Palpitations and atrial fibrillation

What are palpitations?

Palpitations are the sensation of your heart beating in a way that feels unusual, it may feel like it is racing, fluttering, pounding, or skipping beats. Most palpitations are harmless, but some can be a sign of an underlying heart rhythm problem that needs treatment.

Atrial fibrillation (AF) is the most common sustained abnormal heart rhythm. In AF, the upper chambers of the heart beat irregularly and often too fast, which can increase the risk of stroke.

Common symptoms

• A racing or fluttering feeling in the chest
• Feeling that the heart is skipping beats or beating irregularly
• Dizziness or light-headedness
• Shortness of breath
• Tiredness or reduced exercise tolerance

How is it diagnosed?

• ECG: a recording of the heart rhythm at the time of the test
• Ambulatory ECG monitoring: a portable monitor worn for 24 hours to 7 days to catch intermittent symptoms
• Echocardiogram: an ultrasound to check the heart structure and function
• Blood tests: to check thyroid function and other causes

How is it treated?

Treatment depends on the type of rhythm problem:

• Reassurance: if the palpitations are benign and no treatment is needed
• Lifestyle modification: reducing caffeine, alcohol, and stress
• Medications: to control the heart rate or restore a normal rhythm
• Anticoagulation: blood-thinning medication to reduce stroke risk in atrial fibrillation
• Cardioversion: a procedure to restore normal rhythm
• Catheter ablation: a specialist procedure to treat the source of the abnormal rhythm

How should you prepare?

For any appointment it helps to bring: a list of your current medications and doses; copies or details of any previous heart tests (ECGs, scans, or angiogram reports); a note of your symptoms, when they happen, and what brings them on; and your questions. If you have results from another hospital, ask that clinic to send them ahead of your visit.

When to seek urgent help

If your palpitations are accompanied by chest pain, severe breathlessness, fainting, or you feel very unwell, call 999 or 112 immediately.