Atrial Fibrillation: What It Is, Causes, Symptoms, Treatment & Types

What is Atrial Fibrillation?

Atrial fibrillation, also called AF or AFib, is a heart rhythm disorder in which the upper chambers of the heart, known as the atria, beat irregularly fast. In this condition, the atria do not contract in a coordinated way, affecting the blood supply from the upper chambers to the lower chambers of the heart. This irregular blood flow can sometimes lead to blood clots forming inside the heart.

If a clot travels to the brain, it can cause a stroke. Concurrent medical conditions often associated with atrial fibrillation include hypertension, heart failure, coronary artery disease, diabetes and thyroid disease.

Atrial fibrillation may occur occasionally, persist for longer periods, or become a long-term condition that requires regular monitoring and treatment.

What are the Types of Atrial Fibrillation?

Atrial fibrillation is classified into types based on how long the episodes last and their response to treatment. It is also divided based on its cause and trigger. The various types of atrial fibrillation include:

Based on Duration and Treatment Response:

Based on Underlying Cause or Trigger:

How Common is Atrial Fibrillation in India?

Atrial fibrillation is a growing public health challenge in India. A 2024 study in the Indian Heart Journal checked heart monitors worn by hospital patients for 24 hours and found atrial fibrillation in 17.4% of them. The real number is likely to be even higher, as most atrial fibrillation episodes are short and easy to miss during a quick doctor's visit. This burden will keep growing.

People in India are living longer. At the same time, health conditions like diabetes, high blood pressure, and obesity are on the rise. Together, these factors make atrial fibrillation a major concern for the future.

What are the Symptoms of Atrial Fibrillation?

Symptoms of atrial fibrillation are often difficult to detect in its early stages. They usually develop or aggravate as the disease progresses. Sometimes, this heart condition can go undetected until the person undergoes a test like an ECG or has a stroke.

Common early warning signs and advanced-stage symptoms are listed below:

What are the Causes and Risk Factors of Atrial Fibrillation?

Atrial fibrillation does not usually occur due to a single cause. It is a multifactorial disorder that may occur due to various cardiac and non-cardiac conditions and lifestyle factors. These include:

Stages of Atrial Fibrillation

Atrial Fibrillation can get worse over time, moving from early heart changes to a long-term condition. However, managing your health risks at any stage can slow, stop, or even reduce the severity of the disease.

The stages of atrial fibrillation are given in the table below:

Diseases Similar to Atrial Fibrillation

It is easy to confuse atrial fibrillation with other rapid heart rhythms like atrial flutter or supraventricular tachycardia (SVT). They share a lot of the same warning signs. However, each condition has its own trigger, pattern, and level of risk.

The comparison given below can help differentiate these three conditions:

Atrial Fibrillation Vs. Atrial Flutter Vs. Supraventricular Tachycardia (SVT)

What are the Complications of Atrial Fibrillation?

If atrial fibrillation is left untreated, it can lead to serious and sometimes fatal complications, such as:

• Stroke: Irregular heart rhythm can allow blood clots to form in the heart, which may travel to the brain and cause a stroke.

• Heart Failure: Atrial fibrillation can cause the heart to pump less efficiently, which may weaken it over time.

• Cognitive Impairment and Dementia: If you have atrial fibrillation, you are at risk of memory loss, vascular dementia, and impaired cognitive function.

• Clots: Poor blood flow inside the heart can increase the risk of clot formation.

• Cardiomyopathy: Prolonged fast or uncontrolled heart rate can weaken the heart muscle.

• Low Quality of Life: The chronic atrial fibrillation may limit one's activity level as a result of fatigue, shortness of breath, palpitations, and anxiety attacks following each episode.

• Worsening Chest Pain: People with existing heart disease may experience increased chest discomfort or angina.

Atrial Fibrillation During Pregnancy

Having atrial fibrillation during pregnancy puts extra strain on a mother's heart. When the heart works overtime, it can cut down vital blood flow to the baby and cause complications. Doctors assess safety using factors such as current symptoms, overall heart health, and trimester stage. Safe heart medications or blood thinners may be prescribed to keep both safe.

When Should I See My Healthcare Provider?

It is important to seek medical care quickly if you have the following:

• An abnormally rapid, irregular, or fluttery heart rate that persists for longer than several minutes.

• Sudden shortness of breath that occurs for no obvious reason.

• Discomfort, pressure, or chest pain that does not go away.

• Episodes of dizziness or fainting for no apparent reason.

• Extreme fatigue makes everyday activities impossible.

• Numbness or weakness in the face, arm, or leg (possible signs of stroke; seek emergency care immediately).

• Your symptoms do not improve after treatment is initiated, or you experience side effects from medications that you did not previously experience.

How is Atrial Fibrillation Diagnosed?

Several tests are involved in diagnosing atrial fibrillation. Doctors use the following tests to determine the type of AF, if present, and, consequently, the treatment approach:

Diagnostic Overview Table

How is Atrial Fibrillation Managed?

Atrial fibrillation is managed by controlling the heart rhythm or heart rate, reducing the risk of stroke, and treating any underlying cause. The treatment plan depends on the person's symptoms, age, heart health, stroke risk, and other medical conditions.

Here is how you can manage atrial fibrillation:

• Rate Control: Medicines may be used to slow the heart rate and reduce symptoms such as palpitations, breathlessness, and tiredness.

• Rhythm Control: You may need medicines or procedures to restore and maintain a normal heart rhythm.

• Blood Thinners: Anticoagulant medicines may be prescribed to reduce the risk of blood clots and stroke.

• Cardioversion: A controlled electric shock or medicine may be used to restore normal rhythm.

• Catheter Ablation: This procedure may be considered when medicines do not work well or when symptoms do not subside.

• Treatment of Underlying Causes: Managing high blood pressure, thyroid disease, sleep apnea, diabetes, obesity, or heart valve disease can help control atrial fibrillation.

• Lifestyle Changes: Limiting alcohol intake, quitting smoking, maintaining a healthy weight, managing stress, and staying physically active can support heart health.

• Regular Follow-Up: Ongoing monitoring is important to check heart rhythm, medication response, side effects, and stroke risk.

Common Medicines Used to Treat Atrial Fibrillation

Medicines for atrial fibrillation are used to control heart rate, maintain normal rhythm, and reduce the risk of blood clots and stroke. The choice of medicine depends on the type of atrial fibrillation, its symptoms, the patient's age, heart health, stroke risk, kidney function and other medical conditions.

Commonly prescribed medicines for atrial fibrillation include:

• Metoprolol, Bisoprolol, Atenolol, and Carvedilol: These beta-blockers help slow the heart rate and reduce symptoms such as palpitations and breathlessness.

• Diltiazem and Verapamil: These calcium channel blockers may be used to control heart rate.

• Digoxin: This medicine may help control heart rate, especially if you have a risk of heart failure or reduced physical activity.

• Amiodarone, Flecainide, Propafenone, and Sotalol: These antiarrhythmic medicines may be used to restore or maintain a normal heart rhythm.

• Warfarin, Apixaban, Rivaroxaban, Dabigatran, and Edoxaban: These blood thinners may be prescribed to reduce the risk of blood clots and stroke.

Note: Atrial fibrillation medicines should be taken only under medical supervision. Blood thinners can increase bleeding risk and some rhythm-control medicines need regular monitoring for side effects. Medicines should be taken per the prescription of a qualified healthcare professional.

Living with Atrial Fibrillation: Daily Challenges and Caregiving

Living with atrial fibrillation can affect energy levels, daily activities, emotional well-being, and long-term cardiovascular health. With regular treatment, lifestyle changes, and follow-up care, you can manage symptoms and reduce the risk of complications such as stroke.

Hereis how living with atrial fibrillation can affect your daily life:

What is the Prognosis for Atrial Fibrillation?

The prognosis for atrial fibrillation varies depending on the person's age, overall heart health, underlying conditions, and how well the heart rhythm is controlled. Atrial fibrillation is usually a long-term condition, but with timely diagnosis, regular monitoring, medicines, lifestyle changes and procedures when needed, you can manage symptoms and live an active life. However, untreated or poorly controlled atrial fibrillation can increase the risk of stroke, heart failure and reduced quality of life, so ongoing care and follow-up are important.

How Can I Prevent Atrial Fibrillation?

Atrial fibrillation cannot always be prevented, especially when it is linked to ageing, existing heart disease or structural heart problems. However, you can reduce the risk by maintaining good heart health and controlling the following known risk factors:

• Blood Pressure Control: Keeping high blood pressure under control can reduce strain on the heart.

• Healthy Weight Management: Maintaining a healthy weight lowers stress on the heart and may reduce atrial fibrillation risk.

• Regular Physical Activity: Moderate exercise supports heart health and helps control blood pressure, diabetes and body weight.

• Diabetes Management: Good blood sugar control can reduce damage to the heart and blood vessels.

• Alcohol Limitation: Reducing alcohol intake, especially binge drinking, may help lower the risk of atrial fibrillation episodes.

• Smoking Cessation: Avoiding tobacco helps protect the heart and blood vessels.

• Sleep Apnea Treatment: Treating snoring, poor sleep or sleep apnoea can reduce stress on the heart.

• Stress Management: Relaxation techniques, quality sleep, and mental health support may help reduce atrial fibrillation triggers.

• Regular Heart Check-Ups: People with heart disease, thyroid problems, or a family history of atrial fibrillation should have routine medical follow-up.

Atrial Fibrillation Treatment Cost in India

The cost of atrial fibrillation treatment in India depends on the type and severity of the condition, the city of treatment and whether procedures like cardioversion or catheter ablation are required. The overall annual treatment cost can vary, from routine medication and follow-ups to major interventional procedures.

Here is an overview of approximate costs for atrial fibrillation:

Note: Costs for catheter ablation and hospitalisation can vary significantly based on the hospital tier (government vs private), the city, and the complexity of the case. Patients who require long-term anticoagulation, multiple procedures, or ICU admission due to stroke or heart failure complications will face considerably higher overall expenses.

Does Health Insurance Cover Atrial Fibrillation?

Yes, most health insurance policies in India cover atrial fibrillation and its complications. Coverage includes in-patient hospitalisation for cardioversion/catheter ablation, surgeries and day care procedures. Diagnostic tests like ECG, Holter monitoring, echocardiogram and blood tests, doctor consultations and medications can be covered with OPD cover. Some plans may also offer annual health check-ups. However, coverage can vary across insurers and plans and so read the policy details carefully.

If atrial fibrillation has already been diagnosed at the time of purchasing the policy, a pre-existing disease waiting period of up to 3 years may apply, depending on the plan, before any claim can be made.

You may also get a critical illness insurance plan to cover the atrial fibrillation-linked conditions, such as heart attack, stroke, or heart failure. This plan provides a lump-sum payout that can be used to pay for the treatment of atrial fibrillation or act as a substitute for loss of income. However, this plan comes with a waiting period of up to 90 days and up to 30 days of a survival period.

How Much Health Insurance Coverage is Needed for Atrial Fibrillation Treatment?

The right health insurance coverage depends on the severity of the illness, the type of treatment, and the city where treatment is administered. The treatment for atrial fibrillation may include long-term medication, regular consultations with a cardiologist, catheter ablation, etc.

Health insurance coverage of at least ₹10 to ₹15 lakh should be considered, which can cover basic hospitalisation, tests, cardioversion, and short-term medication. However, elderly patients with recurrent episodes or co-morbidities like heart failure, stroke, or hypertension should go for higher coverage of ₹20 to ₹25 lakh, as the cost of hospitalisation and associated treatments may increase significantly.

Make sure to compare various health plans carefully to choose the one that best suits your needs.