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.
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.
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.
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).
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.
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.
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.
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.
Are palpitations always caused by atrial fibrillation?
No, there are many other causes of palpitations (where you become aware of your heart beating more rapidly or more forcefully).
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:
- physical activity
- 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?
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.
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?
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.
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?
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.
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.
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