
Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide. In Asia-Pacific, an estimated 80 million people had AF in 2023. Locally, more than 7% of people above 65 years of age and 1% of younger people between 45 and 65 years. had been diagnosed with AF in 2015. As Singapore’s population ages, the number of people living with AF is expected to rise significantly. However, with early diagnosis, appropriate treatment and healthy lifestyle changes, AF can often be managed successfully.
Your heart has its own electrical system that keeps it beating in a steady, coordinated rhythm. In atrial fibrillation, these electrical signals become disorganised, causing the top chambers of the heart (the atria) to beat rapidly and irregularly. This reduces the heart’s pumping efficiency and alters blood flow in the heart, increasing the risk of blood clots.
AF does not affect everyone in the same way. Some may experience short and intermittent episodes that come and go (i.e., paroxysmal AF), while others have episodes that last longer than a week or require treatment to restore a normal heart rhythm (i.e., persistent AF).
Some people experience noticeable symptoms while others have none and only discover they have AF during a routine health check. Common symptoms include:
The main test used to diagnose AF is an electrocardiogram (ECG), which records
the heart’s electrical activity. Depending on how often your symptoms occur, your
doctor may recommend one or more of the following:
ECG-enabled smartwatches can be useful for detecting AF, particularly if symptoms occur only occasionally. If your smartwatch detects an irregular heart rhythm, consult a healthcare professional for further evaluation and confirmation.
One of the biggest concerns with AF is its link to stroke. When the atria do not contract effectively, blood flow can become slower and may form clots. If a clot travels to the brain, it can block blood flow and cause a stroke. AF is estimated to increase the risk of stroke by about five times. Fortunately, appropriate treatment can significantly reduce this risk.
Early recognition and intervention are vital to reduce damage to brain tissues from stroke. If you suspect someone is having a stroke, remember F.A.S.T.
Although not all cases of AF can be prevented, managing your overall heart health
can lower your risk and reduce future episodes. Simple lifestyle habits include:
You may be prescribed medications to:
❤ Slow a fast heart rate (rate control)
❤ Restore normal heart rhythm (rhythm control)
Depending on the frequency of symptoms, some patients may take these medications daily rather than on an as-needed basis. For some, catheter ablation may be recommended. This minimally invasive treatment uses catheters to target the abnormal electrical signals that trigger AF. Advances in technology have made the procedure safer, with many patients returning home the next day and recovering within one to two weeks.
AF is more than just an irregular heartbeat. It shares many of the same risk factors as heart disease and stroke, including high blood pressure, diabetes, obesity and high blood cholesterol. Unhealthy lifestyle habits such as physical inactivity, smoking and excess alcohol consumption can increase scarring and inflammation in the heart. Over time, this raises the risk of developing AF, coronary artery disease, heart failure and stroke.
The article is contributed by Adj Asst Prof Eugene Tan, Consultant, Department of Cardiology at the National University Heart Centre, Singapore.