Atrial Fibrillation

Understanding Atrial Fibrillation (AFib or AF)

The heart is a muscular pump made up of valves, pipes and an electrical system. Problems within the electrical system cause irregular heart rhythms (arrhythmias). AFib is the most common type of arrhythmia.

If you have AFib, your heartbeat can be fast, chaotic and irregular. AFib can lead to blood clots, stroke or heart failure because your heart isn’t pumping blood like it should.

AFib has three stages (The Three Ps):

1. Paroxysmal: In the beginning, your heart goes in and out of rhythm for few minutes to few hours and returns to normal rhythm on its own.
2. Persistent: As AFib advances, your heart still goes out of rhythm and symptoms persists for more than a week. The heart rhythm does not reset on its own medical treatment or catheter ablation is needed to correct the heart rhythm.
3. Long standing persistent: AFib can become long lasting and lasts for more than a year. It requires electrical shock or medicine or a procedure such as catheter treatment is needed.
4. Permanent atrial fibrillation: When this happens, heart rhythm cannot be rest. Your doctors can control your heart rate with medicines.

AFib Symptoms

You may be able to feel your heart beating irregularly. Some describe it as a flip-flop, fluttering or flickering feeling in their chest. It’s also possible to notice heart rate abnormalities if you wear a fitness tracker, such as a smartwatch.

Although AFib does not always have noticeable symptoms, other signs include:

• Feelings of a rapid, fluttering or pounding heartbeat, called palpitations
• Fatigue, weakness
• Light-headedness
• Shortness of breath
• Chest pain
• Stroke

Diagnosing Atrial Fibrillation

Your doctor will perform a physical exam and listen to your heartbeat. Because arrhythmias are unpredictable, your heart may or may not appear normal at times. Your doctor will also ask you to describe your symptoms.

If no arrhythmia is present, your doctor may have you wear a portable device to track your heart rhythms for 24 hours or longer. Fitness tracker data can also help your doctor determine if you have an arrhythmia.

Doctors consider electrocardiograms (EKG or ECG) the gold standard when it comes to diagnosing AFib. EKGs are often performed in your doctor’s office or at the hospital. They are painless and take minutes to complete. During an EKG:

1. Your doctor attaches electrodes (sensors) to your chest and limbs using an adhesive. This takes a few minutes.
2. The electrodes record your heart’s electrical activity for 10 seconds.

Can fitness trackers detect heart problems?

Fitness trackers that monitor your heart rate can help diagnose AFib. It’s hard to catch an arrhythmia early — irregular rhythms often stop as quickly as they start. But fitness trackers, smart watches or hand-held heart monitoring devices can give doctors a valuable history of your heart’s activity.

Atrial Fibrillation Treatment at IU Health

IU Health Heart & Vascular Care is home to internationally recognized leaders in the treatment of heart rhythm disorders — that’s why doctors from around the U.S. refer their patients to us. Our physicians treat more patients with complex arrhythmias than any other heart care program in Indiana. That means you receive expert care for AFib.

Health problems that can cause AFib include:

• High blood pressure
• Heart disease such as enlarged heart, heart valve disease and heart failure
• Sleep disorder called sleep apnea
• Prior heart surgery
• Family history. An increased risk of atrial fibrillation can occur in some families
• Excessive alcohol use
• Illegal drug use
• Smoking or using tobacco
• Advanced age (more than 65 years)
• Obesity
• Lung diseases, including COPD and chronic lung disease
• Thyroid disease

Approximately 10% of patients have no discernable cause.

Why is it important to treat AFib?

• Blood clots can form in the left upper chamber of the heart due to chaotic and ineffective beating of the heart. Blood clot can lead to stroke and one out of 5 strokes may be due to untreated or undiagnosed AFib. The clot from the heart can travel to various part of the body and can cause bowel, kidneys and limb damage.
• If untreated AFib can weaken the heart and cause heart failure up to 30% patients
• It can also cause heart valve leakage and heart failure
• In a minority of patients AFib can cause slow cognitive decline or dementia

How can we prevent AFib?

• Blood pressure and diabetes control
• Use of sleep mask if you have sleep apnea
• Healthy lifestyle: Heart healthy diet, regular exercise, 7-9 hours of sleep
• Maintain an ideal weight.
• Avoid smoking, excess caffeine intake, and illicit drug use

Catching AFib early is critical to successful outcomes. Our specialists offer a full range of treatment, including:

• Use of blood thinner in patients with a high risk for stroke
• Medical therapy for heart rate and rhythm control
• Simple to complex ablations
• Comprehensive ablation program
  • Catheter and cryoablation of AFib
  • Surgical treatment (hybrid procedure and MAZE procedure)
• Comprehensive assessment for stroke risk, including:
  • Implantation for left atrial appendage closure devices, such as WATCHMAN
• Cardioversion to restore normal rhythm
• Device therapy for heart rate control
• Long-term ambulatory monitoring for better risk stratification
• Risk reduction for better quality of life of patient and treatment outcomes

Our atrial fibrillation team

Our AFib team meets regularly to provide personalized treatment plans for our patients — and adjust them when needed. Our team of AFib experts includes:

• Cardiologists (heart doctors)
• Electrophysiologists (heart rhythm experts)
• Heart surgeons
• Nurse practitioners
• Researchers
• Physician assistants

Our AFib procedure outcomes

• We are one of the only institutions in the state participating in The American College of Cardiology’s AFib Ablation Registry. This registry allows us to better track our AFib data and performance.
• To cure AFib with catheter or cryoablation in most patients
• In patients with complex heart rhythm disorder, hybrid procedure (catheter and minimally invasive surgery) may be required
• Exploring the possibility of same-day discharges and sometimes next day after procedures

Our participation ensures you receive quality care and evidence-based treatments with proven results.

Our AFib Research

Our cardiovascular researchers are working tirelessly to improve AFib care. They often collaborate on the latest advances — from heart procedures to medical therapy. Their efforts have led to shorter, safer procedures, which means a faster recovery and less downtime for you.

Some of our focus areas include:

• Role of autonomic nervous system in treatment of atrial fibrillation
• Using different forms of energy for ablation procedures, including cold, or heat
• Understanding the mechanism of complex heart rhythm disorder and novel technics to cure