Atrial Fibrillation: Types, Risk Factors, Symptoms, Diagnosis, Treatment, Complications

Medically Reviewed by Dr. K on 20 May 2022

Table of Contents:

  1. What Is Atrial Fibrillation?
  2. Types of Atrial Fibrillation
  3. Risk Factors
  4. Symptoms
  5. When To Seek Help
  6. Diagnosis
  7. Treatment
  8. Complications
  9. Outlook


What Is Atrial Fibrillation?

Atrial fibrillation, or AF, is characterised by a fluttering, quivering pulse. Additionally, you might hear the doctor refer to it as arrhythmia. This indicates that the heart's natural rhythm is out of sync. Since your blood is not flowing freely, you are at a higher risk of developing heart failure. That is when your heart cannot keep up with the demands of your body. Additionally, blood will pool within the heart and form clots. If one becomes lodged in the brain, a stroke can occur.

What occurs during AF? Normally, the top portion of the heart (the atria) contracts first, followed by the bottom portion (the ventricles) (the ventricles). Blood is moved by the pacing of these contractions. When someone has AF, the electrical signals that regulate this mechanism are thrown off balance. Rather than cooperating, the atria operate independently.


Types of Atrial Fibrillation

AF is divided into categories based on how long it lasts or what induces it. It's possible that yours will change over time. Whichever one you have, the treatment will be determined by it.

Paroxysmal Atrial Fibrillation

An episode of atrial fibrillation that lasts less than a week is known as a transient atrial fibrillation. It could happen in a matter of minutes or over several days. This form of AF does not need medication, but you should always see a doctor.

It's been dubbed “holiday heart disease" by others. This is AF that occurs after a period of heavy drinking. Your heart can go into AF if it isn't used to all of this operation. It can also happen when you're under a lot of tension.

Persistent Atrial Fibrillation

Persistent AF usually starts as short-term AF (paroxysmal AF). This usually lasts for more than a week. If you're one of the following people, you're more likely to develop persistent AF:

  • Older
  • Have high blood pressure, heart failure, coronary heart disease, chronic pulmonary obstructive disease (COPD), or heart valve disease
  • Previous smoker

It might go away on its own, or you might need medication or therapy to get it to stop. This form of AF can be treated with medication. If that fails, they can use a low-voltage current to restore the heart's normal rhythm. The procedure is known as electrical cardioversion. Doctors normally perform this operation when you are sedated in a hospital, so you won't feel anything. You can go home once it's finished, but you'll need someone else to drive you.

Long-Standing Persistent Atrial Fibrillation

This indicates that your AF has been there for more than a year and is not going anywhere. Medicine and treatment like electrical cardioversion can not stop the AF. To restore your natural heart rhythm, doctors can use ablation (which involves burning some parts of your heart's electrical system).

Permanent (Chronic) Atrial Fibrillation

This can’t be fixed by treatments. If you have this form, you and your doctor will determine if you need long-term treatment to keep your heart rate under control and reduce your risk of stroke.

Valvular Atrial Fibrillation

People with an artificial heart valve or valve disease such as valvular stenosis (when one of the heart valves stiffens) or regurgitation (when a valve doesn't close properly, allowing some blood to flow in the wrong direction) are affected by this kind. If you have mitral valve disease or artificial heart valves, the chances of developing valvular AF increase.

Nonvalvular Atrial Fibrillation

This is a form of atrial fibrillation that isn't caused by a heart valve problem. Other factors, such as high blood pressure or an overactive thyroid gland, are to blame. The underlying cause is not clear.

You have a higher risk of developing non-valvular AF if you are:

  • Older
  • Suffer from high blood pressure for many years
  • Suffer from heart disease 
  • Consume large amounts of alcohol 
  • Have a family member with AF
  • Have been diagnosed with sleep apnea

Blood can pool in your heart in both valvular and nonvalvular AF, increasing your risk of complications like blood clots and strokes. Medicines and other therapies may help reduce the risk of developing these problems.

The form of drug your doctor will recommend to help lower your chances of getting a stroke depends on whether your AF is valvular or nonvalvular.

Acute Onset Atrial Fibrillation 

This fast, chaotic heartbeat appears and disappears quickly. It normally resolves itself in 24 to 48 hours. Health, cardiovascular disease, alcohol dependence, asthma, and lung disease are all contributing factors.

Postoperative Atrial Fibrillation

This is the most common cardiovascular surgery complication. It increases the risk of heart failure and cerebral infarction, which is a type of brain injury caused by a blood clot preventing blood flow in the brain.

Doctors have many ways to treat atrial fibrillation, no matter which type you have. If you are experiencing symptoms, consult your doctor to determine the best course of action.


Risk Factors

AF affects over 2 million people in the United States. It's more common in people over the age of 60.

It's more likely if you have any of the following heart problems:

  • Heart disease due to high blood pressure 
  • Valvular disease
  • Heart muscle disease (cardiomyopathy)
  • Heart defect from birth (congenital heart defect)
  • Heart failure
  • Previous heart surgery
  • Coronary artery disease

People with certain medical conditions have a higher risk, and at least one out of every ten people with AF has no other heart issues:

  • Long-term lung disease (such as COPD)
  • Overactive thyroid gland
  • Sleep apnea
  • A blood clot in your lung, called a pulmonary embolism 

Adenosine, digitalis, and theophylline are among the medications that can increase the risk of AF.

Frequently, it's connected to:

  • Heavy consumption of alcohol, caffeine, or drugs
  • Viruses and infections
  • Genetics 
  • Imbalance of electrolytes



You may experience the following symptoms if your heart is in AF:

  • Pounding or fluttering heart in your chest (palpitations)
  • Rapid heartbeat
  • Slow heartbeat 
  • Skipping heartbeats
  • Feeling tired or weak
  • Feeling dizzy or lightheaded
  • Pain or pressure in the chest
  • Out of breath – difficulty breathing

If you think you may have AF, speak to your doctor about it and get daily checkups.


When To Seek Help

If your heart doesn't return to normal rhythm within a few minutes, or if your symptoms worsen, call your doctor. If you have any of the following symptoms, which may indicate a heart attack or stroke, dial 999 right away.



The electrical activity in your heart is what your doctor is most interested in seeing. They'll most likely run some tests to figure out what's going on. The following tests are used to diagnose atrial fibrillation:

  • Blood tests to make sure the thyroid, liver, and kidneys are all in good working order.
  • Electrocardiogram (ECG) to record how hard the heart is pounding and the timing of electrical signals that pass through it. Around 12 tiny, sticky sensors will be placed on your chest by a nurse or technician. They are connected by wires to a computer that performs the measurements.
  • Chest X-ray: to make sure lung disease isn’t the root of your problems.
  • Echocardiogram: which creates a video of your heart beating using sound waves.
  • CT scans: X-rays that provide a three-dimensional image of your heart.
  • MRI: which creates snapshots and videos of your heart using magnets and radio waves.
  • Exercise stress test: to see how your heart functions when you're active While wearing sensors connected to an ECG system, you could walk on a treadmill or ride a stationary bike.

In addition, the doctor can use specialised equipment to learn more about your heartbeat, such as:

Holter monitor: Your doctor may recommend that you wear this device for a few days while going about your normal routine. It's like having a handheld ECG that collects data from your heart 24 hours a day, seven days a week. It aids the doctor in detecting arrhythmia symptoms. If your AF symptoms come and go, a different type of monitor might be needed for a longer period of time.



Your doctor can prescribe medicines, surgery, or even a pacemaker to restore and maintain a regular heart rhythm, depending on the severity of your symptoms.


Medications are usually the first line of defence for doctors when it comes to treating atrial fibrillation. Various medications can help you regulate the heart's rhythm, slow it down, and prevent blood clots from causing a stroke.

Your doctor will prescribe medications that will:

  • Reduce the heart rate and the intensity of your contractions (beta-blockers and calcium channel blockers)
  • Bring the heart's rhythm back to normal (sodium and potassium channel blockers) (sodium and potassium channel blockers)
  • Blood clots should be avoided at all costs (“blood thinners," or anticoagulants and antiplatelets)

Medical procedures

If treatment fails, your doctor will likely try one of the following to restore your heart's rhythm:

Electrical cardioversion: They'll place special pads on your chest and shock your heart with electricity. Since you'll be under general anaesthesia, you won't notice anything.

Ablation: A thin tube would be inserted into your heart through a cut in one of your blood vessels. Your doctor will then use a laser, radio waves, or intense cold to burn off the tissue on the surface of your heart that's causing the problem. This results in scar tissue that is unable to transmit off-beat signals. Robotic-assisted surgery, which uses smaller cuts and allows for greater precision, is available at some hospitals. A video camera or a small robot will be implanted in your chest by your doctor. It will guide the formation of scar tissue, which may aid in keeping your heart rate in check.

Maze procedure: Your doctor can do this if you're getting open heart surgery for another cause. It works in a similar way to ablation. On the part of the heart that relays the electrical signals that regulate your pulse, your doctor will create a labyrinth of scar tissue. The scar tissue produced by a maze procedure helps your heart get back on track by stopping the faulty signals that trigger an irregular heartbeat. If any of the following apply to you, your doctor can recommend maze surgery:

  • AF drugs are either ineffective or have significant side effects.
  • You have AF and are undergoing heart surgery for reasons unrelated to AF. The surgery could be performed to treat valve disease or blocked coronary arteries, for example.

Mini maze: The majority of people who have AF do not need open-heart surgery. That’s where this minimally invasive option comes in. You could hear it called Cox maze IV. This procedure is similar to ablation, except the doctor will make three or four small cuts in your side and insert tubes, surgical tools, and a small camera.

Convergent procedure: Catheter ablation is combined with a mini maze in this procedure. A surgeon makes a tiny cut under your breastbone to use radiofrequency energy on the outside of your heart, whereas another doctor uses radiofrequency ablation in the pulmonary vein.

Medical Devices

Pacemaker: Can aid in the prevention of the heart beating too slowly. If you take medication to lower your heart rate, you may need one as a backup. The tiny unit will be implanted under your skin after a minor surgery. It's battery-powered and sends small electrical pulses to your heart if it's beating too slowly.

Healthy Lifestyle: You can also protect your heart by making good decisions in your everyday life.

Eat healthy food: Consume plenty of fresh fruits and vegetables, as well as whole grains and lean protein. Caffeine and alcohol should be avoided.

Quit smoking: It has the potential to double your risk of AF.

Stop drinking: It can increase the chances of developing AF. It may also have an effect on how the blood thinners function.

Exercise: It is beneficial to your health as well as your spirit. It aids in the maintenance of solid muscles, healthy blood circulation, and a healthy weight. It can also assist you in sleeping. Exercisers with atrial fibrillation have less arrhythmia episodes, are less likely to be hospitalised, and have a higher quality of life. So that you don't overdo it, talk to your doctor about the right activities for you.

Check labels: Cold medications and other over-the-counter products may contain ingredients that increase your heart rate.

Lower your stress: Stress will exacerbate the problem by raising your heart rate. Rage, fear, and anxiety are all strong emotions that may have the same impact.

As a result, it's important to look after yourself. Look for something to distract you from your troubles and place you in a good mood. Yoga, music, and time management techniques can help to relieve stress.



AF can lead to serious health issues. Your doctor will prescribe medications to restore your heart's natural rhythm and avoid complications.


Both untreated AF and valve disease increase the risk of blood clots and stroke. The combination of the two factors increases your risk even more.

People with nonvalvular AF are five times more likely to have an ischemic stroke, which is caused by a blockage of blood supply to the brain. The risk is 17 times higher in people with mitral valve stenosis.

When the heart beats normally, the two upper chambers, referred to as atria, squeeze and transfer blood into the two lower chambers, referred to as ventricles. The atria quiver instead of squeezing hard in AF. As a result, only a portion of the blood is pushed into the ventricles.

As a result, blood will pool inside the heart. Clots, or blood clumps, can also grow there. A clot in the atria has the potential to travel to the brain. It can block blood flow and cause a stroke if it gets lodged in an artery.

AF medications restore the heart's natural rhythm, prevent blood clots from developing, and reduce the risk of a stroke. Your doctor will use your CHADS2 score to determine how likely you are to have a stroke and whether you need to take any medications to help avoid one. It's essentially a set of questions in which each letter of the name stands for something that might increase the risk of getting a stroke.

Strokes can also be caused by high blood pressure. As a result, it's even more important to maintain a stable blood pressure level through a nutritious diet, exercise, and, if necessary, medication.



To drive blood out of the heart, AF causes the ventricles to beat faster. The heart muscle will become too sluggish to pump enough blood to your body if it beats too hard for an extended period of time. Cardiomyopathy is the medical term for this condition.

Beta-blockers and calcium channel blockers are AF medications that slow the heart rate. These medications may aid in the prevention of cardiomyopathy.


Heart Failure

AF causes the heart to stop pumping blood as efficiently as it can. After a while, the effort of pumping can cause your heart to become so weak that it is unable to pump as much blood as your body requires. This is referred to as heart failure.

Blood will back up in your lungs' veins, causing fluid to accumulate there. Symptoms such as exhaustion and shortness of breath result as a result of this.

AF may also be caused by heart failure. Electrical impulses regulate the beat of your heart. Healthy heart tissue is needed for those signals to function properly.

Heart failure, on the other hand, can stretch your atria, causing thickening and scarring of heart tissue. These changes disrupt electrical signals, which disrupts the heart's rhythm and can lead to AF.

Manage these four main factors to reduce the risk of developing heart failure:

  • Maintain a healthy blood pressure level.
  • Diet and exercise will help you maintain a healthy weight.
  • Please don't smoke.
  • If you have diabetes, keep your blood sugar under control.



To function properly, the body needs a constant supply of oxygen-rich blood.You'll feel drained if your heart can't pump enough blood. If fluid builds up in your lungs because of heart failure, it may contribute to your fatigue.

Pair your tasks with periods of rest to avoid exhaustion. Make an effort to get better sleep at night. Often, get as much exercise as you can. More energy can be gained through a mix of physical activities such as walking and riding, as well as strength training.

Another explanation you're exhausted is if you have sleep apnea. This disorder, which prevents you from breathing normally while sleeping, may occur in conjunction with AF. If you have it, the doctor will monitor you as you sleep and see if you have it. A CPAP machine, which applies moderate air pressure through a face mask to hold your airways open as you sleep, is one treatment for sleep apnea.


Memory Loss

People with AF performed worse on memory and learning tests in experiments than those who did not have the disorder. People with AF are also more likely to develop dementia.

One potential explanation for the correlation is that AF increases your chances of having a stroke, which can cause brain harm. AF can also affect memory by preventing enough blood from reaching the brain.

Blood thinners such as aspirin and a non vitamin K oral anticoagulant (NOAC) such as dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban can be prescribed by your doctor (Eliquis). Changes in your lifestyle that protect your heart, such as maintaining a healthy weight, can also protect your brain.


High Blood Pressure

There's a fair chance you have elevated blood pressure if you have atrial fibrillation (AF). The two conditions sometimes go together.

When everything's going right, the heart pumps along with a steady rhythm you can keep time to. It gently pumps blood across your body, ensuring that all of your cells receive the oxygen they need.

However, high blood pressure means your blood is pumping faster than normal, pressing through your artery walls. If this continues for an extended period of time, the additional stress creates harm that can lead to a variety of issues.




AF will often go away on its own. However, for many people, it is a long-term problem. Both valvular and nonvalvular AF are progressive, which means that symptoms become more frequent and last longer over time.


You will begin with sporadic, mild AF that, years later, does not seem to go away. And, in terms of your wellbeing, how quickly this occurs – what doctors refer to as “the pace of improvement" – could be more critical than how long your AF episodes last. 

Despite this, studies on AF progression and what to do about it are difficult for researchers because they lack a clear way to calculate progression.


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