Atrial fibrillation: a guide for patients

Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance. In AF, the upper chambers of the heart (the atria) beat in a disorganised way rather than in a coordinated rhythm. This can cause the heart to beat irregularly and, often, faster than normal.

How it might feel

Some people notice palpitations — a sensation of the heart racing, fluttering or skipping. Others feel breathless, tired, or light-headed. A proportion of people have no symptoms at all, and AF is found incidentally during a routine check or on a wearable device.

Why it matters

Two issues drive how AF is managed. The first is symptoms and quality of life. The second, and often more important, is stroke risk: because blood does not flow smoothly through a fibrillating atrium, clots can form and travel to the brain. Assessing and, where appropriate, reducing this risk with anticoagulation is a central part of care.

Main approaches to treatment

Treatment is tailored to the individual, but usually considers three threads:

• Reducing stroke risk — assessed using a validated risk score, and treated with anticoagulation where the benefit outweighs the bleeding risk.
• Rate control — medication to keep the heart rate in a comfortable range.
• Rhythm control — restoring and maintaining a normal rhythm, using medication, cardioversion, or catheter ablation.

Catheter ablation is increasingly used earlier in the course of AF, particularly where symptoms persist despite medication or where maintaining normal rhythm is a priority.

What to do next

If you have been told you may have AF, or you are experiencing persistent palpitations, a structured assessment can clarify the diagnosis and the most appropriate plan. If you ever experience chest pain, severe breathlessness, or symptoms of a stroke, call 999.

This article is for general information and is not a substitute for individual medical advice. Reviewed by Dr Iain Sim.

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