10 AF (atrial fibrillation) facts

In this article we will describe 10 facts about atrial fibrillation (AF). AF is the commonest abnormal heart rhythm.

1. What is AF?

Atrial fibrillation (also known as ‘AF’) is an irregular – and often very rapid – heart beat (an ‘arrhythmia’) that can lead to strokes, heart failure and other heart-related complications. AF makes the blood more likely to clot. This is why it causes strokes, and so part of the treatment is to thin the blood.

Typical AF on ECG

2. How common is AF?

It is common, affecting over 2% of the population; but more than 5% if over 75 years, and 10% if over 85 years.

The normal heart rate is 60-90 beats per minute (bpm). In AF, it is often fast (e.g. 120-150 bpm) if untreated – or slow in a few patients.

So. Tell me some more facts about AF (atrial fibrillation).

3. What are the causes of AF? 

The commonest cause is ischaemic heart disease (IHD; which causes heart attacks and angina), which affects 5-10% of the population. It is also caused by problems with the mitral valve (one of the heart’s four valves) and an overactive thyroid gland. 10% of patients have ‘lone AF’, with no cause identified.

4. Are there different types of AF? 

Yes. A few patients have ‘Paroxysmal AF’ (PAF), which means episodes of AF that come and go. For most, it is there all the time.

5. What are the symptoms of AF? 

Symptoms include palpitations, dizziness or shortness of breath. But can also be picked up on a routine ECG done for other reasons, when you are well.

6. How is AF diagnosed? 

The diagnosis is made by doing an ECG.

7. What is the treatment for AF?

The two main treatments for AF are:

• A tablet to control the heart rate. These include a betablocker (e.g. Bisoprolol), Digoxin and Amiodarone. The aim of this medication is to bring the heart rate back down to normal (ideally, to less than 90 bpm when resting).
• A tablet to thin the blood (to prevent strokes). These include Direct Oral Anticoagulants (DOACs, like Apixaban) and Warfarin.

8. Are there any other treatments for AF? 

• Heart failure – water tablets (diuretics) and fluid restriction. Many patients have heart failure as well. If this is so, you may be asked to restrict your fluid intake – sometimes to 1.5 or even 1 litre a day. Ask your doctor if you need to limit your fluids, and how much you can drink each day. If you have heart failure, it is important to take the other tablets for that carefully.
• DC Cardioversion (electric shock to the heart). If the AF has come on recently, one method of reversing it, is to give the heart an electric shock (‘DC cardioversion’). Make sure your doctors have considered that. It can prevent lifelong tablets.
• Cardiac ablation. This is a procedure that uses radiofrequency energy (similar to microwave heat) to destroy a small area of heart tissue that is causing the rapid irregular heartbeats of AF. This may be done when tablets and/or cardioversion have not fully worked, or if the AF keeps coming back after DC cardioversions.

9. What lifestyle changes should I make?

It is a good idea not to smoke, exercise and keep your weight down.

10. What else can the NHS do to help?

• GP. Most patients can be looked after by an NHS GP alone. But if things are not settling you should be referred to a hospital cardiology consultant.
• Hospital cardiology consultant. Ask your GP to refer you to the local hospital cardiology unit (there will be one). Then when you see a consultant (or their deputy, called a registrar) who specialises in heart disease, only let them discharge you when you feel your breathing is OK, AF is controlled, and heart failure (if you have it) is stable. In the meantime, ask for review every 3-6 months – this can be virtual. Many heart doctors subspecialise, e.g. heart failure or problems with the heart rhythm. Make sure you are under the care of the right one. Ask them. They can also get you to see an arrhythmia specialist nurse.
• GP Practice Nurse. Many GPs have a practice nurse that runs a ‘long-term condition’ clinic on their own. Ask for three monthly review there. Some of them work with a clinical pharmacist who can fulfil a similar role.

Summary

We have described 10 AF (atrial fibrillation) facts. If you follow the advice above, you will get better care. Your breathing and other symptoms of AF should improve – and strokes prevented.

Other resources

This a useful patient information leaflet.