Why does atrial fibrillation cause palpitations?

In atrial fibrillation, electrical signals in the upper heart chambers are disorganised. This produces an uneven rhythm, and the lower chambers may respond faster than usual. You may notice a flutter in the chest, thumping beats, a racing pulse, pauses or an uncomfortable awareness of your heartbeat. Episodes can start and stop suddenly or remain present.

Palpitations are a very common presentation of Atrial Fibrillation. Palpitations can also occur with stress, caffeine, fever, thyroid problems, other rhythm changes or some medicines. A clinician may use the pattern of symptoms and a heart-rhythm recording to identify what is happening.

Pause strenuous activity and sit down if palpitations make you feel unwell. Note the start and end time, whether the rhythm feels regular, and any dizziness, chest pain, breathlessness or faintness. Take prescribed rhythm or rate medicines as directed; do not take an extra dose unless your clinician has specifically told you to do so.

Bring a medication list to follow-up visits and mention alcohol, stimulant drinks, illness, poor sleep or other situations that seem to precede episodes. This information can guide a tailored management plan.

Call emergency services if palpitations occur with chest pain, severe breathlessness, fainting, new one-sided weakness, facial droop, speech difficulty, severe confusion or a rapidly worsening condition. Contact a clinician promptly for a first episode of persistent palpitations, a known atrial fibrillation episode that feels different, or symptoms that interfere with normal activity.

Ask what your pulse target is, how to recognise a rhythm change, whether you need rhythm monitoring, which substances or medicines may aggravate palpitations, and when to use urgent services.