Atrial fibrillation is the most common heart rhythm abnormality in adults worldwide,1 affecting over nine million people in the European Union and the United States alone.2^,3 It is a problem that causes the heart to beat too fast, too slow or with an irregular rhythm.4

Atrial fibrillation happens when electrical signals misfire and cause the upper chambers of the heart (the atria) to contract in a fast and irregular manner. This causes blood to pool in these chambers, as the irregular beats do not pump all of the blood into the heart's lower chambers (the ventricles), which prevents the heart from pumping effectively.4^,5

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Many people with atrial fibrillation have no symptoms, particularly when their heart rate is not very fast.  However, common symptoms include palpitations, dizziness, chest pains and breathlessness. Although some people with atrial fibrillation can suffer from it on a regular basis, they do not, or only rarely, experience symptoms.4^,5

It is very important that atrial fibrillation is diagnosed as soon as possible by your doctor or nurse as the condition can cause stroke.

The SPEAK about AF Survey (Stroke Prevention, Education, Awareness and Knowledge), the largest and most extensive ever conducted in people diagnosed with atrial fibrillation and the physicians who treat the condition, revealed that more education is needed about the link between atrial fibrillation and stroke.  Over 3,700 people globally were surveyed including people with atrial fibrillation, cardiologists, neurologists and general practitioners.

The survey found that the majority of physicians and more than half of people with atrial fibrillation stated that the condition has a negative impact on quality of life. Key findings from the survey suggested that whilst healthcare professionals are aware of the link between atrial fibrillation and stroke, not all people with the condition fully realised they were at risk.

Both people with atrial fibrillation and physicians agreed that there was a need for more information about the risk of atrial fibrillation-related stroke, with some people stating that they felt more informed and confident as they learnt more about their condition over time.

To help raise awareness of the link between atrial fibrillation and stroke vote now for your favourite 1 Mission 1 Million project

The risk of atrial fibrillation increases as you get older. It affects 1% of adults worldwide. One in four people aged 55 will develop the condition.1^,2 Atrial fibrillation is more common in people who have heart disease or heart-related conditions like heart failure. It is very uncommon in children.3^,4

Whilst some cases of atrial fibrillation have no known cause, conditions and lifestyle factors known to trigger atrial fibrillation are:3^,4

• High blood pressure
• Being obese or overweight
• Diabetes
• Having an overactive thyroid gland
• Lung cancer
• Drinking too much alcohol or binge drinking

Strokes happen in atrial fibrillation when pools of blood form in the heart because of the upper chambers of the heart (the atria) not contracting properly. Blood sticks together in the atria and forms clots which can travel through the bloodstream and block blood flow to the brain, causing a stroke.1^,2

A stroke is the brain equivalent of a heart attack. Blood must flow to and through the brain for it to work properly. If this flow is blocked by a blood clot, the brain loses its energy and oxygen supply, causing brain damage that can lead to disability or death.3

Atrial fibrillation is one of the most important risk factors for stroke.3 People with atrial fibrillation are five times more likely to have a stroke than someone without the condition4 and up to three million people have a stroke related to atrial fibrillation each year.3^,5^,6

Atrial fibrillation often has a negative impact on people's lives, reducing their physical and mental wellbeing. Often, people diagnosed with the condition feel anxious or scared and, for many, symptoms become worse with time which can severely affect their ability to carry out simple daily tasks. According to the SPEAK about AF Survey, over half of people with atrial fibrillation agreed (64%) that they have become less active since being diagnosed. Their ability to participate in physical activities (51%) or undertake other physical activities such as regular household chores (26%) or travel (22%) are some of the areas mostly affected. Consequently, people can suffer from feelings of depression, denial and anger at the injustice of their 'normal' life being taken from them.

Atrial fibrillation is a very unpredictable disease. People are often reluctant to travel and may avoid social engagements altogether, fearing they may experience atrial fibrillation symptoms.  Frequent hospital visits cause additional disruption and distress to sufferers and their families' lives.

Many people do not understand atrial fibrillation, as symptoms are not visible to the outside world. As a consequence, employers, family members, friends and even physicians may be unaware of the impact that atrial fibrillation has on people's ability to function normally. In turn, they may seem unconcerned and unsupportive.  As a result, people with atrial fibrillation often worry that others will accuse them of exaggerating their symptoms.

For those people who are aware that atrial fibrillation can lead to stroke, the risk is an ever present threat. Many people with atrial fibrillation live with a constant fear about what the future might hold, worrying not only about their personal fate but even more about becoming a burden on their families should they have a stroke.

Hear one person's experiences of living with atrial fibrillation by clicking on the video below.

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1. Miyasaka Y et al. Circulation 2006;114:119-25
2. Fuster V et al. Circulation 2006;114:e257-354
3. Friberg J et al. Epidemiology 2003;14:666-72
4. Ringborg A et al. Europace 2008;10:403-11
5. Coyne KS et al. Value Health 2006;9:348-56

Managing atrial fibrillation focuses on reducing the risk of stroke through "blood thinning" or antithrombotic medication and, secondly, by trying to restore a normal heart rate or rhythm.

Antithrombotic treatment

People with atrial fibrillation at risk of stroke are usually asked to take medication to thin the blood to reduce the chance of blood clots forming. This is called antithrombotic treatment and comprises antiplatelet and anticoagulant medications.  Anticoagulant therapy is indicated for patients at moderate to high risk of stroke. Vitamin K antagonists (VKAs) such as warfarin are commonly used as anticoagulant medication.

VKAs are very effective with long-term use, preventing two out of three strokes in patients with atrial fibrillation.1 However, VKAs can be a difficult medication for people to take as it can interact with other common medications and certain types of food. Patients treated with VKAs need to be monitored carefully by their doctor who must carry out frequent lifelong blood tests and make adjustments to the dose to ensure treatment remains effective.

People with atrial fibrillation at low risk of stroke or who cannot tolerate warfarin are usually given the antiplatelet agent aspirin, which is not as effective as warfarin for stroke prevention.

Rate control treatment

Some patients with atrial fibrillation who have a fast heart rate are given medication to help bring their heart rate back to normal.  This usually improves symptoms such as dizziness.  This type of treatment is called rate control.

Rhythm control treatment

To selected patients the doctor may offer a method called electrical cardioversion that gives the heart an electric shock to bring the rhythm of the heart back to normal.  Restoration of the sinus rhythm can also be induced by pharmacological methods of cardioversion. This is called rhythm control treatment.