Atrial Fibrillation: A Complete Guide to Symptoms, Causes, and Treatment
Know about atrial fibrillation, what it is, recognise the signs, symptoms, causes, treatment options, diagnosis, lifestyle modifications and more.
Written by Dr. Dhankecha Mayank Dineshbhai
Reviewed by Dr. J T Hema Pratima MBBS
Last updated on 19th Sep, 2025
Introduction
Have you ever felt your heart flutter, pound, or race in your chest for no apparent reason? While occasional skipped beats are common, a persistent irregular heartbeat could be a sign of a condition called atrial fibrillation, or AFib. It occurs when the upper chambers of your heart (the atria) beat chaotically and out of sync with the lower chambers (the ventricles). This disrupts blood flow, potentially leading to fatigue, shortness of breath, and a significantly increased risk of stroke. This guide will walk you through everything you need to know about atrial fibrillation, from recognising the early symptoms of atrial fibrillation to understanding the latest treatment options and lifestyle changes that can help you manage it effectively and live a full, healthy life.
What is Atrial Fibrillation (AFib)?
Atrial fibrillation is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. During AFib, the heart's two upper chambers (the atria) beat chaotically and irregularly out of coordination with the two lower chambers (the ventricles). Think of it not as an organised drumbeat, but as a chaotic, quivering mess. This faulty signalling causes a fast and irregular heart rhythm. The heart rate in AFib can range from 100 to 175 beats per minute, far exceeding the normal range of 60 to 100 beats per minute.
Understanding Your Heart's Electrical System
Normally, your heartbeat begins with an electrical impulse from the sinus node, your heart's natural pacemaker, located in the right atrium. This impulse spreads smoothly across the atria, causing them to contract and pump blood into the ventricles. The impulse then pauses briefly at the AV node before proceeding to the ventricles. In AFib, however, these electrical signals become disorganised, firing from multiple locations in the atria simultaneously. This creates a chaotic quiver instead of a strong, single contraction.
Consult a Cardiologist for Personalised Advice
AFib vs. Normal Sinus Rhythm: What's the Difference?
A normal, healthy rhythm (sinus rhythm) is steady and regular, like a metronome. Each part of the heart contracts in a precise sequence to maximize pumping efficiency. In AFib, this order breaks down. The atria fibrillate, or quiver, meaning they can't effectively pump blood into the ventricles. The AV node is bombarded with chaotic signals, causing the ventricles to beat rapidly and irregularly. This inefficiency can make you feel poorly and, over time, weaken the heart muscle.
Recognizing the Signs: Symptoms of Atrial Fibrillation
Some people with atrial fibrillation have no symptoms and are unaware of their condition until it's discovered during a physical examination. For those who do have symptoms, the experience can vary widely.
Common Symptoms You Shouldn't Ignore
The most frequently reported symptoms of atrial fibrillation include:
Palpitations: A sensation of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest.
Reduced Energy: A general lack of energy or severe fatigue that doesn't align with your activity level.
Shortness of Breath: Difficulty breathing, especially during exertion or even at rest, known as afib and shortness of breath.
Dizziness: Feeling lightheaded, faint, or dizzy.
Chest Pain: Pressure or discomfort in the chest (angina), which requires immediate medical attention.
Reduced Exercise Ability: Finding it suddenly harder to perform physical activities you used to do easily.
Silent AFib: When There Are No Symptoms
It's surprisingly common for AFib to be "silent," showing no obvious signs. This is often diagnosed incidentally during a check-up for another issue. Silent AFib is particularly dangerous because the risk of complications like stroke remains just as high. This is why regular check-ups are crucial, especially for those with risk factors like high blood pressure or a family history of heart disease.
What Causes Your Heart to Go Out of Rhythm?
AFib is often related to an underlying heart condition or damage to the heart's structure. However, other factors can also trigger it.
Underlying Heart Conditions
The most common causes include:
High Blood Pressure is the leading risk factor, as it puts extra strain on the heart.
Coronary Artery Disease: Blockages in the heart's arteries.
Heart Valve Problems: Such as mitral valve regurgitation or stenosis.
Congenital Heart Defects: Being born with a heart defect.
Previous Heart Surgery: A history of cardiac procedures.
Sick Sinus Syndrome: Malfunction of the heart's natural pacemaker.
Cardiomyopathy: Disease of the heart muscle.
Lifestyle and Other Risk Factors
Several non-heart-related issues can contribute to what causes heart palpitations and AFib episodes:
Hyperthyroidism: An overactive thyroid gland.
Chronic Lung Diseases: Like COPD or emphysema.
Sleep Apnea: A serious sleep disorder where breathing repeatedly stops and starts.
Excessive Alcohol or Caffeine Use: Binge drinking ("holiday heart syndrome") is a well-known trigger.
Stress and Anxiety: Can initiate or worsen episodes.
Age: The risk increases significantly after age 65.
Obesity and Diabetes are both major independent risk factors.
Potential Complications of Untreated AFib
Leaving atrial fibrillation unmanaged can have serious, long-term consequences for your health.
The Link Between AFib and Stroke
This is the most critical complication. Because the atria are quivering and not emptying properly, blood can pool and stagnate, particularly in a small pouch called the left atrial appendage. This stagnant blood can form clots. If a clot breaks free, it can travel through the bloodstream to the brain, block an artery, and cause an ischemic stroke. In fact, AFib increases an individual's stroke risk by four to five times and is responsible for up to 1 in 7 strokes.
Heart Failure and Other Risks
AFib can weaken the heart muscle over time. The rapid, irregular rhythm means the heart is working inefficiently. This constant strain can lead to heart failure—a condition where your heart can't circulate enough blood to meet your body's needs. Other risks include chronic fatigue, reduced quality of life, and an increased likelihood of developing other arrhythmias.
How is Atrial Fibrillation Diagnosed?
To diagnose AFib, a doctor will likely review your signs and symptoms, conduct a physical exam, and order several tests focused on your heart.
The Electrocardiogram (ECG or EKG)
This is the primary and most important test for diagnosing AFib. An ECG uses small sensors (electrodes) attached to your chest and arms to record the electrical signals as they travel through your heart. It's a quick, painless test that provides a definitive snapshot of your heart's rhythm. The classic sign of AFib on an ECG is an irregularly irregular rhythm with no discernible P-waves (which represent atrial contraction).
Monitors and Event Recorders
Since AFib can come and go, a standard in-office ECG might miss it. A Holter monitor is a portable ECG device you wear for 24 to 48 hours to record your heart's activity as you go about your daily life. For symptoms that occur less frequently, an event recorder can be worn for weeks. You press a button to record your heart's rhythm when you experience symptoms.
Additional Diagnostic Tests
Echocardiogram: An ultrasound of your heart that provides detailed images of its structure and function, checking for valve problems or heart muscle disease.
Blood Tests: To check for thyroid problems or other substances in the blood that may lead to AFib.
Stress Test: Involves running on a treadmill while your heart rhythm is monitored to see how it performs under exertion.
If your condition is complex or difficult to diagnose, a doctor might recommend further monitoring. Consulting a cardiologist online with Apollo24|7 can be a convenient first step to discuss your symptoms and determine if you need these tests.
Atrial Fibrillation Treatment Options
Treatment for AFib aims to reset the heart rhythm, control the heart rate, prevent blood clots, and reduce stroke risk. The strategy is personalised based on your symptoms, the type of AFib, and your overall health.
Goals of AFib Treatment
The main objectives are:
1. Preventing Stroke: Using anticoagulants (blood thinners).
2. Rate Control: Slowing down a rapid heart rate.
3. Rhythm Control: Restoring and maintaining a normal heart rhythm.
Medications for AFib Management
Medications are often the first line of defense.
Rate Control Medications
These drugs slow the heart rate by blocking the erratic signals coming from the atria. They don't fix the rhythm but make it more comfortable. Common options include beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem), and digoxin.
Rhythm Control Medications
Also known as anti-arrhythmics, these drugs (e.g., amiodarone, flecainide, sotalol) aim to restore and maintain the heart's normal sinus rhythm. They are used with caution due to potential side effects.
Blood Thinners (Anticoagulants)
These are critical for reducing afib stroke risk. They work by preventing blood clots from forming. Options include warfarin (which requires regular blood monitoring) and newer direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, and apixaban, which are often preferred for their convenience and safety profile. The choice of the best blood thinners for afib is a decision you must make with your doctor based on your individual risk factors.
Medical Procedures and Surgery
When medications aren't effective or tolerated, procedures may be recommended.
Electrical Cardioversion
This is a procedure where a controlled electric shock is delivered to your heart through paddles or patches on your chest. The shock briefly stops your heart's electrical activity, allowing it to reset and hopefully resume a normal rhythm. It is often planned and performed under brief anaesthesia.
Catheter Ablation
This is a more definitive, minimally invasive procedure. A doctor threads thin, flexible tubes (catheters) through your blood vessels to your heart. Electrodes on the catheter tips use heat (radiofrequency energy) or extreme cold (cryoablation) to create tiny scars in the heart tissue. These scars block the abnormal electrical signals and restore a normal rhythm. Catheter ablation is highly effective for certain types of AFib.
Pacemaker Implantation
In some cases, if a patient has a slow heart rate alongside AFib (a condition called tachy-brady syndrome), a pacemaker may be implanted. It doesn't treat AFib directly but ensures the heart cannot beat too slowly, allowing doctors to safely use medications to control the fast AFib rates.
Living Well with Atrial Fibrillation
A diagnosis of AFib means adopting a heart-healthy lifestyle is more important than ever. This is key to living with atrial fibrillation successfully.
Lifestyle Changes for AFib Management
Eat a Heart-Healthy Diet: Focus on fruits, vegetables, whole grains, and lean protein. Reduce salt, saturated fats, and sugars. The Mediterranean diet is often recommended.
Exercise Regularly: Engage in moderate-intensity exercise like brisk walking or swimming, as approved by your doctor. Avoid overexertion.
Maintain a Healthy Weight: Losing excess weight can significantly reduce the frequency and severity of AFib episodes.
Manage Blood Pressure and Cholesterol: Keep these numbers in check through diet, exercise, and medication if prescribed.
Limit Triggers: drastically reduce or eliminate alcohol and caffeine, as they are common triggers. Quit smoking.
Manage Stress: Practice yoga, meditation, deep breathing, or other relaxation techniques to keep stress levels low.
Monitoring Your Condition at Home
Learning to check your pulse regularly can help you detect an irregular rhythm. Some smartwatches and wearable devices also offer ECG features that can help track rhythm, though they should not replace professional diagnosis. For those on certain medications like warfarin, regular monitoring of blood clotting levels is essential. Apollo24|7 offers convenient home collection for tests like INR (for warfarin monitoring) or thyroid function, making it easier to manage your condition.
Conclusion
Understanding atrial fibrillation is the first and most powerful step toward managing it effectively. While an AFib diagnosis can feel overwhelming, it's important to know that it is a highly treatable condition. With today's advanced medications, procedures, and a strong focus on lifestyle management, millions of people with AFib lead full, active, and healthy lives. The journey involves partnering closely with your healthcare team, adhering to your treatment plan, and becoming an active participant in your heart health. Pay attention to your body, know the symptoms, and don't hesitate to seek help.
Consult a Cardiologist for Personalised Advice
Consult a Cardiologist for Personalised Advice
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