Atrial fibrillation (AFib)
We don’t know exactly what causes atrial fibrillation to develop in some people, but we do know it’s more common in older people and that it affects people with certain conditions more than others, including the following:
A normal heart rate should consist of between 60 and 100 regular beats each minute while you’re resting. But if your heart beats irregularly – for instance if it skips beats or has extra beats – and also often more quickly, you may have a heart condition called atrial fibrillation.
What is atrial fibrillation?
Atrial fibrillation is a type of arrhythmia – or abnormal heart rhythm – where your heart beats at an irregular pace. Usually in atrial fibrillation your heart also beats very rapidly, often between 140 and 180 beats per minute – though it is also possible to have atrial fibrillation if your heart rate is irregular but the speed is normal or even a bit on the slow side.
How common is atrial fibrillation?
According to the National Institute of Health and Care Excellence (NICE), atrial fibrillation is the most common type of sustained heart arrhythmia, affecting around 2.5 percent of the population of England (i). NHS figures, meanwhile, suggest 1.4 million people in the UK are affected (ii), though according to the Stroke Association there could be another half a million people in the UK with undiagnosed atrial fibrillation (iii).
Who is most at risk of developing AFib?
Older people are the most likely to be affected by atrial fibrillation, and since the population of older people in the UK is increasing it’s likely even more of us will be diagnosed with the condition in the future. It is, however, less common in younger people, though atrial fibrillation can develop at any age if you have a medical condition that triggers it. We also know that atrial fibrillation is more common in men than in women (2.9 percent of men are thought to have atrial fibrillation compared with two percent of women) (i).
What does atrial fibrillation feel like?
Some people have atrial fibrillation without realising it because they don’t have any symptoms (read on to find out what symptoms you should look out for). But even if you don’t have symptoms it’s important to find out whether or not you need treatment, since having atrial fibrillation makes you more likely to have a stroke. One easy check you can do yourself is to find out how fast and regularly (or irregularly) your heart is beating. Here’s how to do it:
Sit comfortably for a few minutes until you feel calm and relaxed (avoid smoking or drinking alcohol or caffeine beforehand).
Place your index and middle fingers on your other wrist, at the base of the thumb, and move them around a bit until you can feel your pulse.
Using a clock or watch with a hand that counts seconds, start counting the beats in your pulse for 30 seconds. Then double the number to get your beats-per-minute score. Also try to notice if your pulse is beating at regular or irregular intervals.
A normal pulse should be between 60 and 100 beats per minute at rest. If your pulse is erratic and has a score of more than 100 beats a minute (typically 140 beats a minute or more), there’s a chance you may have atrial fibrillation and should see your GP for a diagnosis.
What does AFib do to your heart?
In a normal heartbeat the muscular walls of the heart’s four chambers – two atria or upper chambers and two ventricles or lower chambers – contract to force blood out and around the body, then relax to let the heart fill with blood again. These contractions are controlled by a complex electrical system that keeps the four chambers working at a regular pace and in the correct order.
If you have atrial fibrillation, however, lots of random abnormal electrical impulses start firing in the atria that override the normal timing controller of the electrical system, making the atria fibrillate (or quiver). As a result, the atria only contract partially, but very rapidly, which can mean the heart muscle deosn't relax properly between contractions. Some of these impulses then pass through to the ventricles, which in turn contract in an irregular rather than regular pattern.
All these things interfere with the normal flow of blood in your heart’s chambers, and sometimes this can lead to the formation of a small blood clot. If this happens there’s a chance that the clot may travel through the blood vessels and into the brain where it could become stuck and form a blockage, cutting off the blood supply and causing a stroke.
A similar problem can happen in a condition called atrial flutter, though with atrial flutter the atria contract very quickly but more regularly, as opposed to irregularly. If you have atrial flutter your heart may beat up to 150 times a minute. Symptoms can be similar to those in atrial fibrillation, plus atrial flutter also increases your risk of having a stroke. Some people with atrial fibrillation also have atrial flutter.
What is the main cause of atrial fibrillation?
We don’t know exactly what causes atrial fibrillation to develop in some people, but we do know it’s more common in older people and that it affects people with certain conditions more than others, including the following:
High blood pressure (this is the most common cause)
Coronary heart disease
Congenital heart disease
Heart valve problems
Pericarditis (inflammation of the sac that surrounds the heart)
Dilated cardiomyopathy (heart muscle weakness)
Hypertrophic cardiomyopathy (thickened heart muscle)
Heart conditions are among the most common risk factors for atrial fibrillation, but other conditions are linked with it too, including:
Hyperthyroidism (overactive thyroid gland)
Carbon monoxide poisoning
Drinking a lot of alcohol – particularly binge drinking – taking illegal recreational drugs like cocaine, smoking and even having a lot of caffeine can also trigger an episode of atrial fibrillation (dietary sources of caffeine include coffee, tea, caffeinated soft drinks and chocolate).
Atrial fibrillation symptoms
According to the NHS the most obvious symptom of atrial fibrillation is heart palpitations (iv). If this happens you may feel as if your heart is pounding, fluttering or beating irregularly, typically for a few seconds (but it’s possible for the sensation to last for a few minutes or even longer).
Along with an irregular heartbeat your heart may beat at a very fast pace, often much higher than 100 beats per minute. See above for details of how to check how fast (and irregularly) your heart is beating.
There are other symptoms that may affect you too, including:
Some people, however, don’t have any symptoms, and they may not realise they have atrial fibrillation until it’s picked up during a test or investigation for another condition or during a general check-up.
Types of atrial fibrillation
How often you experience symptoms will determine which of the four types of atrial fibrillation is affecting you.
Paroxysmal atrial fibrillation
This type of AFib causes symptoms that come and go. Most of the time your symptoms will stop within 48 hours without any treatment, though they may last up to seven days. However even though the symptoms stop without treatment, many people with paroxysmal atrial fibrillation are treated to make sure it stops as quickly as possible. How often the symptoms return varies widely from one person to another.
Persistent atrial fibrillation
Persistent Afib causes symptoms that last longer than seven days and are unlikely to stop without treatment. Like paroxysmal atrial fibrillation, episodes of persistent atrial fibrillation come and go.
Long-standing atrial fibrillation
Long-standing atrial fibrillation is when you’ve had continuous symptoms for a year or more.
Permanent atrial fibrillation
Permanent means you have symptoms all the time. Your heartbeat doesn’t return to a normal rhythm, though treatments may help bring your heart rate back to a normal pace.
Atrial fibrillation ECG
If your doctor or heart specialist suspects you have atrial fibrillation they may refer you for one or more tests, including an electrocardiogram (ECG), an echocardiogram (ultrasound scan of your heart), a chest x-ray or blood tests. Some of these tests check for possible underlying causes of atrial fibrillation such as an overactive thyroid gland, lung problems or heart problems.
An ECG can confirm whether or not you have atrial fibrillation as it records your heart’s rhythm and electrical activity. You may have a test at a local hospital or at your GP’s surgery, or you may be asked to wear a portable ECG recorder for 24 hours or longer.
Atrial fibrillation treatment
If the results of your ECG shows you do have atrial fibrillation there are a number of treatments available, including:
Atrial fibrillation medications
A number of medicines can be prescribed to treat AFib such as:
Medicines that restore a normal heart rhythm (including beta blockers)
Medicines that control how fast your heart beats (including beta blockers and calcium channel blockers)
Anticoagulants that reduce the risk of blood clots forming (including warfarin)
Atrial fibrillation surgery
In other cases, your physician may recommend surgical intervention, which may include:
Cardioversion (a procedure that involves giving the heart a controlled electric shock to help restore a normal rhythm)
Catheter ablation (an operation that destroy tiny sections of heart tissue that are the source of the abnormal electrical impulses – this is usually only recommended when other treatments haven’t been successful)
Implanting a pacemaker to help the heart beat regularly (according to the NHS this is typically offered when medicines aren’t effective or are unsuitable, usually in people aged 80 years and older (v)).
Which treatment or treatments are the most suitable and appropriate for you will depend on things like your age, your overall health, the type of atrial fibrillation you have and your symptoms. Meanwhile if other tests suggest you have an underlying condition that’s causing atrial fibrillation, you may also be given medicines to treat that condition too.
Atrial fibrillation and stroke
The good news is that atrial fibrillation itself isn’t usually life threatening, and it’s common to live a normal, healthy life if you develop it – even if it feels a little uncomfortable at times. But it often needs treatment because having atrial fibrillation means your risk of having a stroke is four or five times higher than normal, because of the way atrial fibrillation interferes with the blood flow in your heart chambers This is why many people who have atrial fibrillation are taking medication to control their heart rate or rhythm, often in addition to treatments to help prevent a stroke.
There are also other, less common, complications of atrial fibrillation too, including:
Worsening chest pain if you already have angina
Problems with certain brain functions, including memory, attention and reasoning
If you have atrial fibrillation it may also affect your fitness to drive. Your doctor should advise you about this when you’re diagnosed. If you’re not sure about this, you can check with the Driver and Vehicle Licensing Agency (DVLA).
Can you live a long life with atrial fibrillation?
The good news is that atrial fibrillation itself isn’t usually life threatening, and it’s common to live a normal, healthy life if you develop it – even if it feels a little uncomfortable at times.
If you’ve been diagnosed with atrial fibrillation it’s important to take any medicines your doctor or heart specialist has prescribed for you. This will help you manage your condition and reduce the risk of any complications developing, such as a stroke.
It’s also a good idea to make your lifestyle as healthy as possible – this may also be helpful if you don’t have atrial fibrillation but want to reduce your risk of developing it.
Living with atrial fibrillation
Healthy lifestyle changes could include the following:
Atrial fibrillation and exercise
Regular exercise may help reduce atrial fibrillation symptoms and help reduce your risk of developing it in the first place (vi). You don’t have to be super fit, just try to be more active in general (aim to be moderately active for 150 minutes each week or 75 minutes a week if you exercise vigorously). Before launching into any new exercise programme, speak to your GP to make sure that you can do it safely, especially if you have an existing medical condition such as atrial fibrillation (your GP can also give you lots of advice on how to start exercising if you haven’t been very active lately).
Keep your blood pressure healthy
High blood pressure is a well-known risk factor for atrial fibrillation, with one large-scale study suggesting high blood pressure increases your risk for atrial fibrillation by 56 percent (vii). Keeping your blood pressure within a healthy range could reduce your risk of developing atrial fibrillation, but it may also reduce how often you experience it and how quickly it progresses if you’re already affected (viii). Read more about blood pressure and how to keep yours within a healthy range in our blood pressure guide.
Having a heart-healthy diet is another important factor if you have – or want to avoid having – atrial fibrillation. A diet that’s low in salt and saturated or trans fats is a good place to start, though you may want to try the Mediterranean diet as there’s evidence it may reduce the risk of atrial fibrillation (ix).
A typical Mediterranean diet includes lots of fruit, vegetables and whole grains with fish, seafood, olive oil, nuts, beans and legumes; moderate amounts of dairy foods and poultry; and limited amounts of red meat, added sugars and highly processed foods.
Keep your weight down
Obesity is a risk factor for atrial fibrillation, so if you need to lose some weight you may find even shedding a modest amount could reduce your atrial fibrillation symptoms. In fact in one study almost half of the overweight people taking part said they didn’t need their atrial fibrillation medicines any more after losing some weight (x). If you’re interested in finding out more about losing weight, take a look at our guide to weight loss: the facts.
Drink alcohol in moderation
Drinking an excessive amount of alcohol can make people significantly more likely to develop atrial fibrillation (vi). Harvard Medical School experts also suggest there’s mounting evidence that drinking less alcohol – or no alcohol at all – could be helpful if you’ve been diagnosed with atrial fibrillation (xi). Discover the facts about alcohol and how to make sure you’re drinking in moderation (that is, no more than 14 units of alcohol each week) by reading our alcohol misuse guide.
Tackle sleep problems
If you don’t get enough sleep – or you’re affected by obstructive sleep apnea, a condition that disrupts your sleep (often severely) – it could affect your chances of developing atrial fibrillation. One study, for instance, has shown almost half of people with atrial fibrillation may have sleep apnoea (xii), while another suggests acute sleep deprivation can make you more than three times more likely than normal to have atrial fibrillation (xiii).
Find out more about getting a better night’s sleep in our sleep and insomnia guide; there’s also lots of helpful information in our guide to obstructive sleep apnoea.
Some experts have found having diabetes means you may also have a 40 percent higher chance of developing atrial fibrillation than someone who doesn’t have diabetes (vi). If you have diabetes and atrial fibrillation, however, keeping your blood sugar levels under control could improve your atrial fibrillation symptoms and reduce how often you get them (xi). Find out more about how your lifestyle could help you manage your diabetes by reading our guide to diabetes diet and lifestyle.
Cut back on caffeine
Experts believe stimulants such as caffeine – particularly artificial sources of caffeine such as energy drinks – are important atrial fibrillation triggers (vi). But it doesn’t necessarily mean you have to give up tea, coffee and chocolate altogether, as one review of studies suggests a moderate amount of caffeine a day may actually reduce your risk of irregular heart rhythms (xiv). If you have more than two or three cups a day, however, you may want to consider substituting some of your caffeinated drinks for decaffeinated (or non-caffeinated) alternatives.
Smokers are thought to have a higher risk of developing atrial fibrillation, with studies showing those who quit their habit may reduce their risk substantially (vi). If you’re a smoker there’s never been a better time to quit than right now – for tips and advice on giving up, read our stop smoking guide.
Natural support for atrial fibrillation
Having a healthy lifestyle may well help reduce your risk of developing atrial fibrillation, plus it may also reduce your symptoms and how often you get them if you’ve already been diagnosed with the condition. As part of a healthy diet you may also want to consider taking nutritional supplements, some of which have been found useful in people with atrial fibrillation symptoms (natural supplements, however, should never be used instead of medicines your doctor has prescribed for you). If you are taking prescription medicines, it’s also a good idea to check with your doctor, a pharmacist or a qualified nutritionist before taking any natural supplements.
Magnesium is a mineral that’s often used to keep the heart stable as it’s involved in nerve transmission, including nerve transmission in the heart muscle. There’s also a theory that people with atrial fibrillation have low levels of magnesium, with one review of 35 studies suggesting patients who’ve had heart surgery could be given magnesium to reduce post-operative atrial fibrillation (xv). Magnesium may also help with one of the main risk factors for atrial fibrillation – high blood pressure. Indeed, studies suggest magnesium may help lower the risk of hypertension as well as help treat high blood pressure (xvi).
Magnesium is available in supplement form – look for a form that’s more easily absorbed such as magnesium citrate. You can also add more magnesium to your diet by eating plenty of dark leafy green vegetables, nuts, seeds, beans, seafood, whole grains and avocados.
A compound found in high concentrations in the mitochondria – the energy-driven cells of the heart – CoQ10 (or ubiquinone) is probably best known for its heart health benefits. There’s also evidence it may be beneficial for people with atrial fibrillation, with one study showing just three percent of volunteers taking CoQ10 had atrial fibrillation episodes after 12 months' treatment compared with 22 percent of volunteers who didn't receive any CoQ10 supplements (xvii). There’s also evidence that CoQ10 may help keep blood pressure levels healthy (xviii).
You can get some CoQ10 from your diet, with the best sources including oily fish, organ meats (such as liver) and whole grains. To get an extra boost, however, you may want to consider trying a good-quality CoQ10 supplement.
High-strength fish oils
The omega-3 fatty acids EPA and DHA – sourced from oily fish as well as certain marine algae – may also be helpful for arrhythmias including atrial fibrillation, with studies suggesting they may reduce the risk of atrial fibrillation in older people (xix).
Fish that are rich in EPA and DHA include salmon, fresh tuna, mackerel, sardines and herring. However if you can’t or don’t like eating fish you may want to consider trying a high-strength fish oil supplement or a vegan omega-3 supplement that contains marine algae.
Found naturally in foods such as vegetable oils and grains, plant sterols may be best known for their potential to reduce our cholesterol levels. However there’s also some evidence they may be useful if you need to manage your blood pressure. For instance one review of 19 clinical studies suggests taking plant sterol supplements may reduce blood pressure significantly in just 12 weeks (xx). The scientists who wrote the review claim plant sterols may be a beneficial complementary therapy for people with high blood pressure, and that they may help prevent high blood pressure too.
Atrial fibrillation is becoming increasingly common, arguably because awareness of the condition is higher now than it’s ever been – and that has led to more people being diagnosed with the condition. Affecting mostly older people, atrial fibrillation may not be a serious problem itself but it significantly increases your risk of having a stroke. Thankfully there are treatments and lifestyle changes you could make that help reduce your risk of any serious complications (or even help prevent your developing atrial fibrillation in the first place).
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Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.