extra beat. An extra beat is called an ectopic beat and is very common. Extra beats are usually nothing to worry about and don't need any treatment.

    If your palpitations don't seem to have an obvious trigger, or are associated with other symptoms such as dizziness or chest pain, see your GP.

    Can I still exercise if I have atrial fibrillation?

    Answer

    Although exercise is usually good for fitness, especially for having a healthy heart, if you have atrial fibrillation, you will need to discuss whether you can exercise with your doctor. Whether you should exercise and how much you should do will depend on your individual circumstances.

    Explanation

    Generally speaking, exercise is good for your heart – it’s recommended that adults do 150 minutes of moderate-intensity physical activity a week. However, atrial fibrillation may occasionally be triggered by exercise.

    Once your atrial fibrillation is under control with appropriate treatment, your doctor may recommend that it’s safe for you to start exercising again. The following advice may help.

    • Build up the amount of exercise you do at first very gradually and always cool down after exercise.
    • Try to do 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.
    • Do something you enjoy like gardening, walking or dancing. You could even turn everyday tasks, like housework, into your daily exercise.
    • Exercise until you feel warm and slightly out of breath.
    • Always stop if you feel sick, dizzy or very breathless.

    How successful is catheter ablation for treating atrial fibrillation?

    Answer

    The catheter ablation procedure has improved over many years and as the success rate has increased, it's now suitable for more people. Over eight in 10 people who have atrial fibrillation ablation for paroxysmal atrial fibrillation have no symptoms one year after their procedure. The success rate is lower if you have persistent atrial fibrillation.

    Explanation

    Although atrial fibrillation ablation can be successful, you may need more than one procedure for it to work. It's also possible that the procedure may not completely cure your atrial fibrillation, but just reduce how often you get symptoms and how long these last. You may be able to take antiarrhythmic medicines to reduce your symptoms further and these may be at a lower dose than before you had a catheter ablation.

    The success of catheter ablation depends on a number of factors, which will be different for each person. These factors include:

    • the type of atrial fibrillation you have
    • the length of time you have had atrial fibrillation
    • whether or not you have any other heart disease
    • any previous treatment you have had for atrial fibrillation or other heart diseases
    • the experience of your surgeon and the equipment available at the hospital where you have the procedure

    If you have any questions about how catheter ablation might work for you, ask your doctor for advice.

    Will I get any side-effects from my medicine for atrial fibrillation?

    Answer

    All medicines have the potential to cause side-effects. Your doctor will discuss these with you before you start any treatment, so you can weigh up the risks and benefits of taking the medicine.

    Explanation

    Although anticoagulants are very effective, these medicines may thin your blood too much, causing you to bleed more than usual if you injure yourself. Other side-effects include severe bruising, heavy bleeding during menstruation for women, bleeding gums and nose bleeds.

    The antiarrhythmic medicine amiodarone can cause problems with your thyroid gland, lungs and liver, and make your skin very sensitive to sunlight. If you’re prescribed amiodarone, you will have regular check-ups and you will need to wear sunscreen and cover up in the sun more than usual.

    Beta-blockers may make you feel tired, cause your hands and feet to feel cold and disturb your sleep. More rarely, this medicine can make you feel sick, cause diarrhoea, rashes, erectile dysfunction, nightmares and dizziness.

    Calcium-channel blockers can cause constipation, swollen ankles and low blood pressure.

    If you have any concerns about side-effects, talk to your doctor. Often, the benefits of your medicine will outweigh the risks and problems caused by side-effects, but each person will react differently to medicines they are given.

  • Resources Resources

    Further information

    Sources

    • Atrial fibrillation. British Heart Foundation. www.bhf.org.uk, published August 2008
    • Atrial fibrillation: the management of atrial fibrillation. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
    • Atrial fibrillation. Map of Medicine. www.mapofmedicine.com, published 13 January 2012
    • Acute atrial fibrillation. BMJ Best Practice. www.bestpractice.bmj.com, published 30 December 2011
    • Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • Atrial fibrillation – background information. Prodigy. www.prodigy.clarity.co.uk, published August 2009
    • Atrial fibrillation drug information. Atrial Fibrillation Association. www.atrialfibrillation.org.uk, published March 2012
    • Camm A, Luscher T, Serruys PW (editors). The ESC textbook of cardiovascular medicine. 2nd ed. Oxford: Oxford University Press, 2009:1101–15
    • Cardioversion for atrial fibrillation. Atrial Fibrillation Association. www.atrialfibrillation.org.uk, published April 2010
    • Catheter ablation for atrial fibrillation. Atrial Fibrillation Association. www.atrialfibrillation.org.uk, published February 2012
    • Surgical ablation. Atrial Fibrillation Association. www.atrialfibrillation.org.uk, published April 2012
    • Factfile: atrial fibrillation – diagnosis and management. British Heart Foundation. www.bhf.org.uk, published 4 March 2012
    • Pacemakers. British Heart Foundation. www.bhf.org.uk, published 1 April 2012
    • Catheter ablation. Arrhythmia Alliance. www.arrhythmiaalliance.org.uk, published April 2010
    • Warfarin 1, 3 and 5mg tablets. electronic Medicines Compendium. www.medicines.org.uk, published 2 September 2010
    • Amiodarone hydrochloride 100mg tablets. electronic Medicines Compendium. www.medicines.org.uk, published 25 July 2012
    • Assessment of palpitations summary. BMJ Best Practice. www.bestpractice.bmj.com, published 23 May 2011
    • Palpitations – first presentation – management. Prodigy. www.prodigy.clarity.co.uk, published March 2009
    • Beechams active cold relief caplets. electronic Medicines Compendium. www.medicines.org.uk, published 2 September 2010
    • Abnormal heart rhythms. British Heart Foundation. www.bhf.org.uk, accessed 10 May 2012
    • Fuster V, Ryden L, Cannom D, et al. Management of patients with atrial fibrillation practice guidelines. Circulation 2011; 123:e269–e367. doi:10.1161/CIR.0b013e318214876d
    • Physical activity and your heart. British Heart Foundation. www.bhf.org.uk, published 1 August 2009
    • Mozaffarian D, Furberg CD, Psaty BM, et al. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008; 118:800–07. doi:10.1161/CIRCULATIONAHA.108.785626
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    Produced by Louise Abbott, Bupa Health Information Team, December 2012.

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