Atrial fibrillation | Manawa tukituki

Also known as irregular heart beat

Atrial fibrillation (manawa tukituki) is a condition that affects the heart, causing an irregular heart beat. This is known as a heart rhythm disorder (arrhythmia). It can cause stroke and heart failure.

On this page, you can find the following information:

What causes atrial fibrillation?
Who is at risk of AF?
What are the risks associated with AF?
What are the symptoms of AF?
Is an irregular pulse always due to AF?
Take a test to check your pulse
How is AF diagnosed?
What are the treatment options for AF?
How can I look after myself if I have AF?

Key points:

If you notice your pulse seems irregular, see your doctor.
Atrial fibrillation (AF) is common as we get older, so see your doctor for regular blood pressure and pulse checks.
Learn about the signs and symptoms of atrial fibrillation so you can seek help early.
If you do have atrial fibrillation, take your medication regularly as this can reduce symptoms and prevent complications such as stroke and heart failure.
With treatment and lifestyle management, there's no reason why you can't continue with an active happy life.

What causes atrial fibrillation?

Normally, your heart beats at a rate of 60 to 100 beats per minute when you are at rest, and all of the heart chambers beat in unison. If you have atrial fibrillation (AF), the electrical signals that control your heartbeat are abnormal. These signals cause the upper chambers of your heart (the atria) to beat unevenly and very quickly. In fact, the atria beat so quickly that the lower heart chambers (the ventricles) can’t quite keep up, and so your heart doesn’t beat in the usual, coordinated manner.

This results in an irregular and rapid heart rate, often ranging from 100 to 180 beats per minute. When this happens, the heart cannot pump blood around the body as well as it needs to.

Below is a video of a Cardiologist (specialist heart doctor) talking about AF.

(Bay of Plenty DHB, NZ, 2019)

There are three different kinds of atrial fibrillation:

Paroxysmal AF – This is a type of AF that comes and goes. Episodes can last for minutes, hours or days but not usually longer than a week.
Persistent AF – AF episodes that last longer than 7 days at a time.
Long-standing persistent or permanent AF – When your AF has been ongoing for more than a year.

AF is a progressive disease, so it is not uncommon for people with paroxysmal AF to develop persistent or permanent AF over time.

Who is at risk of AF?

The causes of atrial fibrillation are not always clear. However there are a number of known risk factors that increase your risk of developing AF. Risk factors include include:

Age – AF can affect adults at any age, but it is more common as people get older, particularly over 65 years
High blood pressure
Heart disease like coronary artery disease or heart valve disease or heart failure
Heart attack
Being overweight or obese
Chronic obstructive pulmonary disease (COPD)
Diabetes
Drinking large amounts of alcohol over a long period of time
Genetics – atrial fibrillation can sometimes run in families
Overactive thyroid gland or other metabolic imbalance
Lung infections such as pneumonia
Sleep apnoea.

What are the risks associated with AF?

Having AF puts you at higher risk of some serious conditions compared to people without AF. For example,

you are 4–5 times more likely to have a stroke
you are 3 times more likely to have heart failure
you are twice as likely to have myocardial infarction and dementia.

To reduce these risks it is important to treat your AF, even if you don't have AF symptoms (see below).

How does AF cause stroke?

Because the atria are contracting quickly and abnormally, they don’t pump blood through the heart properly. Blood can then pool in the heart and a blood clot may form. If the clot breaks loose and leaves the heart, it can travel via your blood vessels to other organs in your body. If a clot lodges in a blood vessel that supplies your brain and cuts off the blood supply, it causes a stroke. Read more about stroke.

How does AF cause heart failure?

Uncontrolled or very fast AF can put strain on your heart and cause it to weaken. This can cause heart failure. This is a condition when the heart is unable to effectively pump around the body. Read more about heart failure.

What are the symptoms of AF?

If you have AF, you may experience palpitations (an awareness of your heart beating or pounding in your chest). Other symptoms include:

chest pain
dizziness
light-headedness
shortness of breath
fatigue and tiredness.

Some people have no symptoms at all, and AF is only detected after a health professional notices that your pulse is irregular.

Image credit: Alila Medical Media / 123RF

Is an irregular pulse always due to AF?

Occasional missed beats or extra beats between regular beats are very common and usually nothing to worry about, but best discussed with your doctor. AF, on the other hand, has no pattern to it at all and is continuously irregular.

Take a test to check your pulse

A quick guide from the British Heart Foundation:

Put one of your hands out so you’re looking at your palm.
Use the index/first finger and middle finger of your other hand and place the pads of these fingers on the inside of your wrist. You should place them at the base of your thumb near where the strap of a watch would sit.
Press lightly and feel the pulse. If you can’t feel anything press slightly harder or move your fingers around until you feel your pulse.
Once you’ve found your pulse, continue to feel it for about 20-30 seconds. Feel the rhythm of the pulse and check if it’s regular or irregular.

Listen to these examples or regular and irregular pulse rhythms from the British Heart Foundation.

How is AF diagnosed?

If you or your doctor thinks you have AF, they may check your pulse, blood pressure, how well hydrated you are and your temperature. They may take a blood test.

AF is diagnosed using a simple, painless test called an electrocardiograph (ECG).

When you have an ECG, small patches connected to wires (electrodes) are placed on your chest to measure the electrical impulses given off by your heart.
These electrical impulses are recorded on a piece of paper called an ECG strip.
The abnormal pattern of electrical impulses seen in people with AF is easily detected by the ECG.

However, if you have paroxysmal (irregular bouts of) AF, your heartbeat may be normal at the time the ECG is recorded. To detect paroxysmal AF, you may need to have a Holter monitor test arranged.

A Holter monitor is a portable device that you wear under your clothes.
It continuously records your heart's electrical impulses for at least 24 hours.

What are the treatment options for AF?

The treatment for AF varies from person to person depending on a number of factors. Treatment will depend on the severity of your symptoms, the cause and duration of your AF, and whether you have any underlying health problems. The main aims of treatment are to:

prevent blood clots, therefore lowering your risk of having a stroke
control your heart rate to restore a normal heart rhythm.

Medication

Blood clot prevention

Having AF puts you at high risk of having a stroke, and preventing blood clots is one of the most important parts of treating AF, as blood clots can cause strokes. To prevent blood clots, you may be prescribed an anticoagulant such as warfarin, dabigatran or rivaroxaban. Anticoagulants are medicines that prevent blood clots from forming and stop existing clots from growing bigger. Because anticoagulants stop blood clots, they may cause bleeding. Your doctor will consider your risk of bleeding and whether anticoagulants are suitable for you. Read more about anticoagulants and which anticoagulant is best for you. Aspirin is no longer recommended for preventing blood clots in people with AF.

Rate control

You may be prescribed medicines to slow down the rate at which your ventricles are beating and help bring the heart rate to a normal level. Medicines used to control the heart rate include groups of medicines called beta blockers (eg, metoprolol, bisoprolol and carvedilol), or calcium channel blockers (diltiazem and verapamil). If your heart rate is still not settled with beta blockers and calcium channel blockers, your doctor may also add digoxin.

Rhythm control

If you are not doing so well on rate control medications your doctor may prescribe medicines or recommend procedures to control your heart's rhythm. Medicines used to control the heart rhythm include amiodarone, sotalol and flecainide. These are usually prescribed by a cardiologist.

Other treatment options

Electrical cardioversion is sometimes recommended to treat fast or irregular heartbeat. It involves the use of low-energy electrical shocks to trigger your heart into a normal rhythm. It is performed under a general anaesthetic.
Catheter ablation is a more invasive method that may be used to restore a normal heart rhythm. In this procedure, a catheter (a long, thin tube) is inserted into a vein in the leg or arm and threaded all the way to the heart. Radio wave energy is used to damage the small portion of tissue responsible for the abnormal electrical signals.
Pacemakers help maintain a normal heart rhythm. They are used for people with AF that has not been effectively treated with less invasive treatments. Before inserting a pacemaker, catheter ablation is used to destroy the atrioventricular (AV) node in the heart. The AV node is a part of the electrical control system of the heart that coordinates the atrial and ventricular chambers. The pacemaker takes over the role of the AV node in maintaining a normal heart rhythm.
Heart surgery is very rarely required. The most common operation performed is known as the maze procedure, where a number of small incisions are made in the atria (upper chambers) of the heart to create a pattern of scar tissue. The scar tissue (which does not carry electrical currents) prevents the abnormal electrical signals that cause AF from travelling through the heart and causing an abnormal heartbeat.

How can I look after myself if I have AF?

Atrial fibrillation can’t always be prevented but lifestyle changes can help control the level of AF symptoms you experience.

Have enough rest and sleep. Tiredness and fatigue is a common trigger for AF.
Reduce the amount of alcohol you drink or avoid alcohol. Drinking alcohol can trigger or worsen symptoms because alcohol can affect your heart’s electrical signals.
Be aware of unhelpful ‘stressors’ in your life and take steps to address these.
Know how to manage any periods of anxiety.
Reduce caffeine intake as it can trigger AF symptoms.
Quit smoking as it can aggravate AF and is also a risk factor for heart attacks and stroke.
Medications. Talk to your pharmacist or doctor before buying any over the counter medicines, complementary medicines or supplements as some can trigger AF symptoms.
Exercise. Some exercises can trigger symptoms of AF. Find out more about how to stay safe while exercising with AF (see below).

The Heart Foundation has more information on adjusting to life with AF.