Atrial Fibrillation

Atrial fibrillation is an abnormal heartbeat rhythm defined by an irregular, disorganized heartbeat.

In atrial fibrillation, sometimes called AFib, the top chambers of the heart quiver (fibrillate), and the fibrillating electrical activity is transmitted to the lower chambers of the heart, where it results in irregular, often fast, heartbeats.

Medical and surgical treatments exist today to restore a normal heart rhythm, relieve symptoms and improve quality of life.

The choice of treatment for AFib depends on the severity of your symptoms, prior treatments that were unsuccessful and other medical conditions that affect risk.

Our multidisciplinary team of cardiologists, surgeons and clinical nurse specialists successfully treats people with AFib in order to slow down the heart rate and reduce symptoms.

What is AFib?

AFib is an extremely fast and abnormal heartbeat.

A healthy person’s heart usually beats about 60 to 150 times per minute.

With AFib, electrical impulses can cause 400 or more beats per minute from the upper chambers of the heart, called the atrium. The heart ventricles struggle to keep up with the faster heartbeat. This can lead to blood pooling in the atrium, which may cause blood clots and strokes.

Who is at risk?

Anyone can develop AFib. However, the likelihood increases with age. Medical research predicts that the number of atrial fibrillation patients will likely increase in the coming years, with people living longer today.

Risk factors for atrial fibrillation include:

• Advanced age: The number of adults developing atrial fibrillation increases markedly with older age. It is rare in children but can occur.
• High blood pressure: Longstanding, uncontrolled high blood pressure can increase your risk of developing AFib.
• Underlying heart disease: Heart disease, valve problems, hypertrophic cardiomyopathy, acute coronary syndrome, Wolff-Parkinson-White syndrome and a history of heart attack are all risk factors.
• Drinking alcohol: Drinking in high volumes increases the risk of atrial fibrillation.
• Smoking: Smoking is a risk factor for many diseases, including AFib. Quitting tobacco lowers these risks.
• Family history: There is a heightened likelihood of developing AFib if you have family members who have been diagnosed with the disease.
• Sleep apnea: Studies indicate a correlation between obstructive sleep apnea and AFib. Treating sleep apnea may improve the condition.
• Athletes: Rapid heart rate, known as supraventricular tachycardia, may trigger AFib in athletes.
• Physical inactivity: A lack of regular physical activity can increase the risk of developing AFib.
• Obesity and being overweight: Maintaining a healthy weight will help prevent the onset of AFib.

Read more from the American Heart Association >>

AFib symptoms

Some people with AFib have symptoms, while others do not. Symptoms usually appear if your heart ventricles are beating faster than normal.

Symptoms include:

Types of AFib

There are three types of atrial fibrillation:

• Paroxysmal (intermittent): Atrial fibrillation is not present all the time and goes back to a normal rhythm on its own.
• Persistent (continuous): When this occurs, AFib is present all the time, but it can be cardioverted (changed by a cardioverter defibrillator) back to a normal rhythm.
• Permanent (chronic): AFib of at least six months’ duration; the heart cannot return to normal rhythm after cardioversion.

Testing for AFib

If your doctor suspects you may have AFib, they will check your heart rate and rhythm.

An electrocardiogram (also called ECG 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.

During an EKG, you will have sensors placed on your chest, arms and legs. These sensors are connected to a machine that measures electrical currents in the body. This test can help check:

• Heart rate and rhythm
• The heart’s electrical signals
• Where contractions are happening in the heart

Surgery for AFib

A catheter-based ablation procedure can destroy tissue surrounding the connection of the pulmonary veins to the left atrium using radiofrequency energy. This procedure can provide a cure for many people with AFib, especially if the AFib is intermittent.

A surgical procedure called the Cox-Maze procedure blocks abnormal electrical signals in the heart. In this operation the surgeon makes small incisions in the atria, creating scar tissue that helps guide the heart’s electrical signals.

The Cox-Maze procedure was developed by experts at WashU Medicine almost 40 years ago, and our surgeons have continued to improve the operation over the years, making it even more effective at fixing atrial fibrillation.