5,000+ patients guided through treatment in Delhi NCREvery case read by a US board-certified physicianWritten opinion with costs within 48 hoursNABH and JCI accredited hospitals onlyArabic, English, Russian and Bengali spokenOur fees are published — hospitals pay us, not youMedical visa invitation letters for eight countries
TIB HIND

If you have sudden weakness on one side, facial droop, or difficulty speaking, this may be a stroke. Get emergency help immediately. Also seek urgent care for a very fast irregular pulse with chest pain, severe breathlessness or fainting.

Home  /  Treatments  /  Heart treatment  /  Atrial fibrillation

Atrial fibrillation and other rhythm disorders

The upper chambers of the heart quiver instead of beating in a coordinated way. The pulse becomes irregular, the heart pumps less efficiently, and blood can pool and clot inside the left atrium.

The symptoms of atrial fibrillation are what bring people to a doctor. The stroke risk is what actually matters most, and it is frequently the part that receives least attention.

Written and clinically reviewed by Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Main risk
Stroke
From clot forming in the left atrium
First priority
Anticoagulation
Assessed on risk score, not on symptoms
Two strategies
Rate or rhythm
Control the speed, or restore normal rhythm
Procedure option
Catheter ablation
Effective in selected patients, not a guaranteed cure
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What atrial fibrillation is

Normally an electrical impulse starts in one place and spreads in an orderly wave, so the atria contract together and then the ventricles follow. In atrial fibrillation, chaotic electrical activity replaces that order. The atria quiver rather than contract, and the ventricles respond irregularly and often too fast.

Two consequences follow. The heart loses the contribution the atria make to filling, which is why some people feel breathless and tired. And blood no longer moves briskly through the left atrium, particularly in a small pouch called the left atrial appendage, where it can stagnate and clot. If a clot leaves and travels to the brain, it causes a stroke.

Atrial fibrillation may come and go, persist until it is treated, or become permanent. Some people feel every episode intensely; others have no symptoms at all and discover it only when a pulse is checked. The stroke risk is broadly similar either way, which is the most important thing to understand about this condition.

It rarely arrives alone. High blood pressure, valve disease — particularly rheumatic mitral disease — thyroid overactivity, sleep apnoea, obesity and alcohol all contribute, and treating them is part of treating the fibrillation.

Symptoms

Symptoms and warning signs

Common symptoms
  • Palpitations — a racing, thumping or irregular heartbeat
  • Breathlessness on exertion
  • Fatigue and reduced exercise capacity
  • Dizziness or light-headedness
  • Chest discomfort
  • Reduced exercise tolerance without obvious palpitations
  • No symptoms at all in a substantial proportion of people
Warning signs of an emergency
  • Sudden weakness, numbness or drooping on one side of the face or body
  • Sudden difficulty speaking or understanding speech
  • Sudden loss of vision
  • Fainting
  • Chest pain with a very fast irregular pulse
  • Severe breathlessness at rest

The stroke risk is independent of how you feel

This is the most misunderstood aspect of atrial fibrillation. Patients with no symptoms have broadly the same stroke risk as those with severe palpitations, and patients whose rhythm has been restored still carry risk. Whether you need anticoagulation is decided by a risk score based on your age, blood pressure, diabetes, previous stroke and other factors — not by whether you feel unwell. Do not stop anticoagulation because you feel fine.

Diagnosis

How it is diagnosed

Capturing the rhythm on a recording is the first requirement; establishing the cause and the risk follows.

Initial tests

  • ECG — confirms the diagnosis if the rhythm is present at the time
  • Holter or event monitor — records over 24 hours or longer to catch intermittent episodes
  • Echocardiogram — looks for valve disease, atrial size and ventricular function
  • Blood tests — thyroid function, kidney function, full blood count and electrolytes

The deciding tests

  • Transoesophageal echocardiogram — excludes clot in the left atrial appendage before cardioversion or ablation
  • Stroke risk scoring — a formal assessment that determines whether anticoagulation is required
  • Sleep study — obstructive sleep apnoea is a common and treatable contributor, and treating it improves ablation results

A recording of the rhythm is essential

We cannot assess atrial fibrillation from a description of palpitations. Send the ECG or Holter report that captured it, along with the echocardiogram — the size of the left atrium and the presence of valve disease substantially change what is worth doing. Also send your current medicines, particularly any anticoagulant and its dose.

Options

Treatment options

There are two strategies, and they are not in competition — most patients need elements of both, plus anticoagulation considered separately.

Priority

Stroke prevention with anticoagulation

Assessed by risk score and considered before anything else, because it is the intervention that prevents the outcome that matters most. Options include warfarin, which requires regular INR testing, and direct oral anticoagulants, which do not. Aspirin is not adequate protection against stroke in atrial fibrillation, despite still being prescribed for it in some places.

Usually appropriate whenYour risk score meets the threshold — which is decided by your age and conditions, not by your symptoms.
Option one

Rate control

Accepting the irregular rhythm but slowing the heart to a comfortable speed, using beta blockers, calcium channel blockers or digoxin. Simple, inexpensive and effective for a great many patients, particularly older ones with few symptoms. It is not a lesser option.

Usually appropriate whenSymptoms are manageable, the fibrillation is long-standing, or restoring normal rhythm is unlikely to be sustainable.
Option two

Rhythm control with medication or cardioversion

Restoring and maintaining normal rhythm using antiarrhythmic drugs, or an electrical cardioversion under brief sedation. A transoesophageal echocardiogram or several weeks of anticoagulation is required first to ensure no clot is present.

Usually appropriate whenSymptoms are troublesome despite rate control, the fibrillation is recent, or the left atrium is not greatly enlarged.
Option three

Catheter ablation

Catheters are used to isolate the pulmonary veins, where the abnormal impulses usually originate, by creating targeted scar with radiofrequency energy or freezing. It is the most effective rhythm control available and the main reason patients travel for this condition. It is not a guaranteed cure — a proportion of patients need a second procedure, and anticoagulation usually continues afterwards based on risk score.

Usually appropriate whenSymptoms persist despite medication, the left atrium is not severely enlarged, and the fibrillation is paroxysmal or of relatively recent onset.
The decision

How the choice is made

Anticoagulation is decided separately

It is not part of the rate-versus-rhythm choice. It is assessed on risk score and continues according to that risk regardless of which strategy is chosen or how successful it is.

Then symptoms and duration

Recent-onset fibrillation in a symptomatic patient with a normal-sized atrium is where rhythm control and ablation work best. Long-standing fibrillation with a dilated atrium is where rate control is usually the sensible answer.

Then what is driving it

Untreated sleep apnoea, thyroid overactivity, uncontrolled blood pressure, significant alcohol intake and untreated valve disease all reduce the success of ablation. Addressing them first is not a delay — it is part of the treatment.

Ablation is a genuinely effective procedure for the right patient and disappointing for the wrong one. Dr. Varughese will tell you which you are before you spend anything, including when the honest answer is that medication is the better route.

Urgency

How urgent is your case

Usually safe to plan travel
  • Rate-controlled fibrillation on stable medication
  • Established anticoagulation with stable monitoring
  • Intermittent episodes that settle on their own
  • Planned elective ablation in a stable patient
Needs local assessment before travel
  • Any recent stroke or transient neurological symptoms
  • Very fast rate with chest pain or breathlessness
  • Fainting
  • New fibrillation not yet anticoagulated with high stroke risk
  • Bleeding on anticoagulation

We will tell you which column you are in

New atrial fibrillation that has not yet been assessed for stroke risk should be seen locally without delay. That assessment is quick, inexpensive and available in your own country.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • ECG showing the atrial fibrillation
  • Holter or event monitor report
  • Echocardiogram report
  • Current medicines with doses, including any anticoagulant

Also helpful

  • Thyroid function tests
  • Kidney function and full blood count
  • Details of episode frequency and duration
  • Any previous cardioversion or ablation reports
Send my reports for review See published cost ranges
Questions

Questions patients ask

It is the most effective rhythm control we have, but cure overstates it. Success is higher in paroxysmal fibrillation with a normal-sized left atrium and lower in long-standing persistent fibrillation with an enlarged one. A meaningful proportion of patients need a second procedure. Anyone quoting you a single success figure without seeing your echocardiogram is quoting a marketing number.

Usually yes, if your stroke risk score requires it — and importantly, that generally remains true even after a successful ablation. The score is based on age and conditions rather than on rhythm, and restoring normal rhythm does not by itself remove the risk. Do not stop anticoagulation without the advice of the doctor managing you.

Direct oral anticoagulants avoid regular INR testing and have fewer food and drug interactions, which is a considerable advantage if reliable monitoring is not available near your home. Warfarin remains necessary for patients with mechanical heart valves and for some with rheumatic mitral stenosis, and it is far less expensive. Kidney function also affects the choice.

No. Aspirin provides very little protection against stroke caused by atrial fibrillation and is not an acceptable substitute for anticoagulation where anticoagulation is indicated. It is still prescribed for this purpose in some places, and if you are on aspirin alone for atrial fibrillation, that is worth reviewing.

Possibly yes — for stroke prevention. Symptomless atrial fibrillation carries broadly the same stroke risk as symptomatic fibrillation, and this is the commonest and most consequential misunderstanding about the condition. Rate control may also be needed if your heart rate is persistently high, because that can weaken the muscle over time.

Usually around ten days to two weeks. That covers assessment, a transoesophageal echocardiogram to exclude clot, the procedure itself with a one to two night stay, and a review before you fly home. Anticoagulation continues throughout and afterwards.

RelatedOn this site
Heart treatment in IndiaRead → Mitral valve diseaseRead → Rheumatic heart diseaseRead → Heart failure and cardiomyopathyRead → Heart surgery cost in IndiaRead →
Contact

Send us your reports

Send an ECG or Holter report showing the rhythm, plus your echocardiogram and current medicines. The left atrial size is what tells us whether ablation is likely to work for you.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

WhatsApp +91 83035 86344  ·  Phone +91 83035 86344  ·  Email tibhind@gmail.com

Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.