Atrial Fibrillation (AFib) in Singapore: Symptoms, Causes and Treatment

Atrial fibrillation (AF, often called AFib) is an irregular and often rapid heartbeat, and it is the most common sustained heart arrhythmia (abnormal heart rhythm) in adults. It matters because AF significantly raises the risk of stroke, and because many people live with it for years without knowing. With Singapore’s ageing population, AF is becoming steadily more common. This page explains what atrial fibrillation is, the symptoms to watch for, why stroke prevention sits at the centre of treatment, and the options available – from medication to catheter ablation. It is general information and not a substitute for advice from your own doctor.

What Is Atrial Fibrillation?

In a normal rhythm, the upper chambers of the heart (the atria) contract in a steady, coordinated way, sending a regular pulse of blood to the lower chambers. In AF, chaotic electrical signals cause the atria to quiver instead of contracting properly. The result is an irregular heartbeat that is often fast. Because blood no longer moves smoothly through the quivering atria, it can pool and form clots – the reason AF is so closely linked to stroke.

Doctors describe AF in three broad patterns:

• Paroxysmal AF – episodes start suddenly and stop on their own, usually within minutes to days.
• Persistent AF – the abnormal rhythm continues until it is treated, for example with medication or a controlled electrical shock.
• Permanent AF – the irregular rhythm is long-standing and a return to normal rhythm is no longer attempted; treatment focuses on controlling the heart rate and preventing stroke.

Many people progress from paroxysmal to persistent AF over time, which is one reason early diagnosis is valuable.

Atrial Fibrillation Symptoms

Afib symptoms vary widely – some people are troubled daily, while others feel nothing at all. Common symptoms include:

• Heart palpitations (a fluttering, thumping or racing sensation in the chest)
• An irregular heartbeat you can feel when checking your own pulse
• Breathlessness, especially with activity
• Tiredness and reduced ability to exercise
• Dizziness or light-headedness
• Chest discomfort or pressure

AF can also be completely silent. In older adults and people with diabetes, the only clue may be unexplained fatigue, and some cases are picked up at a routine health screening or by a smartwatch alert – or, unfortunately, only after a stroke.

When to Seek Emergency Help

Call 995 immediately if you or someone with you develops:

• Sudden face drooping, arm weakness or slurred speech (possible signs of stroke)
• Chest pain that lasts more than a few minutes
• Fainting or collapse
• Severe breathlessness at rest

A very rapid irregular heartbeat together with any of these features needs urgent hospital assessment.

Causes and Risk Factors

Some risk factors cannot be changed:

• Age – AF becomes markedly more common after 60
• A family history of AF
• Existing heart disease, including valve problems, heart failure or a previous heart attack

Others can be treated or improved:

• High blood pressure – the most important modifiable risk factor
• Diabetes, which is common in Singapore
• Obesity and obstructive sleep apnoea (repeated pauses in breathing during sleep)
• An overactive thyroid gland
• Heavy or binge alcohol drinking
• Smoking and physical inactivity

Addressing these factors is part of AF treatment itself, not just prevention.

How Atrial Fibrillation Is Diagnosed

Diagnosis starts with an electrocardiogram (ECG) – a quick, painless tracing of the heart’s electrical activity that can confirm AF if it is present at the time. Because paroxysmal AF comes and goes, a normal clinic ECG does not rule it out, so your cardiologist may arrange:

• A 24-hour Holter monitor or a longer wearable recording, which captures every heartbeat over one or more days
• An event recorder for symptoms that occur only occasionally
• An echocardiogram (an ultrasound scan of the heart) to assess the chambers, pumping strength and valves
• Blood tests to check thyroid and kidney function before starting medication

Treatment Options

Treatment has three goals: preventing stroke, controlling symptoms, and treating the conditions that drive AF.

Stroke prevention comes first. People with AF are around five times more likely to have a stroke than people without it, because clots forming in the atria can travel to the brain. Anticoagulants (blood-thinning medication) can substantially reduce this risk. To decide who needs them, cardiologists use a scoring system (widely known as CHA2DS2-VASc) that adds up stroke risk factors such as age, high blood pressure, diabetes, heart failure and a previous stroke. In plain terms: the more of these factors you have, the stronger the case for anticoagulation. For people who cannot take long-term anticoagulants, a keyhole procedure called left atrial appendage (LAA) occlusion – often known by the device name Watchman – can seal off the small pouch in the atrium where most clots form.

Rate control or rhythm control. Rate control accepts the irregular rhythm but uses medication such as beta-blockers or calcium channel blockers to stop the heart racing. Rhythm control aims to restore and maintain a normal rhythm, using anti-arrhythmic medication or cardioversion (a controlled electrical shock delivered under sedation). The right strategy depends on your symptoms, how long AF has been present and the condition of your heart.

Catheter ablation. In this minimally invasive procedure, thin flexible tubes are guided to the heart through a vein in the groin, and the small areas generating the abnormal signals – usually around the pulmonary veins – are treated with heat or freezing energy or the latest pulse-field ablation technology. Ablation can help reduce or stop AF episodes, particularly in paroxysmal AF, and may be discussed when medication has not controlled symptoms. It is one of several procedures offered as part of specialist care for heart rhythm disorders.

Living With Atrial Fibrillation

Most people with well-managed AF lead full, active lives. Day to day, it helps to take anticoagulants exactly as prescribed, keep blood pressure and diabetes under control, maintain a healthy weight, limit alcohol and caffeine, treat sleep apnoea if present, and attend regular follow-up so treatment can be adjusted as your needs change.

When to See a Cardiologist

See a cardiologist if you have noticed heart palpitations, an irregular pulse, unexplained breathlessness or falling stamina – or if an irregular heartbeat has been flagged at a screening or by a wearable device. Early assessment allows stroke risk to be addressed before complications occur and keeps the widest range of treatment options open.

Frequently Asked Questions

Can you live a normal life with AFib?

Yes. Most people with AF live full and active lives once the rhythm is managed and stroke risk is addressed. Taking medication consistently and attending regular follow-up are the keys.

Is atrial fibrillation dangerous?

AF is not usually immediately life-threatening, but untreated AF raises the risk of stroke and can weaken the heart over time. This is why assessment and stroke prevention matter even when symptoms are mild.

Does AFib go away on its own?

Paroxysmal AF episodes often stop by themselves, but the condition tends to return and may become persistent over time. Treating risk factors such as blood pressure, weight and alcohol intake can reduce episodes.

What is the main cause of atrial fibrillation?

There is rarely a single cause. Age and high blood pressure are the biggest contributors, with diabetes, obesity, sleep apnoea, thyroid disease, alcohol and existing heart disease all adding to the risk.

Can AFib be cured?

Catheter ablation can help stop AF episodes in many people, particularly those with paroxysmal AF, although some need more than one procedure and long-term follow-up is still required. Your cardiologist can advise whether ablation suits your situation.