In Türkiye, 800,000 people have atrial fibrillation (AF), the most common type, characterized by symptoms such as palpitations, fainting, weakness, and fatigue. However, many are unaware of this condition, which can increase their risk of stroke and death. One in four people aged 40 and over will experience AF in their lifetime, and the risk increases with age. Atrial fibrillation is a rhythm disorder that affects an increasing number of people as life expectancy increases.

The complications of AF include palpitations, decreased physical capacity, long-term risk of heart failure, stroke, and, unfortunately, a shortened lifespan. However, recognizing AF and planning personalized treatment, especially in cases where there is no structural heart problem, can help prevent many potential problems.

Atrial fibrillation is an arrhythmia originating in the atria of the heart. In this condition, the heart rhythm becomes rapid and irregular, and patients experience palpitations.

Atrial fibrillation symptoms

The symptoms of atrial fibrillation can vary from person to person, and in some cases, there may be no symptoms at all, so a person may only discover they have AF after an examination. However, the symptoms can be severe:

• Uncomfortable irregular heartbeats or palpitations
• Difficulty exercising and fatigue
• Feeling tired
• Shortness of breath
• Chest pain
• dizziness

These symptoms can last for a few minutes or even hours. Attacks may recur, or they may resolve spontaneously. In some cases, the heart rhythm may not return to normal on its own and may become permanent.

What are the causes of atrial fibrillation?

Atrial fibrillation is the irregular and chaotic contraction of the atria, the upper chambers of the heart. This condition is associated with irregular heart rhythms and uncontrolled heartbeats. However, AF has many potential causes:

• High blood pressure (hypertension) is one of the most common causes. Long-term hypertension can lead to enlargement of the heart chambers and thickening of the heart muscle.
• Cardiovascular diseases, rheumatic heart diseases or heart valve problems can also cause AF.
• Overactive thyroid gland (hyperthyroidism), some lung diseases, and some medications can also cause atrial fibrillation.
• Congenital heart problems, heart surgery, viral infections, pneumonia, and stress can also increase the risk of developing AF.
• In some cases, a specific cause of AF may not be identified; it is possible for a person to experience AF without any heart problems.

How is atrial fibrillation diagnosed?

Diagnosing atrial fibrillation requires first obtaining a detailed medical history. People with suspected atrial fibrillation typically report symptoms such as irregular heartbeats, palpitations, shortness of breath, and fatigue to their doctors. A doctor may perform various tests and examinations to assess symptoms and make a proper diagnosis.

The most common diagnostic method is an electrocardiogram ( ECG ). An ECG is used to evaluate conditions such as heart rhythm and arrhythmias. Atrial fibrillation can be detected by the ECG . However, sometimes atrial fibrillation can be transient, and a normal heart rhythm can appear on the ECG. In these cases, doctors may recommend the use of a Holter monitor or a long-term portable monitor, which can record rhythms over a long period of time. These devices can be used for days or weeks to collect more data on the heart rhythm.

In addition, doctors may order imaging tests, such as echocardiography, to evaluate the heart's structural condition. Blood tests, thyroid function tests, and other tests may also be ordered to identify the underlying cause of atrial fibrillation.

Atrial fibrillation is a treatable condition, and treatment is generally determined by the symptoms and patient characteristics. Treatment options may include medications, blood thinners, electrical cardioversion (a procedure used to correct heart rhythm), and catheter ablation. Treatment should be based on your doctor's evaluation and recommendations.

How is atrial fibrillation treated?

Treatment for atrial fibrillation (AF) varies depending on the individual case and the severity of symptoms. Treatment approaches may focus on controlling the rhythm, regulating the heart rate, preventing clot formation, and relieving symptoms.

• Medications: Rhythm-modifying medications can help control AF episodes and maintain a regular heart rhythm. Blood thinners also reduce the risk of stroke by preventing clot formation.
• Electrical cardioversion: In some cases, when medications fail to treat AF, a controlled electric shock (electrical cardioversion) may be administered to attempt to restore a normal heart rhythm.
• Ablation: Ablation is a minimally invasive procedure generally preferred for patients whose heart rhythms are uncontrollable with medications or whose side effects are severe. In this procedure, the tissues that cause abnormal heart rhythms are destroyed using radiofrequency or freezing (balloon ablation). This allows for the restoration of a normal rhythm.
• Surgical intervention: In some cases, surgical procedures may be necessary to treat AF. Surgical ablation or other interventions may be considered, especially in patients with additional heart problems such as valve disease.
• Anticoagulant therapy: Blood thinners are often used to prevent clot formation in patients with AF. Additionally, valve devices and occlusive devices may be used to prevent clot formation in the atria.

Every patient is different, and the treatment plan must be determined individually. The patient's lifestyle, other health issues, and medication tolerance should also be considered when developing the treatment plan. Close communication with the treating cardiologist is important, as treatment progress may vary depending on the patient's condition and regular follow-up may be necessary.

What are the risk factors for atrial fibrillation?

Atrial fibrillation risk factors include a variety of factors that can play a role in the development of the disease. Some of these risk factors are preventable, while others are due to genetics or other health conditions:

• Advanced age: The risk of atrial fibrillation increases, especially in individuals aged 65 and over.
• High blood pressure (hypertension): High blood pressure can increase the risk of atrial fibrillation by increasing the pressure on the heart and blood vessels.
• Congestive heart failure: If the heart has difficulties pumping, the risk of atrial fibrillation may increase.
• Coronary artery disease: Blockages or narrowing of the heart arteries can increase the risk of atrial fibrillation.
• Valvular heart disease: Damage or problems with the heart valves can contribute to the development of atrial fibrillation.
• Cardiac hypertrophy (thickening of the heart muscle): Abnormal thickening or enlargement of the heart muscle can increase the risk of atrial fibrillation.
• Congenital heart disease: Congenital heart diseases can affect the risk of atrial fibrillation.
• Lung infections and diseases: Lung infections, especially pneumonia, can increase the risk of atrial fibrillation.
• Hyperthyroidism: An overactive thyroid gland can increase the risk of atrial fibrillation.
• Alcohol consumption: Excessive alcohol use can increase the risk of atrial fibrillation.
• Diabetes: Individuals with diabetes may have a higher risk of atrial fibrillation.
• Lung cancer: In some cases, lung cancer or its treatment can increase the risk of atrial fibrillation.
• Genetic factors: Certain heart diseases that are passed down through families or a genetic predisposition to atrial fibrillation may increase the risk of the disease.
• Other factors such as pulmonary embolism, cardiomyopathy, sleep apnea, and obesity may also increase the risk of atrial fibrillation.

However, having these risk factors doesn't mean you'll develop atrial fibrillation; however, they can increase your risk of developing the disease. Managing and controlling these risk factors by your healthcare provider is important to preventing or reducing the effects of atrial fibrillation.

What lifestyle changes should be made in atrial fibrillation? 

Lifestyle changes for people with atrial fibrillation can support treatment and improve overall heart health. Recommended lifestyle changes for people with atrial fibrillation include:

• Contact your doctor: If you notice changes in your heart rhythm or an increase in symptoms, you should contact your doctor. Medication dosages may need to be adjusted based on changes in activity.
• Smoking and alcohol consumption: Smoking is harmful to your heart, so smoking should be avoided. Alcohol consumption can also worsen symptoms of atrial fibrillation or affect your heart rhythm, so avoid alcohol.
• Caffeine intake: Limit your intake of caffeinated beverages. Caffeine, found in coffee, tea, energy drinks, and some sodas, can increase heart rate in some people.
• Medications and other supplements: Some cough and cold medications can affect heart rhythm. Consult a cardiologist before using such medications.
• Stress management and relaxation: Stress can trigger atrial fibrillation symptoms. Relaxation techniques, such as meditation, yoga, or deep breathing, can help reduce stress.
• Healthy eating: A balanced diet can improve heart health. Controlling salt and fat intake is important for maintaining heart health.
• Regular exercise: Regular exercise, as recommended by your doctor, can support overall heart health. However, in some cases, certain exercises can affect your heart rhythm, so it's important to follow your doctor's recommendations.

It's important to remember that atrial fibrillation can vary depending on the individual situation. Therefore, it's important to consult a cardiologist about lifestyle changes or treatment options. Because every patient is different, a personalized treatment plan should be created .