Overview
Atrial fibrillation (AFib) is a common heart rhythm disorder in which the upper chambers of the heart, called the atria, beat irregularly and often rapidly. Instead of maintaining a coordinated rhythm, the atria experience disorganised electrical activity, which can affect the heart's ability to pump blood efficiently.
Some people with atrial fibrillation may have noticeable symptoms, while others may have no symptoms and only discover the condition during a routine examination or heart rhythm test. Common symptoms can include an irregular or racing heartbeat, palpitations, fatigue, dizziness and shortness of breath.
AFib is important to diagnose and manage because it can increase the risk of blood clots and stroke. Treatment is personalised according to the type and duration of AFib, symptoms, stroke risk, underlying heart conditions and overall health. Management may involve medicines, lifestyle and risk-factor modification, cardioversion, catheter ablation or other procedures when appropriate.
Symptoms of Atrial Fibrillation
- Irregular, rapid or pounding heartbeat
- Fluttering or thumping sensation in the chest
- Palpitations
- Shortness of breath
- Fatigue or reduced energy
- Dizziness or lightheadedness
- Weakness
- Reduced ability to exercise
- Chest discomfort
Causes of Atrial Fibrillation
- High blood pressure
- Coronary artery disease
- Heart valve disease
- Heart failure
- Previous heart surgery
- Congenital heart conditions
- Thyroid disorders
- Diabetes
- Obstructive sleep apnoea
- Obesity
- Smoking
- Excessive alcohol consumption
- Increasing age
- Family history of AFib
Risk Factors for Atrial Fibrillation
- Increasing age
- High blood pressure
- Existing heart disease
- Heart failure
- Diabetes
- Obesity
- Sleep apnoea
- Thyroid disease
- Smoking
- Excessive alcohol consumption
- Family history of atrial fibrillation
- Previous cardiac surgery
Diagnosis of Atrial Fibrillation
Atrial fibrillation diagnosis begins with a detailed medical history and physical examination. Since AFib can come and go, documenting the heart rhythm during an episode can be particularly important.
- Electrocardiogram (ECG/EKG) : An ECG records the heart's electrical activity and can identify an irregular rhythm consistent with atrial fibrillation.
- Holter Monitoring: A Holter monitor records the heart rhythm continuously for an extended period. It can help identify intermittent episodes that may not occur during a standard ECG.
- Event or Ambulatory Rhythm Monitoring: Longer-term monitoring may be recommended when symptoms are occasional and a short ECG does not capture an episode.
- Echocardiogram: An echocardiogram uses ultrasound to assess the heart's chambers, valves, pumping function and structural abnormalities.
- Blood Tests: Blood tests may be performed to identify contributing conditions such as thyroid abnormalities or electrolyte disturbances.
- Additional Cardiac Evaluation: Depending on the individual case, doctors may recommend additional investigations to evaluate underlying heart disease and assess stroke or cardiovascular risk.
Treatment Options for Atrial Fibrillation
The appropriate atrial fibrillation treatment depends on symptoms, AFib pattern, stroke risk, underlying heart disease and individual treatment goals. The major goals are to control the heart rate or restore and maintain a normal rhythm, reduce stroke risk and address contributing conditions.
- Cardioversion: Cardioversion is a procedure used in selected patients to restore a regular heart rhythm. It may involve a controlled electrical shock or, in some situations, medication.
- Catheter Ablation for Atrial Fibrillation: Atrial fibrillation ablation is a minimally invasive procedure used to treat abnormal electrical signals responsible for AFib. A catheter is guided through a blood vessel to the heart, and energy is used to create targeted areas of tissue modification that interrupt abnormal electrical pathways.
- Stroke Prevention : Because AFib can increase the risk of blood clots and stroke, doctors assess each patient's risk before deciding whether anticoagulant treatment is appropriate. Risk assessment commonly considers validated clinical risk scores and other patient-specific factors.
- 3D Electroanatomical Mapping: During catheter ablation, advanced mapping technology can create a three-dimensional representation of the heart's electrical activity and anatomy. This helps the electrophysiology team identify areas responsible for abnormal electrical signals and guide the ablation procedure.
- Intracardiac Echocardiography (ICE): In selected ablation procedures, intracardiac ultrasound provides real-time images of cardiac structures from inside the heart. It can assist with catheter positioning and procedural guidance.
- Stroke Prevention: Since AFib can increase the risk of blood clots and stroke, doctors assess each patient's individual stroke risk and determine whether anticoagulant treatment is appropriate. Risk assessment and ongoing monitoring form an important part of long-term AFib management.
Benefits of Early Atrial Fibrillation Treatment
- Control an irregular or excessively fast heart rate
- Reduce troublesome symptoms
- Improve exercise tolerance and quality of life
- Reduce the risk of blood clots and stroke when appropriate preventive treatment is used
- Address underlying cardiovascular risk factors
- Reduce the burden or recurrence of AFib in suitable patients
- Help prevent complications associated with uncontrolled AFib
Complications if Left Untreated
- Blood clot formation
- Stroke
- Heart failure
- Worsening cardiovascular health
- Reduced exercise capacity
- Persistent or progressive rhythm problems
- Reduced quality of life
When Should You See a Doctor?
- Recurrent palpitations or an irregular heartbeat
- Unexplained episodes of rapid heartbeat
- Shortness of breath
- Persistent fatigue or weakness
- Dizziness or lightheadedness
- Reduced exercise tolerance
- A pulse that feels persistently irregular
- A wearable device repeatedly showing an irregular heart rhythm
Prevention & Lifestyle Modifications
- Keep blood pressure under appropriate control.
- Do not smoke or use tobacco products.
- Maintain regular physical activity according to medical advice.
- Follow a heart-healthy eating pattern.
- Maintain a healthy weight.
- Manage diabetes and cholesterol.
- Address sleep apnoea when present.
- Limit alcohol consumption.
- Take prescribed medicines consistently.
- Attend recommended cardiac follow-ups.
- Monitor symptoms and report significant changes to your doctor.
Pre- and Post-Treatment Care
Pre-Treatment
- Review your symptoms and medical history.
- Perform an ECG and other appropriate heart rhythm tests.
- Assess heart structure and function.
- Evaluate stroke and blood-clot risk.
- Review current medicines and medical conditions.
- Identify and manage conditions contributing to AFib.
- Discuss whether rate control, rhythm control, cardioversion, medication or catheter ablation is appropriate.
- Explain the expected benefits, risks and follow-up requirements of the selected treatment.
Post-Treatment
- Taking prescribed medicines exactly as directed.
- Continuing anticoagulation when it has been prescribed.
- Monitoring for recurrence of irregular heart rhythm.
- Attending ECG or other rhythm-monitoring appointments.
- Managing blood pressure, diabetes and other cardiovascular risk factors.
- Following activity recommendations provided by the treating team.
- Reporting recurrent palpitations, dizziness, breathlessness or other concerning symptoms.
- Continuing long-term stroke-risk assessment when appropriate.
