Atrial fibrillation (heart flutter)
Atrial fibrillation, also known as AF, is the most common persistent heart rhythm disorder in adults. In atrial fibrillation, the electrical signals in the upper chambers of the heart become disorganised, which can lead to a fast and irregular heartbeat.
Some people experience symptoms such as palpitations, shortness of breath, fatigue or reduced exercise capacity, while others may not notice the rhythm disturbance at all.
Atrial fibrillation is rarely life-threatening in itself, but it should be assessed and treated because it can increase the risk of complications, including stroke.
What is atrial fibrillation?
Atrial fibrillation is a heart rhythm disorder in which the heart’s normal electrical activity in the upper chambers is replaced by many rapid and uncoordinated electrical impulses. As a result, the heart no longer beats with the regular rhythm seen in people with normal sinus rhythm.
The rhythm disturbance may be temporary and occur in episodes, or it may be persistent. Atrial fibrillation becomes more common with age and is seen more frequently in people with high blood pressure, heart disease, diabetes, obesity or sleep apnoea.
Symptoms of atrial fibrillation
Symptoms can vary considerably from person to person. Some people immediately notice that their heart is beating irregularly, while others are only diagnosed during a routine examination.
Typical symptoms may include palpitations, a rapid pulse, an irregular heartbeat, reduced exercise capacity, fatigue, dizziness or shortness of breath during physical activity. In some people, symptoms may be more pronounced and significantly affect daily life.
The severity of symptoms does not always reflect the extent of the condition. Even people without noticeable symptoms may have atrial fibrillation.
What does atrial fibrillation feel like?
Many people describe atrial fibrillation as a fluttering or unsettled feeling in the chest, or as if the heart is beating quickly, irregularly or skipping beats. Others experience reduced energy, shortness of breath or a noticeable decline in exercise capacity. Some people have no symptoms and are only diagnosed during a routine examination or after an irregular pulse is detected.
How do the symptoms vary?
Many people describe atrial fibrillation as a fluttering or unsettled feeling in the chest, or as if the heart is beating quickly, irregularly or skipping beats. Others notice a sudden change in heart rate and physical performance, particularly during exercise.
Some people experience the rhythm disturbance only for short periods, while others have persistent symptoms. There are also patients who have atrial fibrillation without any noticeable symptoms.
Causes of atrial fibrillation
Atrial fibrillation can develop for many different reasons. The risk increases with age, but a number of diseases and medical conditions can also contribute to its development.
High blood pressure is one of the most common risk factors. Atrial fibrillation is also more common in people with heart failure, heart valve disease, ischaemic heart disease, diabetes, sleep apnoea or obesity.
In some people, higher alcohol intake, infections or other physical stressors can trigger episodes of atrial fibrillation. In other cases, there is no obvious underlying cause.
How is the diagnosis made?
The diagnosis is made by recording the heart’s electrical activity with an ECG. If the rhythm disturbance only occurs intermittently, longer-term monitoring with a Holter monitor or event recorder may be necessary.
If atrial fibrillation is suspected, the structure and function of the heart are often also assessed with echocardiography. Blood tests and evaluation of any accompanying medical conditions may also form part of the assessment.
The aim is both to confirm the diagnosis and to identify possible underlying causes or risk factors.
Treatment of atrial fibrillation
Treatment depends on several factors, including the severity of symptoms, the patient’s age, any accompanying medical conditions and the risk of complications.
For some patients, the main goal is to control the heart rate and reduce symptoms. For others, it may be appropriate to try to restore a normal heart rhythm with medication or other forms of treatment.
An important part of the assessment is also the risk of blood clots. Atrial fibrillation can increase the risk of stroke, and some patients may therefore need anticoagulant treatment.
The specific treatment is always tailored to the individual patient.
Is atrial fibrillation dangerous?
Atrial fibrillation is rarely life-threatening in itself, but the condition can be associated with an increased risk of complications, particularly stroke.
The level of risk varies considerably from person to person and depends on factors such as age, accompanying medical conditions and other cardiovascular risk factors. It is therefore important to assess both the rhythm disturbance itself and the overall cardiovascular risk.
With appropriate assessment and treatment, many people with atrial fibrillation can continue to live an active life.
When should you see a cardiologist?
It may be appropriate to see a cardiologist if you experience persistent or recurring palpitations, an irregular pulse, unexplained fatigue, dizziness or reduced physical capacity.
You should also consider a cardiology assessment if an activity tracker or smartwatch repeatedly detects an irregular heart rhythm.
Frequently Asked Questions
Is atrial fibrillation the same as heart flutter?
Yes. Atrial fibrillation, heart flutter and atrial flutter are different terms used to describe the same heart rhythm disorder.
Can atrial fibrillation go away on its own?
Yes. In some people, atrial fibrillation occurs in attacks that stop spontaneously. In others, the rhythm disturbance becomes more persistent over time.
Can you live with atrial fibrillation?
Many people live active lives with atrial fibrillation. Treatment and follow-up are tailored to the individual patient's situation and risk profile.
Is atrial fibrillation dangerous?
Atrial fibrillation can increase the risk of blood clots and other complications, but the risk varies significantly from person to person.
Can stress trigger atrial fibrillation?
Stress is rarely the direct cause, but physical or mental stress can contribute to triggering symptoms or episodes in some people.
Can alcohol trigger atrial fibrillation?
In some patients, higher alcohol intake may increase the risk of atrial fibrillation episodes.
My smartwatch shows an irregular heartbeat – what does it mean?
Many modern smartwatches can detect signs of irregular heartbeat. Such detection is not in itself a diagnosis, but may prompt further investigation with an ECG or long-term rhythm recording.