CardiologyPublished: March 2025·Updated: ·5 min read

Understanding Atrial Fibrillation: Symptoms, Risks & Treatment Options

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting an estimated 33 million people worldwide. In Singapore, its prevalence is rising alongside an ageing population and increasing rates of hypertension, diabetes, and heart disease. Despite being common, AF is frequently misunderstood — and when left unmanaged, it significantly increases the risk of stroke and heart failure. This guide explains what AF is, how to recognise it, why it matters, and what treatment options are available.

Dr. Peter Chang

Triple Board-Certified Cardiologist & Vascular Specialist

What Is Atrial Fibrillation?

The heart normally beats in a coordinated rhythm driven by electrical signals from the sinoatrial (SA) node — the heart's natural pacemaker. In atrial fibrillation, chaotic electrical impulses fire simultaneously from multiple sites in the upper chambers of the heart (the atria), causing them to quiver rapidly and irregularly rather than contracting effectively. The lower chambers (ventricles) receive these erratic signals and beat in an irregular, often rapid, pattern.

Paroxysmal AF: episodes that start and stop on their own, typically lasting less than 7 days
Persistent AF: episodes lasting more than 7 days that require treatment to restore normal rhythm
Long-standing persistent AF: continuous AF lasting more than 12 months
Permanent AF: a decision has been made to manage rate rather than pursue rhythm restoration

Recognising the Symptoms

AF can range from completely asymptomatic to severely symptomatic. Common presentations include palpitations (a sensation of rapid, fluttering, or irregular heartbeat), breathlessness on exertion or at rest, fatigue, lightheadedness, and chest discomfort. Importantly, up to 30% of people with AF have no symptoms at all — AF is discovered incidentally on a routine ECG or following a stroke. This makes regular cardiovascular screening vital in high-risk individuals.

Causes and Risk Factors

AF rarely occurs in isolation. It is almost always associated with an underlying condition or lifestyle trigger. The most common risk factors include:

Hypertension — the single most common modifiable risk factor
Coronary artery disease and heart failure
Heart valve disease, particularly mitral valve disease
Hyperthyroidism
Obstructive sleep apnoea
Excessive alcohol consumption ('holiday heart syndrome')
Obesity and metabolic syndrome
Age over 65

Why AF Must Be Taken Seriously: Stroke and Heart Failure

AF carries two major complications that require active management. First, stroke risk: blood pooling in the fibrillating atria can clot, and if a clot travels to the brain, a stroke results. People with AF have a 5-fold increased risk of stroke compared to those without. AF-related strokes tend to be more severe and more disabling. Second, heart failure: the chronically irregular and often rapid heart rate in AF can weaken the heart muscle over time, a condition called tachycardia-mediated cardiomyopathy. Both complications are largely preventable with appropriate treatment.

How Is AF Diagnosed?

AF is confirmed by a 12-lead electrocardiogram (ECG), which captures the characteristic irregular rhythm and absence of organised P waves. Because AF can be intermittent, additional monitoring is sometimes required:

24–72 hour Holter monitor: detects intermittent AF over one or more days
Event recorder or implantable loop recorder: for persistent unexplained palpitations or cryptogenic stroke
Echocardiogram: assesses heart structure, valve function, and identifies underlying causes
Blood tests: thyroid function, electrolytes, full blood count

Treatment Options for Atrial Fibrillation

Treatment is guided by two goals: controlling the heart rate or restoring normal rhythm, and preventing stroke. Rate control slows the ventricular rate to a safe range using medications such as beta-blockers, calcium channel blockers, or digoxin. Rhythm control aims to restore and maintain normal sinus rhythm using antiarrhythmic drugs (e.g., flecainide, amiodarone) or catheter ablation. Catheter ablation — specifically pulmonary vein isolation — has become the most effective long-term rhythm control strategy for many patients, particularly those with paroxysmal AF who have failed or cannot tolerate medications. For stroke prevention, most patients require anticoagulation — typically with direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban, which are safer and more convenient than warfarin.

Living Well with Atrial Fibrillation

With proper management, most people with AF lead normal, active lives. Key principles include taking anticoagulation consistently to prevent stroke, monitoring for symptom changes, maintaining a heart-healthy lifestyle (weight, blood pressure, cholesterol, diabetes), limiting alcohol, and managing sleep apnoea — a condition that strongly worsens AF burden. Regular follow-up with a cardiologist is essential to adjust treatment as AF evolves over time.

Frequently Asked Questions

Common Questions About Understanding Atrial Fibrillation

What does atrial fibrillation feel like?

Most patients describe AF as a fluttering, racing, or irregular heartbeat — sometimes as the heart 'skipping beats' or 'doing somersaults.' Some feel breathless, dizzy, or fatigued. Up to 30% of people with AF have no symptoms and are diagnosed incidentally on an ECG.

Can atrial fibrillation be cured?

AF can be put into long-term remission with catheter ablation (pulmonary vein isolation) in many patients, particularly those with paroxysmal AF diagnosed early. Ablation achieves freedom from AF without medication in approximately 60–70% of paroxysmal AF patients at 5 years. Some patients require a repeat procedure. It is more accurate to describe this as long-term remission than a permanent cure.

Is atrial fibrillation dangerous?

AF itself is not immediately life-threatening, but it significantly increases the risk of stroke (5-fold), heart failure, and cardiovascular death. The stroke risk is the primary concern — this is why anticoagulation therapy is central to AF management for most patients.

What is the difference between AF and a normal heartbeat?

A normal heartbeat follows a regular rhythm at 60–100 beats per minute set by the sinoatrial node. In AF, chaotic electrical signals cause the atria to fire 400–600 times per minute. The ventricles respond irregularly, producing an irregular, often rapid pulse.

Where can I get treated for atrial fibrillation in Singapore?

Dr. Peter Chang at Paragon Medical Centre, Singapore, provides comprehensive AF management including ECG, Holter monitoring, echocardiography, rate and rhythm control strategies, anticoagulation management, and referral for catheter ablation when appropriate.