Atrial fibrillation, or AF, is the most common heart rhythm problem I see in clinic, and one of the most misunderstood.
In a normal heartbeat, the upper chambers (the atria) contract in an organised way, triggered by a single electrical signal. In AF, that signal becomes chaotic, so the atria quiver rather than contract properly. The heartbeat that results is often fast and irregular – which is why AF is frequently first noticed as a racing or fluttering pulse, though some people feel nothing at all.
We treat AF for two connected reasons: symptoms, and stroke risk. The quivering atria can allow blood to pool and form small clots, which is why many patients with AF are prescribed a blood thinner, based on a proper risk assessment rather than the diagnosis alone.
For the rhythm itself, there are two broad strategies. Rate control accepts that the heart may stay in AF, but keeps the heart rate itself within a safe, comfortable range using medication. Rhythm control aims to restore and maintain a normal heartbeat, either with medication, a cardioversion (a controlled electrical reset), or a catheter ablation.
Neither approach is automatically better – it depends on your symptoms, how long you’ve had AF, your other health conditions, and honestly, your own preference once you understand the trade-offs. Some patients feel little difference between the two states and prioritise avoiding a procedure. Others feel considerably better back in normal rhythm and want to pursue it actively.
This is very much a decision we make together, not one handed down.