Atrial Fibrillation (AFib)

Atrial fibrillation (AFib) is an arrhythmia (irregular heartbeat). This condition happens when your heart's upper chambers (atria) quiver rapidly and in an uneven pattern. 

AFib can raise your risk of stroke, heart failure or other arrhythmias. But with treatment and a heart-healthy lifestyle, you can significantly reduce your risk of these problems.

The electrophysiologists at the Center for Cardiovascular Health provide the most advanced AFib treatments available. Our specialists perform complex procedures, including re-ablations and treatments for long-term AFib. We regularly care for people with even the most complex cases.

When the atria quiver, they can’t contract and pump blood normally. When this happens:

1. Blood flows sluggishly from your heart’s top chambers. This blood can pool in a small pouch called your left atrial appendage (LAA) and form a blood clot.
2. The blood clot can move out of the LAA and into your bloodstream. From there, it can travel to your brain, causing a stroke.

AFib is a progressive disease that worsens over time without treatment. The three types of AFib are based on how long you’ve had the condition:

• Paroxysmal AFib: This type of AFib lasts for fewer than seven days. AFib episodes may only happen occasionally, and your heart rate returns to normal on its own or with treatment.
• Persistent AFib: You have persistent AFib if you’ve had it longer than seven days. This type will not go away on its own and requires treatment to restore your heartbeat to a normal rhythm. 
• Long-standing persistent AFib: AFib that lasts longer than 12 months is long-standing persistent AFib. It is more difficult to treat than paroxysmal or persistent, but new treatments can restore a normal heartbeat in people with this type of AFib.
• Permanent AFib: AFib becomes permanent if the heart cannot return to a normal rhythm, even with treatment.

AFib doesn’t always cause symptoms, so many people don’t know they have it. But if you do have symptoms, you may experience:

• Anxiety
• Chest pain
• Confusion
• Dizziness
• Feeling lightheaded
• Lack of interest in activities you normally enjoy
• Palpitations (Feeling of your heart fluttering, pounding or beating rapidly)
• Shortness of breath or trouble breathing
• Fatigue

It can be difficult to distinguish between AFib and a life-threatening heart attack. If you have chest pain or trouble breathing, call 911.

AFib affects millions of people in the U.S. Many different factors can cause AFib, but the most common ones include: 

• Coronary artery disease (buildup of plaque in your arteries)
• High blood pressure (hypertension), especially if it’s untreated
• Previous heart surgery

You may have a higher risk of developing AFib if you:

• Are over age 65
• Drink higher amounts of alcohol (regularly drink more than two drinks per day for men and one drink per day for women)
• Have a family history of AFib 
• Smoke
• Use illegal drugs such as cocaine, opiates or methamphetamine

Certain health conditions can also make you more prone to getting AFib, including:

• Diabetes
• Heart failure
• Obesity
• Sleep apnea (when your breathing pauses during sleep)
• Thyroid disease

To diagnose AFib, your provider may start with a physical exam and a discussion of your medical history. They will ask you about health conditions that affect your family members. Then, they may order one or more medical tests, such as:

• Electrocardiogram (EKG or ECG): This noninvasive test records your heart’s electrical activity and is one of the best ways to find an arrhythmia. Your provider places electrodes (stickers with wires) on your chest and connects them to a computer. The computer then records your heartbeat. Sometimes providers combine EKG with exercise (stress test).
• Heart imaging tests: Your provider may use imaging tests to see the structure of your heart and how it moves. These tests may include an echocardiogram (heart ultrasound), heart CT scan or a cardiac MRI.
• Sleep study: If your provider suspects you have sleep apnea, they may order a sleep study. Providers use monitors to record your brain waves and heart rate while you sleep at home or in a sleep center.
• Stress test: During a stress test, you walk or run on a treadmill to speed up your heart rate. During the exercise, our team closely monitors you and records your heartbeat with an ECG.
• Wearable monitor: A cardiac event monitor or patch monitor is a small device you wear at home for a few days or weeks. This type of monitoring is useful if the arrhythmia happens only occasionally. Some of these devices use stickers on your skin, and others require a minor surgical procedure to implant them. A cardiac event monitor detects abnormal heartbeats and sends the information to your provider. 
• Wearable devices: Some watches and wearable fitness devices can identify AFib by recording a 30-second ECG. Then, they can upload the results into your medical chart for review.

Restoring your heartbeat to a normal rhythm is easier if you’ve had AFib for a short time. If you have symptoms of AFib, see your provider right away so you can receive prompt treatment.

Your treatment plan depends on the type of AFib, your age and your health history. Treatment options include:

• Medications: Medications can help your heart pump blood more effectively or prevent blood clots that can lead to stroke. 
• Cardioversion: This procedure uses electrical impulses to restore your heartbeat to a normal rhythm. You may receive cardioversion in an emergency, or it can be a planned procedure.
• Left atrial appendage closure (LAAC): The LAAC procedure permanently closes off the LAA, where blood clots commonly form. It is minimally invasive and doesn’t require open-chest surgery. People who cannot take blood thinners may be eligible for this treatment. Our electrophysiologists have significant expertise and perform a very high volume of LAA closures. 
• Catheter ablation: These minimally invasive procedures use a thin wire (catheter) to permanently damage (ablate) the cells causing AFib. Cardiac catheter ablation is effective for paroxysmal and persistent AFib. As an advanced electrophysiology center, we also offer the convergent procedure to treat long-standing persistent AFib.
• Atrioventricular (AV) nodal ablation: This procedure may be helpful if other therapies have not worked well for you. First, doctors ablate the AV node so it cannot send electrical signals to the bottom chambers of your heart. Then, they implant a pacemaker that takes control of your heartbeat. After AV node ablation, you need a pacemaker for the rest of your life.
• Maze procedure: During the maze procedure, your surgeon creates a “maze” of scar tissue on your heart that blocks AFib signals. In the hands of an experienced cardiac team, most patients have good outcomes from this surgery.

Our team provides expert care for AFib in the Puget Sound area.