Atrial Fibrillation (AF)
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder, affecting over 1.4 million people in the UK. It causes an irregular and often rapid heartbeat, and increases the risk of stroke by up to five times.
Dr Matthew Balerdi provides comprehensive AF assessment in Hull, Grimsby and Scunthorpe including ECG, ambulatory monitoring, echocardiography, and personalised stroke risk and treatment planning.
What is Atrial Fibrillation?
In atrial fibrillation, the heart's upper chambers (atria) fire chaotic electrical signals instead of contracting in a coordinated way. This causes an irregular and often rapid heartbeat, which can reduce the heart's efficiency and allow blood to pool and form clots.
AF is classified into four types based on its pattern and duration:
Paroxysmal AF
Episodes that start and stop on their own, usually within 48 hours
Persistent AF
Lasts longer than 7 days and usually requires treatment to restore normal rhythm
Long-standing Persistent AF
Continuous AF lasting more than 12 months where rhythm control is still being pursued
Permanent AF
AF accepted by the patient and clinician; rhythm control is no longer pursued
Key Facts About AF
Affects over 1.4 million people in the UK
Increases risk of stroke by up to 5 times
Up to a third of patients have no symptoms
Stroke risk reduced by over 60% with anticoagulation
Reference:
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
Symptoms of AF
AF can present with a wide range of symptoms, though some patients may have none at all.
Common Symptoms
- Palpitations — a noticeable irregular or racing heartbeat
- Breathlessness, especially on exertion
- Fatigue and reduced exercise tolerance
- Dizziness or lightheadedness
- Chest discomfort or tightness
- Fainting or near-fainting episodes
Important: The absence of symptoms does not mean AF is harmless. Silent AF carries the same stroke risk as symptomatic AF and still requires assessment and treatment.
Causes and Risk Factors
AF can result from a combination of medical conditions and lifestyle factors. Identifying and managing these can help reduce the burden of AF.
Medical Risk Factors
- Increasing age (particularly over 65)
- High blood pressure (hypertension)
- Heart failure
- Heart valve disease
- Obesity
- Obstructive sleep apnoea
- Diabetes mellitus
- Thyroid disease (especially hyperthyroidism)
- Chronic kidney disease
Lifestyle Triggers
- Alcohol consumption (even moderate amounts)
- Caffeine in excess
- Intense or prolonged endurance exercise
- Cold water immersion
- Psychological stress
- Stimulant drugs (recreational or otherwise)
- Sleep deprivation
How AF is Diagnosed
Diagnosis requires capturing the arrhythmia on an ECG. Further investigations help identify the underlying cause and guide treatment.
ECG & History
A 12-lead ECG is the gold standard. AF shows absent P waves and an irregularly irregular QRS rhythm. A detailed history helps clarify the pattern, triggers, and impact on daily life.
Heart Rhythm Monitoring
For intermittent symptoms, prolonged monitoring is essential. Options include 24-hour Holter, Zio XT patch (up to 14 days), KardiaMobile, and implantable loop recorders for cryptogenic cases.
Echo & Blood Tests
An echocardiogram is essential for all new AF to assess heart structure and function. Blood tests include thyroid function, FBC, renal function, and lipids. The CHA2DS2-VASc score determines stroke risk and guides anticoagulation.
Treatment Options
AF management has three pillars: preventing stroke, controlling the heart rate, and restoring normal rhythm where appropriate.
Stroke Prevention
Anticoagulation is the single most important intervention for most patients with AF. Direct oral anticoagulants (DOACs) are first-line:
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Edoxaban (Lixiana)
- Dabigatran (Pradaxa)
Warfarin remains appropriate for patients with mechanical heart valves or moderate-severe mitral stenosis.
Rate Control
Rate control aims to slow the ventricular response to a comfortable level. Target resting heart rate is typically 60-90 bpm.
- Beta-blockers (bisoprolol, atenolol)
- Calcium channel blockers (diltiazem, verapamil)
- Digoxin (particularly in heart failure)
Rate control is often sufficient for patients with minimal symptoms.
Rhythm Control
Rhythm control aims to restore and maintain normal sinus rhythm. The ESC 2023 guidelines support early rhythm control for improved outcomes.
- DC cardioversion (electrical)
- Antiarrhythmic drugs (flecainide, amiodarone, dronedarone)
- Catheter ablation (pulmonary vein isolation)
Catheter ablation is increasingly recommended as first-line rhythm control, particularly in paroxysmal AF.
When to See a Specialist
You should consider a specialist cardiology opinion if you experience any of the following:
- New or worsening palpitations, particularly if irregular
- An irregular pulse found on routine examination or smartwatch
- A known diagnosis of AF with ongoing symptoms despite treatment
- Concerns about stroke risk or anticoagulation
- Interest in catheter ablation or rhythm control options
- Unexplained breathlessness, dizziness, or fatigue
- A stroke or TIA where AF may be the underlying cause
Tests You May Need
Based on your symptoms and clinical assessment, Dr Balerdi may recommend one or more of the following investigations.
Initial consultation from £165 · Follow-up from £110 · ECG from £80 · Echocardiogram from £350
View full price list →Reviewed by Dr Matthew Balerdi, Consultant Imaging Cardiologist (FRCP) — Last reviewed: April 2026
Concerned About Atrial Fibrillation?
Early diagnosis and treatment of AF can significantly reduce your risk of stroke and improve your quality of life. Book your assessment today.