Atrial Fibrillation and Its Role in Stroke

Atrial fibrillation is the most common heart rhythm disturbance in the UK, affecting more than one million people. Although manageable, the condition can lead to deadly stroke without appropriate treatment

In the UK, around 1.2 million people have atrial fibrillation (AF), a term used to describe an irregular and abnormally quick heartbeat. The heart condition has been shown to significantly increase the risk of stroke. AF happens when electrical pulses within the heart fire randomly from the atria (upper chambers of the heart), causing it to twitch. This erratic heart rhythm reduces the efficacy of the   heart and, in severe cases, can lead to heart failure.

A normal, regular heart rate should pump between 60 and 100 beats per minute at resting. The heartbeat in those with AF, however, can be considerably quicker, sometimes exceeding 100 beats per minute. Typical symptoms of AF include feelings of dizziness, shortness of breath, fatigue and chest pains. One of the key symptoms of AF to watch out for is heart palpitations. Those who experience palpitations report feeling their heart pounding in their chest or experience a fluttering sensation; an episode may last anywhere between a few seconds to minutes.

Diagnosing AF

It’s important to keep in mind that in certain instances, the condition may not present with any symptoms whatsoever. In some cases, AF is only identified during a routine check-up with a doctor. A quick, painless procedure called an electrocardiogram—or ECG—is sometimes used to diagnose AF. This test records the rhythm and electrical activity of the heart to give doctors a clear picture of a patient’s overall heart health. A patient may also be offered an echocardiogram to produce an image of their heart’s structure and to see how it is working. Commonly, doctors will take a blood sample to test for the condition.

What causes AF?

While it is not entirely clear what causes AF, medical experts recognise that the condition is more common in elderly people and those with other pre-existing heart conditions such as atherosclerosis, congenital heart disease, pericarditis and hypertension (high blood pressure). There are also various other medical conditions that can be attributed to AF, including diabetes, asthma, an overactive thyroid gland, lung cancer and pulmonary embolisms. In some cases, an AF diagnosis is not associated with any other medical condition, which can be confusing for patients. This may occur in athletes, for example, and is called ‘lone atrial fibrillation’. According to the NHS, lifestyle choices such as excessive alcohol consumption, obesity and smoking are among the highest risk factors for developing AF.

How does AF cause stroke?

Stroke, commonly referred to as a ‘brain attack’, occurs when the blood supply to the brain is cut off. AF can cause blood clots to form in the heart chambers. If a blood clot travels to the brain through the bloodstream, it can block essential blood flow to the brain and ultimately result in a stroke. According to the British Heart Foundation, the risk of stroke is increased by a huge four to five times in those with AF than those without the condition.

What treatment is available?

With appropriate treatment, the risk of stroke in those with AF can be significantly reduced. To this end, doctors will typically prescribe anticoagulant (blood-thinning) drugs such as warfarin and NOACs to patients with the condition to reduce the risk of blood clots. Some patients may be prescribed with anti-arrhythmic medication to help restore a normal heart rhythm. These include beta-blockers like bisoprolol and sotalol, flecainide and amiodarone. If a patient doesn’t respond well to the prescribed medications, a catheter ablation will be offered. This minimally invasive procedure involves inserting a flexible, thin tube into the blood vessels that lead to the heart to ablate (terminate) the abnormal electrical pathways in the heart tissue that cause AF.

Reducing the risk of stroke

Beyond prescription medications, there are measures patients with AF can take at home to reduce their risk of stroke. Cardiovascular specialists advise quitting smoking, avoiding heavy consumption of alcohol, eating a healthy, balanced diet and taking regular exercise (current government guidelines state that individuals get 150 minutes of moderate-intensity exercise per week). Quit smoking today with advice from NHS Choices and speak with your doctor before radically overhauling an unhealthy lifestyle. It is also vital to schedule regular check-ups with your doctor to monitor blood pressure and cholesterol levels—conditions known to significantly increase the risk of stroke.

Check your heartbeat

Regularly check your heartbeat to keep an eye on any rhythm irregularities:

  • Sit and rest for 5 minutes. Do not smoke or drink during this time
  • Hold out your left hand, palm facing upwards, elbow slightly bent
  • Place the index and middle fingers of your right hand firmly on the left wrist at the base of the thumb
  • Count the number of beats you feel for 60 seconds using second hand on a clock. A normal heart rate during rest should be between 60 and 100 beats per minute

Heart palpitations: when should I worry?

Heart palpitations—or heartbeats that suddenly become more noticeable—may seem alarming. They can be caused by a wide range of factors including hormone changes, lack of sleep, strenuous exercise, heart conditions, smoking, alcohol, illegal drugs, stress, anxiety, excitement and nervousness. Even though they are usually harmless, heart palpitations can also be caused by or associated with underlying conditions. These include congenital heart disease, heart failure, AF, supraventricular tachycardia, anaemia, diabetes and heart failure. As some of these conditions can be serious, individuals should visit their doctor if they experience frequent heart palpitations that last a long time or have a history of heart problems.

Examining the heart

Everyday technology is developing at an incredible rate, and this includes medical technology. A huge drive by the NHS towards prevention of disease rather than just cure will help free resources and reduce waiting times. One approach is to engage patients in playing a greater part in their healthcare and new devices that use smartphones and apps are helping to achieve this. If a doctor needs to examine your heart, they typically perform an electrocardiogram or ECG. Until recently, this was performed using a machine with adhesive electrodes and wires or ‘leads’ printing various traces onto graph paper. Today, simple, low cost devices can be clipped to your smartphone allowing you to take a quality ECG anytime, anywhere. Results can then be emailed to your doctor. Thus, time to reach diagnosis and treatment are significantly reduced. Undoubtedly, patients will experience a step-change in healthcare over the coming years.


people in the UK suffer with atrial fibrillation-related strokes every year—that’s 1 person every 18 minutes


This article was originally published in Live to 100 with Dr Hilary Jones. Read the digital edition, here. 

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