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Atrial fibrillation

Atrial fibrillation is a condition in which your heartbeat is not regular, and may be too fast. It’s the most common type of heart problem leading to irregular heartbeats (arrhythmia).

About one in every 50 people in the UK have atrial fibrillation. You’re more likely to get it as you get older.

Different types of heart arrhythmia
Arrhythmia is a disturbance of the normal electrical rhythm of the heart

Details

  • Symptoms Symptoms of atrial fibrillation

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

    If you have symptoms, they could 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 or reduced exercise tolerance
    • shortness of breath
    • feeling dizzy or light-headed
    • fatigue (tiredness)
    • passing more urine than usual

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

    There are different types of atrial fibrillation. The type you have will determine your symptoms.

    • Paroxysmal atrial fibrillation is when your heart rate suddenly begins to beat rapidly and then returns to normal. Symptoms may be mild or severe.
    • Persistent atrial fibrillation is when your heart rhyme is abnormal for more than a week. This may stop on its own or with treatment.
    • Permanent atrial fibrillation is when your normal heart rhythm can't be restored with having treatment.

    If you have any of the above symptoms, see your GP straightaway.

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  • Diagnosis Diagnosis of atrial fibrillation

    You may not be aware that you have atrial fibrillation. It may only be discovered by chance if you seek medical attention for another reason. However, if you experience any symptoms or have any concerns about your heart rhythm, you should see your GP. They will ask about your symptoms, medical history and check your pulse. They may ask if you’ve noticed what sets off your symptoms.

    If your pulse is irregular, you’re likely to have a test called an electrocardiogram (ECG). This records the electrical activity of your heart and will show how well it’s working.

    Your GP may refer you for other tests, including:

    • blood tests
    • an echocardiogram - this is an ultrasound scan that produces a clear image of your heart muscles and valves to see how well it's functioning
    • an 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 breathlessness, your GP may refer you to hospital immediately.

  • Treatment Treatment of atrial fibrillation

    There are a number of different treatments available for atrial fibrillation. Your treatment will be tailored to you. It will depend on your symptoms, the type of atrial fibrillation you have and what’s causing it.

    Some treatments are used to stop your heart beating in a disorganised way or to control the speed at which it beats. Others can reduce the chance of you having complications, such as a stroke.

    Your doctor will discuss your treatment options with you.

    Medicines

    Your doctor may prescribe you one or more medicines to help manage your symptoms. You may need to take medicines for several months or years to manage your heart problems. Each year (sometimes more often), you will see your doctor so they can review whether you need to stay on your medicines.

    Medicines to control your heart rate

    You may be given medicines to control how fast your heart is beating. This means you’ll still have atrial fibrillation, but your heart will beat more slowly and effectively. These medicines include beta-blockers, digoxin 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 beta-blockers, flecainide and amiodarone. An alternative to these is having your heart rhythm corrected using an electrical pulse, which is called cardioversion. This is described below.

    Medicines to reduce blood clotting

    Atrial fibrillation can make it more likely that your blood will clot, which may increase your risk of having a stroke. Depending on how high your risk of stroke is, your doctor may prescribe you a medicine called an anticoagulant. This will thin your blood and reduce your risk of stroke. Examples are warfarin, apixaban, dabigatran etexilate and rivaroxaban.

    Hospital treatment

    If your symptoms are severe or medicines are not controlling your atrial fibrillation, you may need to have a procedure in hospital. Options include electrical (DC) cardioversion (referred to as cardioversion from now on) and catheter ablation. These procedures are carried out in hospital by a cardiologist (a doctor who specialises in identifying and treating heart and blood vessel conditions), usually under local anaesthesia and sedation.

    Cardioversion

    Cardioversion is a procedure where you receive a controlled electric shock to restore your heart's normal rhythm. You may be offered cardioversion straightaway if your atrial fibrillation started less than 48 hours ago and medicines haven’t helped, or if you’re very unwell. If your symptoms have lasted more than 48 hours and your cardiologist thinks cardioversion will help, you will be prescribed anticoagulants to take for at least three weeks before and four weeks after your cardioversion.

    You may need to have a transoesophageal echocardiogram before having a cardioversion to check for any blood clots in your heart. To do this, a device called an ultrasound probe is passed into your oesophagus (the pipe that goes from your mouth to your stomach) to look at your heart.

    Cardioversion is less likely to work if you’ve had arrhythmia for over a year. It might also not be suitable for you if your atrial fibrillation comes and goes – your cardiologist will talk you through your best options.

    You can learn more about how to prepare for cardioversion and how the procedure is performed on our web page on cardioversion.

    Catheter ablation

    Catheter ablation can be carried out to destroy the precise areas of your heart that are sending out irregular electrical signals.

    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 treated, for example, by using high frequency radiowaves or cold liquids, such as nitrogen.

    At least half of patients with atrial fibrillation who are treated with catheter ablation find that it solves the problem. Catheter ablation can work particularly well for people who have attacks of atrial fibrillation only occasionally. It doesn’t always work first time though – about one in every four patients has to have the procedure repeated.

    Atrioventricular (AV) node ablation

    Another type of ablation that works for some people is called AV (atrioventricular) node ablation. This is also known as ‘pace and ablate’. This destroys the part of your heart tissue that carries electric signals from the upper to lower chambers of your heart (the AV node). It will stop your heart’s faulty signals. You’ll need to be fitted with a pacemaker to have this type of treatment. Pacemakers are very good at controlling your heartbeat and are very reliable.

  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Causes Causes of atrial fibrillation

    Your heartbeat is controlled by electrical signals (impulses), which travel through your heart making the muscles contract. The signals travel from the two upper chambers of your heart (atria) to the two lower chambers (ventricles) 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. This causes your heart to contract irregularly and so puts your heart out of rhythm.

    About nine out of every 10 people with atrial fibrillation have another condition that’s causing their heart rhythm problems. 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 artery disease
    • congenital heart disease (heart problems that you’re born with)
    • • thyroid gland problems
    • obesity
    • diabetes
    • chronic obstructive pulmonary disease (COPD)
    • sleep apnoea
    • chronic kidney disease

    You may also find that your atrial fibrillation is triggered by too much caffeine, alcohol or use of recreational drugs.

  • Complications Complications of atrial fibrillation

    If you have atrial fibrillation, you may be about five times more likely to have a stroke than someone who doesn’t have the condition. You’re also at increased risk of having congestive heart failure. This stops your heart pumping blood around your body as well as it should.

    Atrial fibrillation can cause stroke because your heart might not fully pump all the blood out of the chambers with each beat. Blood left sitting in the chambers of the heart can be more likely to clot. The blood clot can then travel to your brain where it can block your blood supply and cause a stroke.

    If you have atrial fibrillation and your doctor thinks you’re at a higher risk of a stroke, they may prescribe you an anticoagulant medicine, such as warfarin. This is to reduce the chance of a blood clot forming. If you can't take anticoagulant medicines, you may be prescribed aspirin and clopidogrel instead. But taken together, these can increase your risk of bleeding. For more information, speak to your doctor.

  • FAQ: Palpitations and atrial fibrillation Are palpitations always caused by atrial fibrillation?

    No, there are many other causes of palpitations and most are not serious.

    More information

    If you have palpitations, you’ll become aware of your heart racing, beating in a strange pattern or pounding. Most people experience palpitations at some time – including people without atrial fibrillation. While palpitations can be unpleasant and distressing, they are normally harmless and go away on their own. Palpitations can be triggered by:

    • other types of irregular heart beat (arrhythmia)
    • heart disease
    • anxiety, panic attacks or depression
    • an overactive thyroid gland
    • diabetes
    • the menopause
    • pregnancy
    • an illness causing a high temperature (fever)
    • anaemia (where your blood isn’t carrying enough oxygen)
    • some medicines (such as cold or flu medicines containing caffeine)
    • alcohol, cigarettes and recreational drugs

    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.

  • FAQ: Exercise and atrial fibrillation Should I exercise if I have atrial fibrillation?

    It may well be safe for you to exercise, only if your atrial fibrillation is under control. See your doctor for advice first.

    More information

    Generally speaking, exercise is good for your heart and helps you to stay healthy. The government recommends that adults do 150 minutes of moderate-intensity physical activity a week. This type of activity will get you warmer and slightly out of breath, but it shouldn’t be exhausting – you should still be able to talk.

    Once your atrial fibrillation is under control, your doctor may recommend that it’s safe for you to start exercising again. Sometimes, people with atrial fibrillation can find that they get tired easily with exercise, but this should improve as you get fitter. The following advice may help.

    • Build up the amount of exercise you do gradually.
    • Try to do 150 minutes (two and a half hours) of moderate exercise each week. Each exercise session should be at least 10 minutes long. You could do quite a few short sessions to meet the weekly target.
    • Always stop if you feel sick, dizzy, get palpitations or other symptoms.

    Check out our information dedicated to helping people get started when it comes to exercise for more tips and advice.

  • FAQ: Medicine side-effects Will I get any side-effects from my medicine for atrial fibrillation

    All medicines can cause side-effects. Discuss these with your doctor or pharmacist before you start any treatment, so you can weigh up the risks and benefits of taking the medicine.

    More information

    Medicines for atrial fibrillation can cause some side-effects. We explain some of the more common side-effects below. Make sure you read the patient information leaflet that comes with your medicine to understand what side-effects your medicine can cause. Talk to your pharmacist or doctor about these if you’re concerned.

    Although anticoagulants, such as warfarin, work well to prevent blood clots, they may thin your blood too much, which can increase your risk of bleeding. To make sure your risk of bleeding isn’t too high, you may have regular tests to see how quickly your blood clots. Your treatment can then be adjusted if need be.

    The antiarrhythmic medicine, amiodarone, can sometimes cause problems with your thyroid gland, lungs and liver, and make your skin very sensitive to sunlight. If you’re prescribed amiodarone, you’ll have regular check-ups and 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 make you dream more, possibly disturbing your sleep.

    Calcium-channel blockers can cause changes in blood pressure, headaches and swollen ankles.

    If you have any concerns about side-effects, talk to your pharmacist or doctor. Mostly, the benefits of your medicine will outweigh the risks and problems caused by side-effects.

  • FAQ: Types of arrhythmia How does atrial fibrillation differ from other types of arrhythmia?

    Atrial fibrillation is caused by faulty electrical signals in the upper chambers of your heart (your atria). Other types of arrhythmia are caused by faulty electrical signals in different areas of your heart.

    More information

    Other types of arrhythmia are caused by problems in other areas of the heart.

    • Supraventricular tachycardia happens when extra electrical signals fire from the area between the upper chambers (atria) and lower chambers (ventricles) of your heart.
    • Ventricular tachycardia happens when electrical signals fire too quickly in your ventricles, meaning the blood is pumped out too soon.
    • Ventricular fibrillation happens when electrical signals fire off in different areas of your ventricles at the same time, causing your heart to quiver.
    • Heart block happens when the electric signals travelling from your atria to your ventricles are blocked.
    • Tachy-brady syndrome happens when the node in your heart which first starts an electric signal (your sinoatrial node) does not work properly.

    You might also get ectopic beats. These are early (premature) or extra heartbeats, and can cause you to have palpitations. Ectopic beats are usually harmless and you generally won’t need any treatment for them, unless they are very frequent or severe.

    For information on the symptoms, diagnosis and treatment of other heart rhythm problems, see Bupa’s web page on arrhythmia.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Map of Medicine. Atrial fibrillation. International View. London: Map of Medicine; 2015 (Issue 2)
    • Synchronized electrical cardioversion. Medscape. www.emedicine.medscape.com, published October 2014
    • Atrial fibrillation and stroke information page. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, published March 2015
    • Arrhythmias. Oxford Handbook of Cardiology, 2nd ed. (online). Oxford Medicine Online. www.oxfordmedicine.com, published May 2012
    • Heart rhythms. British Heart Foundation. www.bhf.org.uk, published December 2015
    • Catheter ablation. Medscape. www.emedicine.medscape.com, published July 2015
    • Pacemaker and AV node ablation for AF. AF Association. www.atrialfibrillation.org.uk, published October 2009
    • Gray's Anatomy: The Anatomical Basis of Clinical Practice, Expert Consult – 40th ed. Elsevier, 2008; 1789.
    • Atrial fibrillation. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published July 2015
    • Atrial fibrillation. Medscape. www.emedicine.medscape.com, published November 2014
    • Palpitations. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published May 2015
    • Palpitations. PatientPlus. www.patient.info/patientplus, published February 2014
    • Physical activity guidelines for adults (19–64 years). Department of Health. www.gov.uk, published July 2011
    • Physical activity guidelines for older adults (65+ years). Department of Health. www.gov.uk, published July 2011
    • Atrial fibrillation. British Heart Foundation. www.bhf.org.uk, published July 2015
    • Oral anticoagulants. PatientPlus. www.patient.info/patientplus, published June 2015
    • Amiodarone hydrochloride 100mg tablets. electronic Medicines Compendium. www.medicines.org.uk, published March 2015
    • Beta-adrenoceptor blocking drugs. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed September 2015
    • Calcium-channel blockers. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed September 2015
    • Ventricular tachycardia (VT). The Merck Manuals. www.merckmanuals.com, published September 2013
    • Ventricular fibrillation (VF). The Merck Manuals. www.merckmanuals.com, published September 2013
    • Types of atrial fibrillation. National Heart, Lung and Blood Institute. www.nhlbi.nih.gov, published September 2014
    • Palpitations and ectopic beats. British Heart Foundation. www.bhf.org.uk, published October 2014
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