Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia in which the heart’s upper chambers (atria) beat irregularly and much faster than normal. Instead of contracting in a coordinated and rhythmic way, the atria quiver or “fibrillate,” causing the heart to beat fast and irregularly. AF can be classified into several types based on the duration and frequency of episodes. If the episodes last for short period such as hours or days and go back to the normal rhythm on its own, it is called paroxysmal AF. However, AF episodes that continue and don’t go back to the normal rhythm are called persistent AF. The longer you remain in AF, the less likely you will go back to the normal rhythm, so it is important to treat AF sooner rather than later.
The condition is generally more common in older adults, but it can occur at any age. If you are above the age of 40, you have a 1:4 chance of developing AF. While AF can happen in people with normal hearts, it is seen more often in patients with other medical conditions such as high blood pressure, heart disease, diabetes, and sleep apnoea. It is also strongly associated unhealthy lifestyle such as excessive alcohol intake and obesity.
Fig 83 risk factors
As a result of the sluggish blood movement, blood can pool in the atria and form clots, which can increase the risk of stroke or other complications. This is one of the main causes of complications in patients with AF. The risk of stroke can be significantly reduced in patients with AF by using anticoagulation (blood thinning tablets). It is very important that your risk of stroke is assessed by your electrophysiologist to decide if you need to start anticoagulation to reduce your risk of stroke.
Fig 80 AF and stroke 1
The symptoms of AF may vary from person to person, and some individuals with AF may not have any symptoms at all.

However, common symptoms of AF may include:


Heart palpitations or a racing heartbeat



sick 1

Fatigue or

difficulty breathing1

Shortness of


Fainting or near fainting


Dizziness or light-headedness

chest 1

Chest pain or discomfort


    The treatment for AF can vary depending on the severity of the condition, the underlying cause, and the individual's overall health. The management of AF often requires a full management plan to address several aspects:

    This is one of the most important issues to deal with. If your cardiologist calculates that your risk is high, then he will start you on blood thinning tablets.
    This can be done by a simple procedure called cardioversion which involves using electrical shocks or medications to restore a normal heart rhythm
    • It is an easy option that simply involves taking tablets daily
    • However, it’s not a long-term fix and if medications are stopped, AF will start again
    • Long-term success with medications is only in the range of about 40%
    • The choice of medications is best decided by your electrophysiologist to suit your case
    • Simple procedure performed by catheters introduced through the vein in the thigh to reach the heart and destroy the area causing
    • Offers the best chance of staying in normal rhythm in comparison to tablets (80% vs 40%)
    • Success rate in average is about 80% in the long term (depends on the case)
    • Low risk of complications <1%
    • Some patients may require more than one procedure to achieve control of AF
    • There are different ways to perform the treatment such as burning or freezing technologies. The outcomes between different technologies are fairly similar. Your Electrophysiologist will choose the best modality for your case
    • This is mainly performed now at the time of cardiac surgery for other reasons (such as valve replacement or bypass surgery)
    • Rarely performed for the sole reason of treating AF after the introduction of catheter ablation
    • This used to be a more acceptable strategy 20 years ago
    • May still be appropriate in frail and elderly patients
    • The emphasis is more these days on maintaining normal rhythm
    • Occasionally, this can be achieved with a pacemaker implant followed by a small ablation to sever the nerve that connects the upper and lower chambers
    • Weight loss: Being overweight increases the risk of AF recurrence and reduces the success rate of ablation procedures. Weight loss is an important part of AF management.
    • Snoring and obstructive sleep apnoea (OSA): Patients with OSA are more likely to have AF. If you snore at night, consult a pulmonologist to have a sleep study performed and if needed use a CPAP machine.
    • Regular exercise: Moderate regular exercise reduced the risk of AF, however excessive (endurance) training may increase the risk of AF.
    • Alcohol: Increased alcohol intake is directly related to AF. Avoiding alcohol can reduce the chances of developing AF
    • Reducing stress: easier said than done, but may help reduce the risk of AF.
    • Avoiding excessive caffeine can also help reduce the risk of AF.

    AF is a complex arrhythmia and its management often requires collaboration between the patient and electrophysiologist and long-term follow up