Atrial Fibrillation (AF)

Atrial fibrillation (AF) is a heart condition that causes an irregular and often abnormally fast heart rate. It is one of the most common forms of abnormal heart rhythm and a major cause of stroke. We estimate that in Cheshire and Merseyside around 66,000 people have an irregular heartbeat (AF), a condition which, if untreated, can lead to stroke. Around 52,000 people had a stroke or mini-stroke (Transient ischemic attack -TIA) in 2016/17.



What is atrial fibrillation?

When the heart beats normally, its muscular walls contract (tighten and squeeze) to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats.

In atrial fibrillation, the heart’s upper chambers (atria) contract randomly and sometimes so fast that the heart muscle can’t relax properly between contractions. This reduces the heart’s efficiency and performance.

Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria. These impulses override the heart’s natural pacemaker, which can no longer control the rhythm of the heart. This causes the person to have a highly irregular pulse rate.

The cause isn’t fully understood, but it tends to become more common as you get older. It may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking.

Causes of Atrial Fibrillation
What are the symptoms of atrial fibrillation?

Sometimes, AF doesn’t cause any symptoms and a person is completely unaware that their heart rate isn’t regular.

However, AF can cause problems including dizziness, shortness of breath and tiredness.

You may be aware of noticeable heart palpitations, where your heart feels like it’s pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a few minutes.

Read more about the symptoms of atrial fibrillation.

How can I check for atrial fibrillation?

A normal heart rate should be regular and between 60 and 100 beats per minute when resting.

In AF, the heart rate is irregular and can sometimes be very fast. In some cases, it can be considerably higher than 100 beats per minute.

You can measure your heart rate by checking your pulse. You can measure your pulse multiple ways, for example:

  • Pulse oximeters: These are devices that clip onto your finger or earlobe and measure your blood oxygen level and heart rate.
  • Smartphones / Smartwatch: Some smartwatch/smartphones have built-in sensors or apps that can measure your heart rate.
  • Home Blood Pressure Monitors: Some home blood pressure monitors can detect AF, it will state this on the product, so please check before purchasing.
  • Feeling the pulse in your neck or wrist: Use the British Heart Foundation guide to make sure you know how to check your pulse.

Download the know your pulse leaflet.

When to see your GP?

You should make an appointment to see your GP if:

  • you notice a sudden change in your heartbeat
  • your heart rate is consistently lower than 60 or above 100 – particularly if you’re experiencing
  • other symptoms of atrial fibrillation, such as dizziness and shortness of breath

See your GP as soon as possible if you have chest pain.

Treating atrial fibrillation

Most people with AF will require an anticoagulant, but a small number of these won’t as it depends on the risk.

Anticoagulation means that you take a medicine to reduce the chance of a blood clot forming and having an AF-related stroke. An anticoagulant medicine makes the blood take longer to clot. It plays a vital part in helping to prevent strokes specifically caused by AF.

Anticoagulant drugs like warfarin and a newer class of drugs called DOACS, are the most effective treatments to reduce the risk of stroke in people with AF.

There are different types of DOACs including: rivaroxaban, dabigatran, apixaban and edoxaban.

Some people with AF need medications to help control the rate and rhythm of their heart.

These medications are most commonly beta blockers and anti-arrhythmic drugs.

Occasionally, a procedure such as ablation or cardioversion may be needed.

If I’ve got AF, what can I do to reduce the risk of having a stroke?

AF can increase the risk of a blood clot forming inside the heart. If the clot travels to the brain, it can lead to a stroke.

AF increases the risk of a stroke by around five times. However, with appropriate treatment the risk of stroke can be substantially reduced.

Most people with AF will require an anticoagulant, but a small number won’t, as it depends on risk.

Depending on your level of risk, you may be prescribed warfarin or a newer type of anticoagulant, such as DOACS.

They work by slowing down the blood’s clotting process, and reduce the risk of stroke by nearly two thirds for people with AF. In other words, these treatments can prevent about six out of ten strokes.

Your GP or pharmacist will be able to discuss your options with you.

Aspirin isn’t recommended to prevent strokes caused by AF, but is still used for other heart conditions and on the advice of your cardiologist, you may be on aspirin and an anticoagulant.

Although AF can greatly increase the risk of stroke, there are other factors that can contribute to a stroke, including:

  • smoking
  • high cholesterol
  • high blood pressure
  • physical inactivity
  • being overweight
  • diabetes

The good news is some of these factors are modifiable – this means you can do something about them to reduce your chance of a stroke, whether or not you have AF.