Atrial fibrillation is an abnormal heart rhythm that can cause stroke, heart failure, heart attack, chronic kidney disease, dementia, and death.

Atrial fibrillation is classified as paroxysmal (intermittent episodes lasting 7 days or less), persistent (lasting more than 7 days), long-standing persistent (lasting more than 1 year), or permanent.¹

In the US, atrial fibrillation affects about 10.55 million people and is more common among men than women. Other risk factors include older age, smoking, high blood pressure, diabetes, heart disease, high alcohol consumption, sleep apnea, an overactive thyroid gland, and possibly genetic factors.

Typical symptoms include heart palpitations, trouble breathing, chest pain, feeling faint, difficulty with exercising, and fatigue. However, 10% to 40% of people with atrial fibrillation have no symptoms.

Atrial fibrillation is diagnosed on an electrocardiogram (ECG), which is a noninvasive test that measures electrical activity in the heart. Some people use wearable devices such as smartwatches to evaluate heart rhythms; atrial fibrillation detected with these devices should be confirmed with ECG or additional cardiac testing. For patients diagnosed with atrial fibrillation, an ultrasound (echocardiogram) can help assess heart structure and function and identify possible causes of atrial fibrillation such as heart valve disease.

Individuals with atrial fibrillation symptoms should undergo ECG. In addition, patients with an unexplained stroke should be evaluated for abnormal heart rhythms. If these evaluations do not detect atrial fibrillation, patients may receive an implantable loop recorder, a device implanted in the chest that continuously records electrical heart rhythms for up to 4 years.

Patients at risk of or diagnosed with atrial fibrillation benefit from lifestyle and risk factor modification, including blood pressure control, weight loss, moderate exercise, smoking cessation, and limiting or abstaining from alcohol use. These changes can help prevent development or recurrence of atrial fibrillation and may decrease the risk of complications from atrial fibrillation.

Based on risk score calculators, patients with atrial fibrillation who are predicted to have a 2% or higher likelihood of developing a stroke or blood clots are typically treated with an oral blood-thinning drug (anticoagulant) such as a direct-acting anticoagulant (apixaban, dabigatran, edoxaban, or rivaroxaban) or warfarin.

Antiarrhythmic drugs and/or electrical cardioversion, which involves sending a mild electrical shock to the heart with external patches or paddles, may be used to convert atrial fibrillation to a normal heart rhythm. Catheter ablation is an invasive procedure that delivers heat or cold energy to destroy the heart tissue that is causing atrial fibrillation. For certain patients, catheter ablation reduces symptoms and decreases the likelihood of developing persistent atrial fibrillation. For patients who have atrial fibrillation and heart failure with reduced ejection fraction (the heart does not pump blood effectively to the rest of the body), catheter ablation improves symptoms, quality of life, heart function, and cardiovascular outcomes.

Published Online: April 24, 2025. doi:10.1001/jama.2025.2888

Conflict of Interest Disclosures: None reported.