Patient Care

Atrial Fibrillation at a Glance

There’s a good reason your physician checks your pulse each time you visit the doctor. Your heart rate says a lot about your health, and noticing an irregular heart rate can catch a number of conditions early on.

The most common type of irregular heart rate is called atrial fibrillation or AFib. “Fibrillate” means “to quiver” – and atrial fibrillation occurs when the electrical pulses that keep your heart beating fire abnormally in the uppermost chambers of the heart (the atrium), causing the atrium to flutter or quiver. There are several different types of AFib categorized based on their causes and duration, but each type can lead to complications if left untreated.

How Atrial Fibrillation Happens

Your heart is the muscle at the center of your circulatory system and is essential in pumping blood throughout your body. Blood carries the oxygen your organs need to function and keep you healthy. The heart beats thanks to a complex electrical system that controls the rate and rhythm of your pulse. When functioning normally, this electrical system coordinates the contractions of various chambers of the heart and allows blood to pump in and out of the heart at a steady pace. This is a complicated system, and when something like illness or injury weakens any part of it, the heart can begin to beat abnormally and can’t provide blood when and where the body needs it. In the case of AFib, the fluttering or quivering is caused by a misfiring of electrical pulses.

It can sometimes be difficult to notice when your heart beats irregularly. Most people need a physical examination to catch a slightly irregular heartbeat. In more severe cases, you may feel a noticeable rapid or irregular heartbeat or experience other symptoms of AFib. These symptoms can include, but are not limited to:

  • Fatigue
  • Fluttering or thumping feeling in the chest
  • Dizziness
  • Weakness
  • Shortness of breath
  • Confusion and anxiety
  • Chest pain or pressure – If you experience chest pain or pressure due to an irregular heartbeat, this indicates a medical emergency and a possible heart attack. Call 911 immediately.

The Difference Between Atrial Fibrillation, Heart Attack and Stroke

AFib a separate condition from heart attacks and strokes, but it is important to understand the difference and symptoms of each. Atrial fibrillation itself is not fatal, but it can put you at a much higher risk for life-threatening conditions such as heart failure or stoke.

A heart attack occurs when adequate blood cannot reach the heart due to a blockage – usually a clot in the coronary artery. Many heart attacks are sudden, intense and obvious, but others start slowly with mild pain and discomfort. If you experience any indication of a heart attack, such as chest pain or pressure, discomfort in other areas of the upper body (arms, neck, jaw, back or stomach), shortness of breath, dizziness or nausea – call 911 and get emergency help immediately. Even if it doesn’t feel serious in the moment, the “silent” symptoms of a heart attack can indicate that you need immediate medical attention.

A stroke occurs when the blood supply to the brain is limited or interrupted. Similar to a heart attack, this is usually caused by a clot, plaque build-up or blockage in the arteries. The FAST assessment is a good way to remember the immediate signs of a stroke:

  • Face: One side of the face droops when you ask the person to smile
  • Arms: The person cannot lift both arms or one drifts downward when they try
  • Speech: The person’s speech is slurred or strange
  • Time: If you observe any of these symptoms, call 911 immediately

Detecting and Treating Atrial Fibrillation

An electrocardiogram, or EKG, is used to diagnose AFib. This painless test is usually performed at the doctor’s office, but sometimes patients may be asked to wear a monitoring device at home to track their heart rhythm over a period of time. Whether or not you experience noticeable symptoms of AFib, once diagnosed, it is important to seek treatment to help balance your heart’s rhythm. Many cases of AFib can be treated with medication. Rate-control or anti-arrhythmic medication can help regulate your heartbeat and control fibrillation. To help prevent strokes, some patients are also prescribed medication such as aspirin to prevent clotting in the bloodstream. But in cases where medication does not help or major side effects occur as a result of certain medication, further surgical intervention may be necessary.

There are a few common procedures to treat AFib.

Ablation is a procedure that uses freezing or cauterizing to create scar tissue in the heart which breaks up the irregular electrical impulses causing fibrillation to help return heart rate and rhythm to normal.

The surgical treatment of AFib is called the Cox-maze procedure – and it was pioneered right here at Washington University School of Medicine. In 1987, former chief of cardiothoracic surgery James Cox, MD, performed the first maze procedure at Barnes-Jewish Hospital in St. Louis. During this procedure, the surgeon makes small, strategical incisions in the atria where the fibrillation occurs. These incisions create scar tissue in the form of a “maze” which, similarly to the scar tissue created during ablation, interrupts the irregular electrical impulses and allows regular impulses to pass through.

The most recent version of the procedure, the Cox-maze IV procedure, is considered the “gold standard” for the treatment of atrial fibrillation. This procedure can help return the heart’s rate and rhythm to normal, prevent blood clots and greatly reduce your risk for stroke. It is most often performed when AFib medication or ablation procedures don’t work, or when a patient experiences blood clots or strokes as a result of AFib. In some cases, when a patient is already undergoing heart surgery for another heart issue and also experiences atrial fibrillation, surgeons will provide the option to perform the maze procedure at the same time.

Read More: Emeritus Evarts A. Graham Professor of Surgery James Cox, MD, FACS, named recipient of the Jacobson Innovation Award

AFib may seem minor or even unnoticeable at first, but it can lead to serious conditions down the line if not properly diagnosed and treated. Ensuring your heart is healthy and functioning properly is a key part of keeping yourself feeling your best. Your risk for AFib (and many other heart conditions) increases with age and other factors such as existing heart or thyroid disease, high blood pressure and family history of AFib. You can check your pulse at home – a normal resting heart rate should be between 60-100 beats per minute – and keep an eye on any signs or symptoms to help catch early warning signs of irregular heartbeat. Regular visits to your doctor can ensure AFib is noticed and treated early on to prevent complications in the future. If you notice any signs of stroke or heart attack, call 911 immediately.

Atrial Fibrillation Surgery at Washington University

Washington University cardiothoracic surgeons are internationally recognized as leaders in heart surgery. Our team utilizes an interdisciplinary approach alongside other expert physicians at the Washington University and Barnes-Jewish Heart and Vascular Center to ensure all-around care. Our cardiothoracic surgeons have long been recognized for pioneering innovations in heart and lung disease and remain on the cutting-edge of research and care. Barnes-Jewish Hospital consistently ranks among the best hospitals in the nation for cardiology and heart surgery, according to U.S. News & World Report.

To make an appointment with our nationally recognized Washington University heart surgeons, or to refer a patient, please call 314-362-7260.