Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest
Weakness
Reduced ability to exercise
Fatigue
Lightheadedness
Dizziness
Shortness of breath
Chest pain

Atrial fibrillation may be:

Occasional.
Persistent.
Long-standing persistent.
Permanent.
Fast AF
Slow AF

Possible causes of atrial fibrillation

High blood pressure
Heart attack
Coronary artery disease
Abnormal heart valves
Heart defects you’re born with (congenital)
An overactive thyroid gland or other metabolic imbalance
Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
Sick sinus syndrome — improper functioning of the heart’s natural pacemaker
Lung diseases
Previous heart surgery
Viral infections
Stress due to surgery, pneumonia, or other illnesses
Sleep apnea

Risk factors

Age. The older you are, the greater your risk of developing atrial fibrillation.
Heart disease. Anyone with heart disease — such as heart valve problems, congenital heart disease, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery — has an increased risk of atrial fibrillation.
High blood pressure.
Other chronic conditions. such as thyroid problems, sleep apnea, metabolic syndrome, diabetes, chronic kidney disease or lung disease
Alcohol Xs. Binge drinking may put you at an even higher risk.
Obesity
Family history

Complications

Sometimes atrial fibrillation can lead to the following complications:

Stroke.
Heart failure.

Investigations

Electrocardiogram
Holter monitor.
Echocardiogram.
Blood tests (FBE, U&E, TSH, Calcium, Magnesium)
Chest X-ray.

Management

Rate control

Metoprolol

Bisoprolol

Atenolol

Digoxin

Verapamil

AV node ablation

Permanent pacemaker

Rhythm control

Flecainide

Sotalol

Amiodarone

Electrical cardioversion

Catheter ablation

Anticoagulation

The NHFA’s AF guidelines have simplified estimating stroke risk by removing female sex from the risk calculator, leaving CHA₂DS₂-VA (Congestive heart failure, Hypertension, Age >75 years [2 points], Diabetes, Stroke/transient ischaemic attack [2 points/1 point respectively], Vascular disease, Age >65 years).⁹ This has resulted in the following recommendations for both sexes:

CHA₂DS₂-VA = 0: Oral anticoagulants (OACs) are not recommended
CHA₂DS₂-VA = 1: OACs should be considered
CHA₂DS₂-VA = 2: OACs are recommended.

Examples

Warfarin

Apixaban

Pradaxa

Xarelto