Understanding Atrial Fibrillation

💡 What is Atrial Fibrillation?

Atrial fibrillation (AF) is the most common type of irregular heartbeat (arrhythmia). Instead of beating in a steady rhythm, the upper chambers of your heart (atria) quiver chaotically, causing an irregular and often fast pulse.

You might feel your heart racing, fluttering, or pounding. Some people feel tired or breathless. But many people with AF don't notice any symptoms at all — it's often found during a routine check or when checking blood pressure.

AF itself isn't usually life-threatening, but it significantly increases your risk of stroke, which is why treatment focuses on two things: controlling the heart rhythm and preventing blood clots.

Types of AF

• Paroxysmal AF — comes and goes, usually stops within 48 hours
• Persistent AF — lasts longer than 7 days, may need treatment to stop
• Permanent AF — continuous, heart stays in AF

⚠️ Why Does AF Increase Stroke Risk?

When the heart's upper chambers quiver instead of beating properly, blood can pool and form clots. If a clot travels to the brain, it causes a stroke.

People with AF are 5 times more likely to have a stroke than people without AF. This is why most people with AF are prescribed blood-thinning medication (anticoagulants).

Your Stroke Risk Score (CHA₂DS₂-VASc)

Your GP will calculate your stroke risk using a score called CHA₂DS₂-VASc. This considers factors like:

• Age (65+ or 75+)
• High blood pressure
• Diabetes
• Previous stroke or TIA
• Heart failure
• Vascular disease
• Sex (women score slightly higher)

Most people with AF and a score of 2 or more (1 or more for women) will be offered anticoagulants.

💊 How Is AF Treated?

1. Preventing blood clots (anticoagulants)

Blood thinners reduce stroke risk by preventing clots from forming. Common options include:

• DOACs (e.g., apixaban, rivaroxaban, edoxaban) — most commonly used now
• Warfarin — older option, requires regular blood tests (INR)

DOACs are preferred for most people because they don't require regular monitoring and have fewer food/drug interactions.

2. Controlling heart rate

Medications to slow the heart rate so it doesn't beat too fast:

• Beta-blockers (e.g., bisoprolol, atenolol)
• Calcium channel blockers (e.g., diltiazem, verapamil)
• Digoxin — sometimes used in addition

3. Controlling heart rhythm

In some cases, your doctor may try to restore normal rhythm:

• Cardioversion — electrical shock to reset the heart
• Ablation — procedure to destroy tissue causing abnormal signals
• Anti-arrhythmic drugs (e.g., flecainide, amiodarone)

❓ Questions to Ask Your GP