Atrial fibrillation (AF)

Atrial fibrillation explained

Your heart is controlled by a conduction system which sends out electrical signals. This causes a heartbeat. Atrial fibrillation is a type of arrhythmia, which is a problem in the conduction system that can make your heart beat too slowly, too quickly and in an irregular way.

Atrial fibrillation happens when the electrical signals in the top chambers (atria) of your heart do not get sent out properly. They should be steady and regular, but instead they quiver or twitch (fibrillation). This causes your heart to beat randomly, which means it does not pump blood as well as it should.

There are different types of atrial fibrillation:

• Paroxysmal atrial fibrillation is when you have one or more episodes in 7 days. They usually stop without treatment.
• Persistent atrial fibrillation is when you have one or more episodes for more than 7 days. You’ll usually need treatment.
• Long-standing atrial fibrillation is when you’ve had continuous atrial fibrillation for 1 year or more.
• Permanent atrial fibrillation is when you live with atrial fibrillation long-term, even after having treatment. You may continue to have treatment to lower your risk of having a stroke.

Atrial fibrillation is not life-threatening but it can create blood clots in the heart that may cause a stroke. If you have atrial fibrillation, it makes you five times more likely to have a stroke.

Symptoms of atrial fibrillation

The symptoms of atrial fibrillation can include:

• palpitations (the feeling that your heart is racing, pounding, fluttering or like you have missed heartbeats)

• chest pain

• finding it harder to exercise

• tiredness

• shortness of breath

• dizziness or feeling faint.

Speak to your healthcare professional if you have any of these symptoms.

Should I still call 999 or go to hospital if I'm worried about my health?

It's essential to dial 999 if you have any symptoms that could be a heart attack. If you think you need to be seen before you can speak to your GP but you do not think you’re having a heart attack, call 111 for an assessment.

Do not delay because you think hospitals are too busy. The NHS still has systems in place to treat people for heart attacks. If you delay, you are more likely to suffer serious heart damage and more likely to need intensive care and to spend longer in hospital.

Atrial flutter

Atrial flutter is an arrhythmia that causes your heart to beat much faster than it should (around 300 beats per minute instead of the usual 60 to 100).

Some people with atrial fibrillation have atrial flutter. If this is the case, you may get periods of atrial flutter followed by periods of atrial fibrillation. If you have atrial flutter you’ll still be at risk of further heart conditions or a stroke and you may need treatment. 

• Find out more about atrial flutter.

Causes of atrial fibrillation

The cause of atrial fibrillation is not always known but damage to the heart is the most common cause. This can be caused by: 

• high blood pressure

• heart valve disease

• congenital heart disease

• pericarditis

• cardiomyopathy

• coronary heart disease

• diabetes

• living with obesity

• having had surgery on your heart

• stress

• sick sinus syndrome. 

Atrial fibrillation can be linked with other health conditions, including:

• asthma
• thyroid diseases
• lung cancer
• pulmonary embolism.

Sometimes it can be triggered by other things, like:

• alcohol
• caffeine
• smoking
• recreational drugs
• emotional stress
• spicy food.

Many people will not already have any conditions or risk factors but will still get atrial fibrillation. Your risk of getting atrial fibrillation increases as you get older too. When no cause can be found, it's known as ‘lone atrial fibrillation’.

Diagnosing atrial fibrillation

Atrial fibrillation usually gets noticed when a healthcare professional is checking your pulse during a physical exam or health check-up. If they think you may have atrial fibrillation, they will send you for more tests. These may include:

• an ECG (electrocardiogram)

• an echocardiogram

• chest X-ray

• blood tests.

You can check your heart rate by feeling your pulse at your wrist. A normal heart rate is steady and usually between 60 and 100 beats a minute when you're resting.

If you have atrial fibrillation, your pulse will have no set pattern and the beats might have different strengths. This is how your healthcare professional will be able to see the pattern of atrial fibrillation when looking at the results of your ECG.

Some devices like smart watches have tools that can help notice atrial fibrillation. This can be useful in first finding out about an issue with your heartbeat, but only a healthcare professional can diagnose you.

• Watch our video on how to take your pulse.

Treating atrial fibrillation

Your doctor will find the best treatment for you to control the rate and rhythm of your heart. This may include:

• medication such as beta blockers and anti-arrhythmic drugs

• ablation

• cardioversion

• having a pacemaker fitted. 

Anticoagulant drugs and DOACs are the most effective treatments to reduce the risk of stroke in people with atrial fibrillation. 

Living with atrial fibrillation

Atrial fibrillation will affect your life but it’s a manageable condition. With the right treatment and lifestyle, you can still live well. To do so, it’s important to think about things like:

• Emotional support. Talking to people about your condition can be hard. Dealing with stress and anxiety is also common after being told you have a heart condition. Visit our emotional support hub for advice and support if you’re struggling with the change of pace.
• Practical matters. You might have to think about things like driving, going on holiday or travel insurance after being diagnosed with atrial fibrillation. Your healthcare professional can help with any queries you might have.

Taking your medication and following the guidance of your healthcare professional is the best way to live with atrial fibrillation well. Living a healthy lifestyle is very important too. A healthy lifestyle includes:

• eating healthily
• being physically active
• quitting smoking
• cutting down on alcohol
• controlling high blood pressure
• working on your cholesterol levels
• managing other conditions like diabetes.

Read how Andrew, who was diagnosed with atrial fibrillation aged 60, did not let his diagnosis stop him doing what he enjoyed. 

More information and support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have.
• Speak to others with heart conditions by joining a support group or online community.
• Sign up to our Heart Matters magazine and online information packed with health and lifestyle tips.