Atrial fibrillation

Information

Atrial fibrillation is a common heart condition. It causes your heart to beat irregularly and often very fast. It can cause palpitations where you feel your heart fluttering or pounding. Estimates suggest up to 6 million Americans and around 1 million in the UK have the condition. It’s rarely life-threatening in itself but can lead to more serious conditions that are, such as stroke or heart failure.

What is atrial fibrillation?

Atrial fibrillation, often called AFib or AF, is the most common form of heart arrhythmia – where the rhythm of the heartbeat is disturbed. Normally, when you are at rest, your heart beats regularly at somewhere between 60 and 100 times a minute – you can feel this as your pulse.

Your heart has four chambers – a left and right atrium (the atria) at the top and a left and right ventricle at the bottom. Each beat of the heart is triggered by an electrical signal from the heart’s natural pacemaker – a group of cells in the right atrium called the sinus node (also called sinoatrial node or sinoauricular node).

In AFib, along with the usual signals from the sinus node, different areas around the atria produce multiple random electrical impulses. This means the sinus node can’t control the heart rhythm properly and makes the atria quiver, or ‘fibrillate’ – hence the name atrial fibrillation. It can make your heartbeat highly irregular and often very fast, anywhere from 100 to 170 or more beats a minute. It also makes your heart pump blood less efficiently round your body.

AFib can come in brief episodes, from a few minutes to hours, or be permanent. It’s usually categorized as one of four types:

Paroxysmal atrial fibrillation – comes and goes without any treatment, lasts no more than seven days but usually stops within 48 hours or sooner.
Persistent atrial fibrillation – episodes last longer than seven days (if untreated) and usually need treatment to restore normal heart rhythm.
Long-standing persistent atrial fibrillation – where you have atrial fibrillation for a year or longer and need rhythm control treatment.
Permanent (or accepted) atrial fibrillation – you have atrial fibrillation all the time. Usually attempts to restore normal rhythm have either failed or you’ve decided not to have treatment to correct the arrhythmia. If you later decide to have rhythm control treatment, you’ll be reclassed as having long-standing persistent AFib.

How atrial fibrillation affects you day to day will depend on your personal circumstances and what type of AFib you have. In a 2018 survey among people with AFib on the HealthUnlocked website, some people said it had no effect on their relationships, work or social life – “It’s just a nuisance” – while others said it had forced them to stop work, limited their social lives and even led to divorce: “I no longer have any social life as I am scared of going into an abnormal rhythm. I don’t like to exert myself like I used to as, again, I feel scared in case it sets off another attack.”

What are the symptoms of atrial fibrillation?

Atrial fibrillation often causes no symptoms – about a third of people with AFib are unaware of the condition until it is found, often during a check-up or investigation for something else. Those who do have symptoms might:

Have palpitations – feeling an uncomfortable, racing, irregular heartbeat or a fluttering or pounding in your chest
Feel weak or tired
Feel faint, lightheaded or dizzy
Be short of breath
Become fatigued when doing normal exercise
Feel confused or anxious
Sweat excessively, especially if AFib wakes you at night
Have chest pains or a feeling of pressure in the chest – chest pain can indicate a medical emergency unrelated to AFib. See your doctor if you have chest pain.

‘I get an irregular heartbeat and general feeling of exhaustion. I thought it was a heart attack.’
– response in 2018 HealthUnlocked atrial fibrillation survey

How is atrial fibrillation diagnosed?

The main tool for diagnosing AFib is an electrocardiogram (ECG, or EKG) that records your heart’s electrical activity. Your doctor may suspect AFib after discussing any symptoms you have and examining you. But the ECG reading is the only way to confirm an AFib diagnosis.

You may be given an ECG at your doctor’s surgery or at a hospital. You are connected to a machine by a series of wires that record electrical activity in your heart. It takes only a few minutes and is painless.

However, because AFib typically comes in episodes, you might not have an abnormal heartbeat at the time of the test. If that’s the case, you may be asked to wear a small monitor for 24 hours or a couple of days, or be given a monitor to use for longer that you can activate when you do have symptoms so your abnormal heartbeat can be recorded.

Whichever way your ECG is produced, the result will be a graph showing your heart’s behaviour.

Other tests you will likely be offered are mainly to rule out other conditions.

These tests include:

an echocardiogram – an ultrasound scan of the heart, which shows how the heart and valves are working, to check for other problems
a chest X-ray –to check for lung problems that could cause atrial fibrillation
blood tests – for anaemia, an overactive thyroid gland (hyperthyroidism) or kidney problems. Anaemia and overactive thyroid can both cause palpitations and a racing heart while kidney problems may be a risk factor for getting AFib.

What causes atrial fibrillation?

It’s not known precisely what causes AFib, but many things influence your risk of having it. It often occurs alongside a range of other health conditions but is also seen in people who are extremely fit and healthy, such as athletes.

Age is a key factor: you can get AFib at any age, but the older you are, the more likely it is. Around 70 per cent of those diagnosed are between 65 and 85 years old.

Having any one of a range of other health conditions increases your chance of AFib. These include:

High blood pressure (hypertension)
Coronary artery disease (coronary heart disease)
Congenital heart disease – heart defects that are present at birth
Mitral valve disease – in which the hearts valves are leaky
Cardiomyopathy – in which the heart muscle is inflamed
Pericarditis – inflammation of the protective membrane around the heart
Overactive thyroid (hyperthyroidism)
Obstructive sleep apnoea – in which breathing pauses or is extremely shallow during sleep.

Chronic kidney disease
Pneumonia
Asthma
COPD (chronic obstructive pulmonary disease)
Lung cancer
Diabetes
Pulmonary embolism
Carbon monoxide poisoning

Atrial flutter is another condition that can develop into AFib. Atrial flutter is like atrial fibrillation but heart rhythms more organized than in AFib.

When you have no other health conditions associated with your AFib, it’s called lone atrial fibrillation.

Several lifestyle factors increase the risk of AFib and may trigger the onset or episodes of AFib. These include:

Heavy long-term drinking or binge drinking
Being overweight or obese
Taking ‘recreational’ drugs, especially amphetamines or cocaine
Having lots of caffeine, such as in coffee, tea or many fizzy drinks
Smoking
Having had previous heart surgery

In the 2018 HealthUnlocked atrial fibrillation survey among 348 patients, 78 per cent said they had made various lifestyle changes to help cope with their condition.

What are the effects of atrial fibrillation?

Apart from causing symptoms such as breathlessness, fatigue, palpitations and so forth, untreated AFib can have potentially life-threatening effects. The condition means your heart does not pump blood as efficiently as it should. This can cause blood to ‘pool’ and form clots. Clots can break off and be pumped round the body with your blood and cause blockages. A clot that travels to the brain can cause a stroke – it’s estimated that AFib causes around 15 per cent of all strokes and strokes caused by AFib tend to be more severe than other types.

AFib can also mean you have a fast heart rate for extended periods. This can weaken the heart muscle and eventually lead to heart failure and bring long-term disability or death.

Like many long-term conditions, AFib can also bring on psychological effects such as anxiety and depression.

‘Don’t panic. It’s a condition which can be managed in various ways, even though it is not completely and permanently curable.’
– response in 2018 HealthUnlocked atrial fibrillation survey

How is atrial fibrillation treated?

Atrial fibrillation is treated with medicines or procedures to restore a normal heart rate or rhythm and to cut the risk of stroke. In cases where another condition, such as overactive thyroid, is the underlying cause of AFib, treating that condition might make the AFib go away.

Exactly what treatment or medications you are offered will depend on things such as your general health, whether you have other health conditions, your age, symptoms and what type of AFib you have.

The main AFib treatments are:

Medication to cut your stroke risk – anticoagulants, such as warfarin or several newer drugs including apixaban, dabigatran, edoxaban and rivaroxaban. These all thin the blood to prevent clotting. With warfarin, a well-established and widely used medicine, you need regular blood tests to make sure you are getting the right dose. It also has potentially dangerous interactions with other drugs and – like all blood thinners – brings a risk of bleeding. The newer drugs carry similar bleeding risk, but you don’t need regular blood tests and they don’t appear to interact with other medicines.
Medication to control your heart rate or rhythm – known as antiarrhythmics. Medicines used to control the heart rate include beta-blockers, such as atenolol or bisoprolol, and calcium channel blockers like diltiazem or verapamil. Other medicines may also be tried. To control the heart’s rhythm, medicines such as amiodarone, flecainide or a beta-blocker such as sotalol might be tried.
Cardioversion – this is an electric shock treatment used to try to restore your heart’s normal rhythm (called ‘normal sinus rhythm’ or NSR). It’s usually done in hospital and you might have to take anticoagulants for a few weeks before and after the procedure. Sometimes cardioversion is used as emergency treatment, but generally only in those with a low stroke risk.
Catheter ablation – a type of keyhole surgery, in which thin wires are guided into your heart and are used to find and destroy tissue that’s producing the unwanted electrical signals. This operation takes several hours and is done while you are asleep under general anaesthetic.
Pacemaker – a small battery powered device is implanted in your chest in a minor operation with local anaesthetic, so you are awake throughout. Pacemakers tend to be used for AFib only in older people where other treatments haven’t worked or aren’t suitable. Generally, pacemakers are used when a person’s heart beats too slowly, but in AFib they can help keep a regular heartbeat.

‘Ask if you can have ablation. It doesn’t always work first time but it’s worth it. My first one kept the AF away for 12 months. The second also lasted 12 months but the third was 3 years ago and, touch wood, all okay’
– response in 2018 HealthUnlocked atrial fibrillation survey

New medications are being developed all the time, so it’s worth keeping abreast of what’s available through a site such as Drugs.com. You can also use it to find out more about any medicines you are prescribed.

All medication carries the risk of side effects, and you should discuss with your doctor or pharmacist the risks and benefits of any medicines you are prescribed. You should also discuss any over-the- counter medicines, supplements or herbal remedies you intend to take as many can aggravate AFib.

‘Learn all you can about AF, and also all the different drugs available – anticoagulants, beta blockers, etc.’
– response in 2018 HealthUnlocked atrial fibrillation survey

Living with atrial fibrillation

There are many things you can do to make life with AFib easier and most of them will also improve your general health and wellbeing. Try to eat a suitable balanced diet, get a good night’s sleep, take regular exercise, limit your intake of alcohol and caffeine, stop smoking and avoid illegal drugs. Take any prescribed medication as directed.

‘Make lifestyle changes and see where it gets you. Stop smoking, drinking alcohol and coffee, and eating sugar and chocolate. Lose weight and eat a healthy diet. Exercise but accordingly to ones age.’
– response in 2018 HealthUnlocked atrial fibrillation survey

Diet

Diet is important in managing AFib, especially if you are on warfarin. Many foods, such as green leafy vegetables and some vegetable oils, are rich in vitamin K. Your body uses vitamin K to make blood clotting agents. Warfarin thins your blood to stop clotting. Sudden changes in the amount of vitamin K you get can either thicken the blood with the risk of clotting (if you eat more) or thin it further with a risk of bleeding (if you eat less). You should aim to keep your vitamin K intake steady, so it stays in balance with the warfarin – you can find special cookbooks that help with this.

AFib is linked to being overweight, and a healthy diet can help you get to a healthy weight.

Low-sodium and low-fat diets are often recommended for people with AFib (and other heart conditions). Salt intake should be limited especially if you have high blood pressure. Alcohol and caffeine are best avoided as both are known triggers for AFib.

Some people take vitamin D supplements – in the 2018 HealthUnlocked survey 30% of respondents said they’d increased vitamin D intake. But the evidence around this is mixed. While several studies have suggested vitamin D deficiency might cause AFib, others have found no association with AFib and at least one found that too much vitamin D might cause AFib.

Smoking

Nicotine is a heart stimulant, so smoking tobacco is a big risk factor for AFib. Smoking is also a risk factor for coronary artery disease and many other conditions. If you smoke, quitting is one of the best things you can do for your overall health and to help control your AFib.

Exercise

If you already do regular exercise, keep it up. If you don’t take exercise, think about being more active – even something as simple as a daily walk will do you good. What exercise you can do depends on how generally fit you are and what you enjoy. If you aren’t used to exercise, you should check with your doctor about what would be a sensible level of activity for you. Exercise has many benefits, including:

helping you keep a positive outlook
helping to regulate your ‘body clock’ which in turn helps you sleep better
helping you to reach and stay at a healthy weight
keeping you physically fit and so better able to fight off infections and cope with illness

‘AFib is an inconvenience. I play walking football 4 times a week and when I get short of breath it is frustrating. But I pace myself and try and manage my symptoms’
– response in 2018 HealthUnlocked atrial fibrillation survey

Learn about your AFib

It’s worth learning all you can about your condition. This will help you understand what might help and what won’t. It will equip you for discussions around treatment and any options your healthcare team suggest. AFib is a largely unpredictable condition and while some things can certainly trigger episodes, triggers are different for different people and there’s little hard evidence for many of the things people believe trigger their episodes. Nevertheless, you should be aware of things that trigger your AFib so you can manage it better.

Stress

Some research suggests that just over half of people with intermittent AFib say psychological stress is their most notable trigger. Most people have some stressful situations in their daily lives and learning about ways to deal with stress can help you cope. You can get tips on coping with stress from the American Psychological Association or NHS.UK

Low mood and depression

Any serious medical condition can make people anxious or low and can in some cases lead to depression. It’s normal for everyone to feel a bit down now and then, but if the feelings don’t lift you may need some help. People with AFib commonly have periods of anxiety or depression. Often just talking about how you feel can lift your mood and doing things you enjoy will help too. But if you feel down for days on end, tell your doctor – there’s a lot that can help you get back to your usual self.

Smartphone apps

There’s a range of free and low-cost apps some people find helpful in managing their AFib. They range from simple apps that remind you when to take medication through to sophisticated kit that can track your heart and let you share information with healthcare staff. You can find apps by searching for ‘atrial fibrillation’ in your device’s app store.

New Life Outlook has reviews of a few AFib apps that give an idea of the sorts of things they can do.

Support

Family, friends, work colleagues and your healthcare team can all support you – ask for help if you need it. Many people find talking to others with atrial fibrillation is an invaluable source of comfort, advice and information – other people with AFib have the best idea of what you are dealing with.

‘Find out about all treatment options, join forums to see how others live with the condition … do what’s right for yourself once you gather all the facts’
– response in 2018 HealthUnlocked atrial fibrillation survey

There are various online communities and Facebook groups for people with atrial fibrillation – they are easy to join, and you can read what others are talking about, ask questions and discuss your worries.

Visit the AF Association community at HealthUnlocked

You can also find local support groups where you can meet others with AFib face-to-face and take part in various activities. Your doctor or hospital healthcare team may be able to recommend a suitable group near you. Most AFib and other heart condition organizations can also direct you to local groups.

In the US, Mended Hearts and StopAfib offer ways to find local support.

In the UK, the AF Association lists local support groups. The British Heart Foundation also has a network of groups for anyone with a heart condition, including atrial fibrillation.

There’s a wealth of information online to help you find out about anything related to atrial fibrillation. StopAfib has a comprehensive resources page that provides more than 170 links to organisations and information about the condition.