Significant changes have occurred during the last few decades across the North Atlantic climate system, including in the atmosphere, ocean, and cryosphere. These large-scale changes play a vital role in shaping regional climate and extreme weather events across the UK and western Europe. This review synthesizes the characteristics of observed large-scale changes in North Atlantic atmospheric and oceanic circulations during past decades, identifies the drivers and physical processes responsible for these changes, outlines projected changes due to anthropogenic warming, and discusses the predictability of these circulations. On multi-decadal time scales, internal variability, anthropogenic forcings (especially greenhouse gases), and natural forcings (such as solar variability and volcanic eruptions) are identified as key contributors to large-scale variability in North Atlantic atmospheric and oceanic circulations. However, there remain many uncertainties regarding the detailed characteristics of these various influences, and in some cases their relative importance. We therefore conclude that a better understanding of these drivers, and more precise quantification of their relative roles, are crucial for more reliable decadal predictions and projections of regional climate for the North Atlantic and Europe.