Atrial Fibrillation: What It Is, Symptoms, and Connection with High Blood Pressure

Atrial fibrillation (AF) is the most common cardiac rhythm disorder in the world: it affects approximately 1 million Italians, and its prevalence is expected to double by 2050 as the population ages. The main problem is that it is often silent—and in silence, it accumulates damage.

What is Atrial Fibrillation?

Under normal conditions, the heart beats rhythmically and synchronously: the upper chambers (atria) contract in an orderly fashion, pushing blood into the ventricles, which in turn pump it into the arteries.

In atrial fibrillation, the electrical signal in the atria becomes chaotic: instead of contracting rhythmically, the atria "quiver" at 300–600 impulses per minute, in a disorganized and ineffective manner. The result is an irregular and often faster than normal heartbeat.

The most dangerous consequence is not the irregular rhythm itself, but the formation of blood clots: blood stagnating in the non-contractile atria tends to clot, forming small clots that can migrate to the cerebral arteries and cause a stroke.

Epidemiological Data: AF in Italy

• 1 million Italians have diagnosed atrial fibrillation (ISS, 2025)
• An estimated 300,000 others have it without knowing (silent AF)
• AF increases the risk of stroke by 4–5 times compared to the general population
• 20–25% of all strokes in Italy are caused by AF (SPREAD Guidelines 2024)
• Prevalence: 0.5% in the 40–50 age group → 10% over 75 → 17% over 85
• Approximately 120,000 new cases of AF are recorded annually in Italy

Types of Atrial Fibrillation

Clinical classification distinguishes 4 main forms based on duration and spontaneity of conversion to normal rhythm:

Paroxysmal AF is the most common and insidious: it appears and disappears without obvious symptoms, can last a few minutes or several hours, and during that time, the thromboembolic risk is already real. Many patients do not know they have it.

Symptoms of Atrial Fibrillation

When AF is symptomatic, the most common symptoms are:

• Palpitations — sensation of the heart "beating strangely," accelerated or irregular
• Shortness of breath even with mild exertion or at rest
• Unusual fatigue and reduced exercise tolerance
• Dizziness or feeling of instability
• Chest pain or pressure (in cases of rapid AF)
• Feeling of "emptiness" or pre-syncope

However, in a significant percentage of cases—estimated between 25% and 40%—AF is completely asymptomatic. It is discovered by chance during a blood pressure measurement, a routine ECG, or in the worst cases, after a stroke.

Connection between Hypertension and Atrial Fibrillation

High blood pressure is the main modifiable risk factor for atrial fibrillation:

• Approximately 70% of AF patients also have hypertension
• Uncontrolled hypertension increases the risk of developing AF by 40–50%
• The mechanism: high blood pressure causes dilation and fibrosis of the left atrium, creating the anatomical substrate for the anomalous electrical circuits of AF

This connection makes blood pressure control not only important for the heart and arteries, but also for preventing AF and its consequences—including stroke.

How it is Diagnosed

A definitive diagnosis of AF requires an ECG—electrocardiogram. But paroxysmal AF poses a problem: it may not be present during a routine ECG in the doctor's office.

Diagnosis methods:

• 12-lead ECG (in clinic or emergency room) — immediate diagnosis if AF is present at that moment
• 24–48 hour Holter ECG — continuously records heart rhythm; captures paroxysmal episodes within a 1–2 day window
• 7–30 day Holter ECG (patch recorder) — significantly increases sensitivity for rare paroxysmal AF
• Implantable devices (loop recorder) — monitoring for months/years in high-risk cases
• Blood pressure monitors with IHB detection — signal rhythm abnormalities during routine measurement, acting as a first screening

Blood Pressure Monitors and AF Screening: What Science Says

In recent years, scientific evidence has accumulated on the role of blood pressure monitors with an IHB (Irregular HeartBeat) algorithm as tools for home-based AF screening.

A study published in the European Heart Journal (2022) evaluated 3,800 hypertensive patients over 65 who regularly measured their blood pressure at home. 6.7% of participants had AF, but in more than half of the cases, it had not yet been diagnosed. The IHB algorithm of the monitor correctly identified 78% of AF episodes, with a specificity of 87%.

The conclusion: the blood pressure monitor does not replace the ECG, but it can be the first warning sign that prompts the patient to seek medical attention, allowing for early diagnosis and the initiation of anticoagulant therapy before an ischemic event.

The VitaeChek Pulse 3 integrates the IHB algorithm: with each measurement, it analyzes the heart rhythm and automatically signals the presence of irregular beats, with an icon on the display and a voice alert in Italian. If the signal is repeated on subsequent measurements, it's time to take this data to the doctor for an ECG.

Treatment of Atrial Fibrillation

AF treatment has three objectives:

1. Control of thromboembolic risk (stroke prevention)

Oral anticoagulant therapy—with direct anticoagulants (DOACs: apixaban, rivaroxaban, dabigatran, edoxaban) or with warfarin—is the cornerstone of stroke prevention in AF patients. Risk is stratified using the CHA₂DS₂-VASc score: scores ≥ 2 in men and ≥ 3 in women indicate anticoagulation.

2. Heart rate control

Reducing ventricular rate (target < 110 bpm at rest) improves symptoms and cardiac function. Medications: beta-blockers, non-dihydropyridine calcium channel blockers (diltiazem, verapamil), digoxin.

3. Rhythm control (cardioversion)

In some patients, especially young individuals or those with recent-onset AF, the aim is to restore sinus rhythm (electrical or pharmacological cardioversion) and maintain it with antiarrhythmic drugs (flecainide, propafenone, amiodarone) or with catheter ablation.

Lifestyle and AF: What You Can Do

The modifiable risk factors for AF are the same as for hypertension:

• Blood pressure control — the most important: bringing blood pressure below 130/80 mmHg reduces the risk of AF by 25–30%
• Weight loss — in obese subjects with AF, a 10% weight loss significantly reduces the frequency of episodes and improves the effectiveness of ablation
• Alcohol reduction — even moderate consumption (5–7 alcoholic drinks/week) is associated with an 18% increased risk of AF
• Treatment of sleep apnea — CPAP reduces AF recurrence after ablation by 42%
• Diabetes control — optimal HbA1c reduces the risk of AF by 13%
• Moderate physical activity — protective; caution: extreme physical exercise (endurance athletes) is associated with an increased risk of AF

Frequently Asked Questions

Can one live well with atrial fibrillation?

Yes. Most patients with well-treated AF lead normal lives. Anticoagulant therapy reduces the risk of stroke by 60–70%, and many patients with controlled AF do not experience significant limitations in daily activities.

Can a blood pressure monitor diagnose AF?

No—a definitive diagnosis requires an ECG. But a monitor with an IHB algorithm can signal rhythm abnormalities that warrant a cardiological visit. It is a first screening, not a diagnosis.

Is AF dangerous even without symptoms?

Yes. Asymptomatic AF carries the same thromboembolic risk as symptomatic AF. Not experiencing symptoms does not mean the heart is not fibrillating, and it does not reduce the risk of stroke.

Do I have to stop playing sports if I have AF?

It depends on the type of AF and the treatment. Moderate physical activity (walking, swimming, low-intensity cycling) is generally recommended. High-intensity sports require an individual cardiological evaluation.