Atrial fibrillation – commonly called AFib or AF is the most common sustained heart rhythm disorder, affecting approximately 2% of Australians and becoming more prevalent with age. While AF is rarely immediately life-threatening, it significantly increases the risk of stroke and heart failure if left untreated. With appropriate management, most people with AF can expect to continue to live active and healthy lives.
How Does AF Occur?
Normally, the heart beats in a regular, coordinated rhythm controlled by an electrical signal that begins in a small region of the upper right chamber (the right atrium). In AF, chaotic electrical signals fire rapidly and irregularly throughout both upper chambers (the atria), causing them to quiver rather than contract effectively.
As a result, the lower chambers (ventricles) receive irregular signals and beat unevenly, often too fast. This reduces the heart’s pumping efficiency and allows blood to pool in the atria, which can lead to clot formation and stroke.
Symptoms
AF symptoms vary widely. Some people experience no symptoms at all and are only diagnosed incidentally during a routine health check. Others may notice:
- Palpitations – a sensation of a racing, fluttering, or irregular heartbeat
- Shortness of breath, particularly with exertion
- Fatigue or reduced exercise tolerance
- Dizziness or light-headedness
- Chest discomfort
- Swelling in the legs (if heart failure develops)
Did you know? AFib can be intermittent (paroxysmal), coming and going on its own, or persistent and long-standing. The type of AF influences treatment decisions.
Causes and Risk Factors
AF is associated with a range of underlying conditions and lifestyle factors:
- High blood pressure (the most common risk factor)
- Coronary artery disease or previous heart attack
- Heart failure or structural heart disease
- Diabetes
- Obesity and obstructive sleep apnoea
- Thyroid disorders (particularly overactive thyroid)
- Excessive alcohol intake
- Increasing age
Diagnosis
AF is diagnosed using an electrocardiogram (ECG), which records the heart’s electrical activity. Because AF can be intermittent, your cardiologist may recommend:
- A 24-hour or longer Holter monitor – a portable ECG worn continuously to capture episodes
- Commercially available smart watches and other wearables are increasingly able to record ECG tracings and/ or detect AF to assist in making the diagnosis
You may also need:
- Echocardiogram (heart ultrasound) to assess heart structure and function
- Sleep study to exclude obstructive sleep apnoea (OSA)
- Blood tests to check thyroid function, kidney function, and other relevant markers
Treatment Options
Management of AF has two main goals: preventing stroke, and managing symptoms by controlling the heart rate and/or restoring normal rhythm.
Stroke Prevention – Anticoagulation
Because AF significantly increases stroke risk, many patients are prescribed blood-thinning medication (anticoagulants). Modern oral anticoagulants (often called NOACs or DOACs – such as apixaban, rivaroxaban, or dabigatran) are highly effective and have largely replaced older medications like warfarin for most patients.
Important: Never stop taking your anticoagulant without speaking to your doctor. The decision to take blood thinners is based on your individual stroke risk and should not be changed without medical guidance.
Rate Control
Rate control aims to slow the ventricular rate to a comfortable range (usually below 100 beats per minute at rest). Medications such as beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem), or digoxin are commonly used.
Rhythm Control
Rhythm control aims to restore and maintain a normal heart rhythm (sinus rhythm). Options include:
- Antiarrhythmic medications such as flecainide, amiodarone, or sotalol
- Electrical cardioversion – a brief controlled electric shock delivered under sedation to reset the heart’s rhythm
- Catheter ablation – a minimally invasive procedure in which targeted areas of heart tissue responsible for abnormal signals are carefully destroyed using radiofrequency energy or freezing (cryoablation). Ablation has a good success rate and may reduce or eliminate the need for long-term medication.
Managing AF Day to Day
Living well with AF involves both medical treatment and healthy habits:
- Take all medications as prescribed and attend all follow-up appointments
- Monitor your pulse regularly – your cardiologist or GP can teach you how
- Manage weight, blood pressure, and blood sugar
- Limit or avoid alcohol, even moderate amounts can trigger episodes in some people
- Treat sleep apnoea if present, this can significantly improve AF control
- Stay physically active within limits agreed with your cardiologist
- Reduce stress and prioritise sleep
Seek urgent care if: You experience sudden severe shortness of breath, chest pain, a very fast heart rate that doesn’t settle, or any symptoms of stroke (sudden face drooping, arm weakness, or speech difficulty – remember the FAST acronym: Face, Arms, Speech, Time to call 000).