Atrial fibrillation (AF) is an abnormal heart rhythm (arrhythmia) characterised by rapid and irregular beating. This is caused by unusual electrical activity in the upper chambers (atria) of the heart which causes the lower chambers (ventricles) to beat quickly and irregularly. It is the most common heart rhythm problem and can occur in patients of any age though it is more commonly seen in older patients.
AF is not immediately life-threatening but may result in heart failure in acute and chronic settings. AF also predisposes a patient to blood clot formation in the atria, particularly the left atrial appendage. In an event of clot embolisation from the heart to the brain, a stroke occurs.
Paroxysmal atrial fibrillation (occasional): The AF comes and goes spontaneously, and usually last for a few minutes to hours. Patients may feel intermittent palpitations with this.
Persistent: The AF might last for more than seven days and require treatment with medication to restore a normal heart rhythm.
Long-standing persistent: The AF occurs often for a period of more than a year.
Permanent: AF is continuously occurring and the patient accepts that this will be long-term.
If atrial fibrillation (AF) is left untreated, it can lead to life-threatening complications like strokes or heart failure.
Atrial fibrillation increases the risk of stroke by five times.
Managing high blood pressure (hypertension): Taking medication and making lifestyle changes to manage hypertension reduces the risk of AF.
Exercising regularly: Moderate-intensity exercise lowers blood pressure and reduces the risk of coronary artery disease that could lead to development AF.
Eating a heart healthy diet: Eat more whole grains, vegetables and fruits and cut down on salt and solid fats. This reduces one’s risk of medical conditions such as coronary artery disease which are associated with higher risks of experiencing AF.
Reduce the risk of many health conditions associated with atrial fibrillation by eating a heart healthy diet
Maintaining a healthy weight: One should aim to maintain a healthy Body Mass Index (BMI) under 27 kg/m2. This will help to reduce the effects or complications associated with AF.
Smoking cessation: Quitting smoking reduces the risks of AF.
Managing stress: This reduces one’s risk of experiencing an abnormal heart rhythm like AF.
Reducing alcohol or caffeine consumption: Drinking too much caffeine or alcohol, especially binge drinking, can trigger incidences of AF.
The exact cause of atrial fibrillation (AF) remains unknown.
Existing heart conditions: Those who suffer from heart diseases (such as coronary artery disease or heart valve disease), heart failure or have a history of heart attack, have increased risks of AF.
Chronic conditions: Those with chronic conditions such as sleep apnoea, diabetes mellitus or lung problems have a higher risk of AF.
High blood pressure (hypertension): High blood pressure increases the risk of AF.
Overactive thyroid gland (hyperthyroidism): Some patients who suffer from thyroid diseases may experience abnormal heart rhythms (arrhythmias) including AF.
Obesity: Those who are obese are more likely to suffer from AF.
Excessive alcohol or caffeine consumption: Binge drinking alcohol or consuming to much caffeine can lead to incidences of AF.
Smoking: Smoking can increase the risk of AF.
Genetics: Those with a family history of AF are more likely to suffer from the condition.
Age: Anyone below the age of 50 years old has a 0.1% chance of suffering from AF but this risk increases to 10% for those above the age of 80 years old.
Checking pulse: This is a simple test that can help with the detection of AF and can be done by the doctor as part of a physical examination or by yourself. If you are checking your own pulse, make sure you do not smoke or consume caffeine before taking the measurement.
Electrocardiogram (ECG): This is the main diagnostic test for AF. It measures your heart rhythm and electrical activity, which shows if the heart is beating too quickly. If you have AF, the ECG should show absent P waves and rapid disorganised electrical activity.
Holter: A Holter monitor is a portable ECG recorder which measures your heart rhythm for 24 to 48 hours. This is used because a typical ECG is rather short and may not be able to capture a moment of AF.
Blood tests: Help check for possible conditions that might lead to AF.
Echocardiogram: An ultrasound of the heart allows doctors to look at the functions and structures of the heart and valves to detect any structural abnormalities.
Medications: Medical therapy with drugs can be given to slow down the heart rate or convert AF back to the normal sinus rhythm.
Procedures
Electrical cardioversion: An electric shock will be delivered to the heart to convert an irregular or rapid heart rhythm (arrhythmia) back to a normal heart rhythm.
Catheter ablation: A thin tube called an electrode catheter is used to conduct an electrophysiology study (EPS) which locates the site causing the abnormal heart rhythm. A radiofrequency energy is then delivered to ablate (or destroy) areas of abnormal electrical activity.
Stroke prevention is achieved by anticoagulation with strong blood thinning agents. There are two types of anti-clotting medications in Singapore: Warfarin and Direct-acting Oral Anti-Coagulants (DOACs). Both medications effectively reduce the risk of stroke though they might slightly increase the risk of both external and internal bleeding. Patients taking Warfarin will need to go for regular blood tests to ensure that they are taking an appropriate dose that is unique to them.
Alternatively, treatment for the heart’s left atrial appendage is also available in the form of the WATCHMAN® left atrial appendage device, which is a permanent implant designed to keep harmful sized blood clots from entering your blood stream. This is typically recommended in patients who have had significant bleeding issues with anticoagulation.
Your doctor will assess and evaluate the extent of your condition, before recommending the most suitable treatment. Some factors that will be considered include:
理解心房颤动 / Understanding Atrial Fibrillation (Chinese version)
Memahami Fibrilasi Atrium Bersama / Understanding Atrial Fibrillation (Malay version)
American Heart Association. (n.d.). What is atrial fibrillation (AFib or AF)? Retrieved February 11, 2025, from https://www.heart.org/en/health-topics/atrial-fibrillation/what-is-atrial-fibrillation-afib-or-af
Centers for Disease Control and Prevention. (n.d.). Atrial fibrillation. Retrieved February 11, 2025, from https://www.cdc.gov/heart-disease/about/atrial-fibrillation.html
UpBeat. (n.d.). Atrial fibrillation (AFib). Retrieved February 11, 2025, from https://upbeat.org/heart-rhythm-disorders/atrial-fibrillation-afib
Subscribe to our mailing list to get the updates to your email inbox...
