Atrial fibrillation

• Paroxysmal: comes and goes with age, with episodes lasting from minutes to days
• Persistent: episodes last continuously for more than seven days and treatment is usually needed to restore the heart’s normal rhythm
• Longstanding: going on for over 12 months and often unaffected by treatment
• Permanent: fibrillation is present all the time, no treatment can restore normal rhythm

If you have AF, you may well also alternate having atrial flutter. With atrial flutter, rather than chaotic electrical impulses in the atria, the rhythm is regular. This less common type of atrial arrhythmia also increases the risk of stroke and heart failure.

Yes, it’s easy to test your own heartbeat by taking your pulse in your neck – just avoid drinking caffeinated beverages beforehand to make sure you're taking a resting heart rate. 

Here’s how to do it:

• Sit down quietly for at least five minutes
• Place the index and middle finger of your right hand on the pulse in your neck 
• Double it to find out your BPM

A normal resting heart rate is between 60 and 100 BPM. If you have atrial fibrillation, your heart will often be beating at over 100 BPM. 

Concerned about your heartrate? Contact your doctor as soon as possible or make an appointment with one of our specialists for diagnostic tests. 

Your consultant may suggest that you take any of a range of medications. The aim of these is to help alleviate your symptoms and reduce your risk of serious complications:

• Flecainide to help maintain a normal heart rhythm
• Beta-blockers such as Bisoprolol to slow your heart rate and help maintain a normal heart rhythm
• Calcium channel blockers such as Verapamil or Diltiazem which can help to reduce your heart rate to below 90 BPM
• Digoxin to help lower your heart rate further 
• Amiodarone to help restore and maintain a normal rhythm
• An anticoagulant to help prevent your blood from clotting causing a stroke, such as Rivaroxaban, Apixaban, Edoxaban, Dabigatran or sometimes Warfarin

Like most medications, some AF treatments can have side effects. 

• Flecainide may make you feel sick and, in rare cases, cause heart rhythm disorders. 
• Beta-blockers can cause tiredness, cold hands and feet, low blood pressure, low mood and impotence.
• Verapamil can cause constipation, low blood pressure and ankle swelling. 
• Amiodarone can cause thyroid derangement, liver function abnormality and lung scarring, so is rarely used for long-term treatment. 
• Anticoagulants can sometimes cause bleeding. 

If you're worried about possible side effects, speak to your cardiologist or GP who can offer personal advice based on your condition and risk profile. 

Yes, there are several types of cardiac ablation, each designed to treat different heart arrhythmia conditions. Your consultant will use imaging technology to accurately locate the affected area in your heart and recommend the procedure best suited to your condition.

• Pulmonary vein isolation: uses hot or cold energy to create tiny scars in the upper left chamber of your heart where the four lung veins (pulmonary veins) connect, blocking irregular electrical signals.
• Atrioventricular node ablation: helps to control your heart rate if you have permanent AF. It uses heat energy to create a tiny scar and block the pathway between the upper and lower chambers of your heart, known as the atrioventricular node. This stops the fast, irregular signals associated with AF. You’ll need to have a permanent pacemaker fitted first.
• Radiofrequency (RF) catheter ablation: a small sheath (a simple tube) is inserted into one of your veins or arteries, usually in your groin, to create an opening. Electrode catheters – thin, wired tubes – are inserted through the sheath and guided up to the heart using X-rays taken beforehand. Radiofrequency will deliver hot energy through the catheter and into the areas of your heart that are causing irregular rhythms, destroying the abnormal heart tissue and blocking these rhythms.
• Cryoablation: any diseased tissue or abnormal cells are frozen and destroyed by an intensely cold gas applied using a needle-like applicator, called a cryoprobe. The entire procedure usually takes a few hours and you'll likely be able to go home on the same day.
• Pulsed Field Ablation (PFA): while traditional heart ablation methods rely on thermal technologies, pulsed ablation doesn't require heat energy, which can damage and destroy surrounding healthy tissue. Instead, high-voltage electrical fields are used to more precisely target and destroy any affected heart cells causing the arrhythmia while preserving healthy tissue.
• Surgical AF ablation - including Surgical MAZE: sometimes offered when you also need surgery to another part of your heart, such as a heart valve, or when your atria are large. Known as a convergent hybrid ablation procedure, it can be performed as minimally invasive surgery. A surgical MAZE procedure creates multiple scars using heat, freezing or a scalpel to electrically break up the upper chambers of your heart and stop atrial fibrillation.