Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting approximately 1.5 million people in the UK. It is associated with a fivefold increased risk of stroke — making early detection and appropriate treatment critically important. Yet many people live with AF without knowing it, or dismiss their symptoms as “just palpitations.”
What Happens in Atrial Fibrillation
In a normal heart rhythm (sinus rhythm), the sinus node in the right atrium generates a regular electrical impulse that triggers coordinated atrial and ventricular contraction. In AF, disordered electrical activity in the atria produces chaotic, irregular signals — the atria quiver rather than contract effectively, and the ventricular response (and thus the pulse) becomes irregularly irregular. This has two primary consequences: reduced cardiac output (the heart is pumping less efficiently) and, critically, the risk of blood clot formation in the atria (particularly the left atrial appendage). If a clot forms and embolises to the brain, it causes a cardioembolic stroke — typically the most severe type of stroke.
Symptoms of AF
AF can be symptomatic or completely asymptomatic (detected incidentally on ECG). Symptomatic features include: palpitations (the most common — awareness of an irregular, fast, or fluttering heartbeat); breathlessness; fatigue and reduced exercise tolerance; dizziness or light-headedness; and occasionally chest discomfort. Symptoms vary enormously — some people are severely limited; others notice little. Paroxysmal AF (intermittent episodes that terminate spontaneously) may cause episodic palpitations with completely normal periods between.
Detection and Diagnosis
The pulse check is the simplest screening tool — an irregularly irregular pulse warrants further investigation. ECG confirms AF. Smartphone-based photoplethysmography (Apple Watch, Kardia device, some Fitbits) can detect AF reliably and has enabled many incidental diagnoses. NICE recommends opportunistic pulse palpation for AF in people over 65 in primary care. If you notice irregular palpitations, having your pulse checked is the first, simple step.
Stroke Prevention: The Priority
Anticoagulation (preventing clot formation) is the most important AF treatment decision — more important than rhythm or rate control for most patients. Risk is assessed using the CHA₂DS₂-VASc score. Most patients with AF over 65, or with additional risk factors, will be offered oral anticoagulation (warfarin or DOACs — direct oral anticoagulants such as apixaban, rivaroxaban, edoxaban or dabigatran). DOACs are now preferred over warfarin for most AF patients due to their consistent dosing, fewer food and drug interactions, and comparable or superior efficacy.
Frequently Asked Questions About AF
Is AF life-threatening?
AF itself is rarely immediately life-threatening for most people. The principal danger is stroke — AF-related strokes are typically severe and disabling. With appropriate anticoagulation, the stroke risk is substantially reduced. AF is also associated with heart failure over time if rate and rhythm are not managed. With proper treatment, most people with AF live normal, active lives.
What triggers AF episodes?
Common triggers include alcohol (particularly binge drinking — “holiday heart”), caffeine (variable — some people are highly sensitive, others not), infection/fever, sleep deprivation, dehydration, intense exercise (particularly in endurance athletes — AF is more common in long-distance cyclists and runners), and emotional stress. Identifying and managing personal triggers can significantly reduce episode frequency.
Can AF be cured?
Catheter ablation (destruction of the arrhythmic tissue in the atria, typically targeting the pulmonary vein triggers) can achieve long-term freedom from AF in 60–80% of suitable patients, particularly those with paroxysmal AF of shorter duration. It is the most effective rhythm control strategy available and is increasingly performed in younger, fitter patients earlier in the disease course.
Browse health monitors at Huncoat Pharmacy. Related: Blood Pressure, Stroke Prevention.
At Huncoat Pharmacy: Pharmacy First, NHS heart health services, Heart health home testing, Private prescription service.