Atrial Fibrillation (AFIB)

Atrial fibrillation (AFIB) is the most common type of arrhythmia or abnormal heart rhythm. AFIB is caused by an electrical problem in the heart. It affects more than 6 million people in the U.S. and is most commonly diagnosed in older adults.

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On this page

• What Is Atrial Fibrillation (AFib)?
• What Are the Symptoms of AFib?
• How Do You Diagnose AFib?
• How Do You Treat AFib? 

What Is Atrial Fibrillation (AFib)?

Atrial fibrillation, also known as AFib, is an abnormal heart rhythm caused by an electrical problem in the heart. AFib occurs when the top two chambers of the heart (the atria) beat irregularly. This typically causes a fast heartbeat and affects the heart’s ability to pump blood to the rest of the body.

AFib itself is not typically life-threatening, but it is a serious condition that can cause discomfort. If undiagnosed or untreated, AFib can increase the risk of other serious conditions, such as heart failure, blood clots, and stroke.

How common is atrial fibrillation?

AFib is the most common type of abnormal heart rhythm, affecting 6 million people in the U.S. and 40 million people around the world. The risk of developing AFib increases with age. Although AFib can occur in people of any age, it is most common in older adults.

What are the types of atrial fibrillation?

There are several categories of AFib, including:

• Paroxysmal atrial fibrillation –A type of AFib that causes episodes that come and go. Each episode can last only minutes or up to a week.
• Persistent atrial fibrillation – A type of AFib that lasts longer than a week but less than a year.
• Long-term persistent atrial fibrillation – lasts more than a year.
• Permanent atrial fibrillation – When the patient and their provider(s) have decided to make no further attempts to restore normal heart rhythm.

What causes AFib?

AFib is caused by a problem with the heart’s electrical system, which causes the heart to beat fast and irregularly.

Age is the leading risk factor for atrial fibrillation. Other major risk factors include coronary artery disease, myocardial infarction (heart attack), heart valve problems, congenital heart conditions present at birth, high blood pressure, obstructive sleep apnea, obesity, alcohol use, and thyroid disease.

What are AFib risk factors and complications?

AFib risk factors

• Being over age 65.
• Caffeine and alcohol use, especially in large amounts.
• Changes in the amount of minerals (electrolytes) in the body.
• Extreme stress.
• Family history of AFib or heart disease.
• Having high blood pressure, sleep apnea, obesity, or other chronic health problems.
• Intense physical activity, such as endurance sports.
• Personal history of heart problems or heart surgery.
• Smoking.
• Using illegal drugs.

Complications of AFib

Although AFib isn't usually life-threatening, it can lead to serious health problems like stroke.

AFib causes the heart to pump blood improperly, which may result in pooling or clotting into a small appendage in the left atrium called the left atrial appendage. If a blood clot moves to an artery in the brain, it can lead to stroke.

In fact, about 15 percent of all strokes occur in people who have AFib.

Untreated AFib can also lead to other serious, even life-threatening, conditions such as:

• Cardiomyopathy (heart muscle disease).
• Heart failure.

How can I reduce my risks of AFib?

You may not be able to prevent AFib, especially if you have a family history or another type of heart disease. However, a healthy lifestyle can help prevent or lessen the risk of AFib and other heart conditions.

To reduce your risk of AFib:

• Check your blood pressure and cholesterol levels.
• Drink in moderation and quit smoking.
• Eat a balanced diet with lots of heart-healthy foods.
• Maintain a healthy weight.
• Regularly work out and stay active.
• Take your medicine as prescribed and have regular follow-ups with your doctor.

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What Are the Signs and Symptoms of AFib?

AFib symptoms can vary. Some people have no symptoms or very vague symptoms such as fatigue. Others can be very symptomatic with chest pain, palpitations, shortness of breath, or lightheadedness.

AFib can cause a fast heartbeat, sometimes as high as 170 beats per minute. The most common symptom is palpitations, which some describe as a fluttering sensation in the chest.

Common AFib signs and symptoms include:

• Chest pain.
• Confusion.
• Dizziness.
• Fatigue.
• Lightheadedness
• Shortness of breath

When should I see a doctor about my AFIB symptoms?

If you have AFib symptoms, contact your primary care provider or cardiologist right away. You should contact a provider when you are experiencing:

• Chest pain.
• Lightheadedness or dizziness.
• Rapid heart rate (heart rate consistently above 100 bpm).
• Shortness of breath.
• Syncope (passing out).

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How Do You Diagnose AFib?

Sometimes, providers may suspect AFib after listening to your heart sounds or feeling your pulse. However, the only way to truly diagnose atrial fibrillation is by obtaining an electrocardiogram (ECG/EKG). This test records the electrical activity of your heart, shows abnormal rhythms, and can sometimes detect heart muscle damage.

What to expect during your visit

When you arrive for your first appointment, you'll meet with a physician, nurse practitioner, or physician assistant. He or she will ask about your medical history and AFib symptoms.

We'll give you a:

• Complete education session about AFib symptoms, risks, and treatments.
• A tailored patient education packet for you to take home.

Together, you will design and agree on a care plan which may include additional testing. Tests to diagnose AFib and help to formulate a treatment plan may include:

• Electrocardiogram (ECG or EKG) — This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
• Echocardiogram (ECHO) — This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The ECHO sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
• Holter monitor — This wearable ECG device records your heart's activity throughout the day.
• Event recorder — This portable device is similar to a Holter monitor. However, it only records when you are having symptoms.
• Electrophysiology (EP) study — A minimally invasive test that assesses your heart's electrical system. The test is performed by inserting catheters and electrodes through blood vessels that enter the heart.

AFib outlook

AFib is not usually life-threatening, but getting early treatment can help reduce the risk of related problems. You should work closely with your doctor to manage your AFib.

Make sure you go to all your medical appointments, follow your doctor’s instructions, take your medications (if any) as directed, and tell your doctor about any changes in your AFib symptoms.

Your overall outlook can be dependent on your lifestyle choices. Obesity, untreated sleep apnea, and alcohol use are significant contributing risk factors for AFib.

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How Do You Treat AFib?

Each case of AFib is unique and requires customized treatment. Your treatment will depend on your symptoms, age, how long you've had AFib, and heart function.

The goals of AFib treatment are to:

• Decrease symptoms.
• Normalize and control your heart rate.
• Prevent blood clots to reduce the risk of stroke.

At the UPMC Heart and Vascular Institute, our experts will find the right treatment for you.

Medicine to treat atrial fibrillation

One of your provider’s first priorities will be to determine your risk of blood clots and stroke. Your provider may prescribe:

Blood thinners that prevent clots from forming and help reduce risk of stroke, such as:

• Apixaban (Eliquis^®).
• Aspirin.
• Dabigatran (Pradaxa^®).
• Edoxaban (Savaysa^®).
• Rivaroxaban (Xarelto^®).
• Warfarin (Coumadin^®).

Medications to control heart rate and rhythm

Your provider will recommend two potential treatment options:

• Rhythm-control strategy which helps to reduce atrial fibrillation episodes by frequency and duration.
• Slowing your heart rate to avoid rapid or fast heart rates.

Drugs can be used to slow the heart rate or to help stay in normal rhythm.

Rate control drugs to slow the heart rate include:

• Atenolol.
• Bisoprolol (Zebeta).
• Carvedilol (Coreg).
• Digitalis or Digoxin.
• Diltiazem (Cardizem®).
• Metoprolol (Lopressor® or Toprol-XL^®).
• Verapamil.

Rhythm control drugs to maintain a regular heart rhythm include:

• Amiodarone (Pacerone® or Cordarone^®).
• Dofetilide (Tikosyn^®).
• Dronaderone (Multaq^®).
• Flecainide (Tambocor^®).
• Propafenone (Rhythmol^®).
• Sotalol (Betapace^®).

Based on your unique case, our AFib experts can decide if medication is right for you.

Cardioversion for atrial fibrillation

Cardioversion is a noninvasive treatment that restores your heart's normal rhythm with a shock or drug.

What happens during cardioversion?

Electrical shock cardioversion

• Sends a jolt of electricity through your chest wall to the heart while you are under moderate sedation.
• Interrupts the abnormal heart rhythm of AFIB and often resets it back to normal sinus rhythm.

Chemical cardioversion uses medicine to achieve the same effect.

UPMC's Heart and Vascular Institute offers both types of cardioversion treatment for AFib and other heart arrhythmias.

Catheter-based ablation for atrial fibrillation

Catheter ablation or pulmonary vein isolation is a minimally invasive procedure that can help the heart achieve and maintain a normal rhythm. It removes or destroys (ablates) a small amount of tissue that is causing abnormal heart rhythm.

At UPMC, our experts have authored and published book chapters and research on ablation techniques and perform many procedures each year.

What happens during catheter-based ablation?

During your ablation, your doctor will:

• Use general anesthesia so you will be asleep during the procedure.
• Insert a small tube or a thin wire called a catheter into a large vein in your groin and guide it to your heart.
• Use x-ray and ultrasound imaging technology to guide and observe the procedure.

When the catheter is in the right place, your doctor will burn a small amount of tissue using:

• Cryoablation which uses extreme cold to freeze and scar the heart tissue.
• Radiofrequency ablation which heats the tip of the catheter to burn and scar the heart tissue.

Implantable devices for atrial fibrillation

Your UPMC doctor may suggest implanting a device to help control how your heart beats:

• Pacemakers are used to help regulate slow heart rates. Some patients who have fast heart rates with atrial fibrillation convert to a very slow normal rhythm or have pauses in their heartbeat. A pacemaker delivers electrical impulse to help speed the heart rate up.

What happens during device implantation?

An electrophysiologist — a cardiologist who specializes in treating heart rhythm problems — implants the device and connects its electrodes to the heart during a minimally invasive procedure.

Cardiac surgery for atrial fibrillation

If you have severe AFIB that hasn’t responded to other treatments, the experts at UPMC's Center for Atrial Fibrillation may suggest surgery.

Surgery may give you better long-term results when:

• Less invasive AFIB treatments haven't worked.
• You have changes to your heart's structure such as enlarged heart chambers or a leaking valve.

What happens during cardiac surgery for atrial fibrillation?

This will depend on the type of procedure you are having.

One of the most common surgical procedures for AFIB is a MAZE procedure. During MAZE, your surgeon will make tiny cuts on the outside of your heart to create a maze-like pattern of scars in your atria. These scars block the abnormal electrical signals.

There are two types of MAZE procedures for AFIB:

• Open MAZE surgery – An open-heart procedure. That means your surgeon will open your chest to perform the procedure.
• Minimally invasive MAZE surgery – Doesn't involve opening your chest but requires smaller incisions.

Surgeons at UPMC's Center for Atrial Fibrillation are experts in the MAZE procedure. Our research and experience have helped advance this treatment for AFib.

Benefits of MAZE procedures for AFib include:

• Targeting abnormal electrical signals from the outside surface of the heart called epicardium.
• Reducing the amount of atrial fibrillation in patients with difficult to treat atrial fibrillation —especially those who have been in atrial fibrillation for a year or more.

Another type of cardiac surgery for AFIB is called isolated left atrial appendage ligation.

Surgeons may suggest this type of surgery if you are a good candidate for MAZE surgery, as they are typically performed together. Using a clip to clamp off the left atrial appendage also helps to reduce the abnormal signals that cause atrial fibrillation. The clip may also reduce the risk of stroke.

Hybrid ablation for atrial fibrillation

Hybrid ablation is a minimally invasive treatment for AFIB. It combines both the surgical MAZE procedure and left atrial appendage clip with catheter-based pulmonary vein isolation. The procedure targets small amounts of tissue on the inside and outside of the heart, creating scar tissue that blocks abnormal electrical signals.

What happens during hybrid ablation?

Your hybrid ablation will be performed by an electrophysiologist and a cardiac surgeon. The procedures are done in stages.

Typically, the MAZE and left atrial appendage clip procedure are performed first by the cardiac surgeon. Then, approximately eight weeks later, pulmonary vein isolation is performed by the electrophysiologist.

You will be asleep during these procedures with general anesthesia.

Your doctors will:

• Make a few small incisions in your chest and insert instruments to perform the surgical procedure on the outside of your heart.
• Insert a catheter into a blood vessel and guide it to the inside of your heart.
• Use heat or cold to burn small amounts of tissue, creating scars that block abnormal electrical signals on both the inside and outside of your heart.

Watchman™ device for atrial fibrillation

Many people with AFIB take blood thinners to lower their stroke risk, but they aren't safe for everyone. Left atrial appendage closure (LAAC) using a Watchman or Amulet device may lower the risk of stroke in some people with AFIB who are unable to take blood-thinning drugs.

These devices are implanted in the left atrial appendage of the heart. This is the part of the heart where blood clots may form that cause stroke in people with AFib.

Some people who might benefit from LAAC include those who:

• Have AFib not caused by heart valve disease.
• Have an increased risk of stroke and can't safely take blood thinners due to prior bleeding events, medication interactions or intolerances, or concern for frequent falls and head injury.

What happens during a LAAC procedure?

During a LAAC procedure, your doctor will:

• Use general anesthesia so you will be asleep during the procedure.
• Use a blood vessel in your groin to place a catheter containing the Watchman or Amulet device.
• Use special x-ray imaging, called fluoroscopy and transesophageal echocardiogram (ultrasound probe in the esophagus), to guide the catheter and device into the right place in the left atrial appendage.
• Advance the device out of the catheter and into your left atrial appendage to close it off.

In most cases, LAAC takes about one hour or less to perform. Over time, scar tissue forms around the device and closes off the left atrial appendage permanently.

How effective are treatments for AFIB?

Our experts can recommend the best AFIB treatment for you and develop a plan to help you manage your risk for stroke and other complications. With early diagnosis and ongoing care, AFIB can be effectively treated or managed.

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Why Choose UPMC for AFIB Care?

The UPMC Heart and Vascular Institute provides the latest AFIB research and treatment options.

Our experts are leaders in AFIB techniques and teach patients and families about the condition.

The UPMC Cardiac Electrophysiology Program offers the full range of treatments for AFIB and other heart arrhythmias.

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By UPMC Editorial Staff. Last reviewed on 2024-10-01 by Erica Byers, CRNP.