Atrial Fibrillation (AFib)

Atrial fibrillation (AFib) — an irregular or quivering heartbeat — affects more than 2.2 million Americans. It’s the most frequently diagnosed form of cardiac arrhythmia.

At the UPMC Heart and Vascular Institute's Center for Atrial Fibrillation, we believe that early detection and treatment of atrial fibrillation lead to better results.

Contact the UPMC Heart & Vascular Institute

Request an appointment online, call 1-855-UPMC-HVI (876-2484), or email us.

What Is Atrial Fibrillation (AFib)?

Atrial fibrillation is an irregular, rapid heart rate. The condition is often referred to as "AFib" or "AF."

During atrial fibrillation, the heart's two upper chambers (the atria) quiver — instead of beating effectively — out of coordination with the two lower chambers (the ventricles). This may lead to palpitations, shortness of breath, weakness, and a variety of other symptoms.

Although atrial fibrillation itself is usually not life-threatening, it can increase the risk of serious complications, including stroke. For some people, episodes of AFib come and go (paroxysmal), while for others, the condition doesn't go away (persistent).

Causes of atrial fibrillation

Changes in your heart, as a result of heart disease or high blood pressure, can often cause atrial fibrillation.

Atrial fibrillation risks

Atrial fibrillation is very common, particularly among people over 60.

At any age, your risk for atrial fibrillation is increased if you have a history of:

  • High blood pressure
  • Coronary artery disease or heart attack
  • Abnormal heart valves
  • Diabetes
  • Sleep apnea
  • Obesity

Atrial fibrillation complications

Although atrial fibrillation itself usually isn't life-threatening, it can lead to complications.

It causes blood to be pumped improperly, resulting in pooling or clotting. 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 atrial fibrillation.

Untreated atrial fibrillation can also lead to other serious, potentially life-threatening conditions, including:

Your visit to the UPMC Atrial Fibrillation Center

When you arrive for your initial appointment, you’ll meet with a nurse practitioner or physician assistant, who will ask about your medical history and atrial fibrillation.

You'll receive:

  • A comprehensive education session about AFib, potential symptoms, risk factors, stroke risk, and treatment options.
  • A personalized patient education packet for you to take home.

Next, you’ll meet with a doctor from the UPMC Center for Atrial Fibrillation. This doctor will explain your treatment options and together, you will develop a plan of care. This may be based on your duration of AFIb, symptoms, and past medical history.

Once a treatment plan has been agreed upon, further testing may be required, like blood tests, an echocardiogram, and other tests.

Certain treatment options may require you to be admitted to the hospital and will be scheduled before you leave the office.

Find out what to expect during your diagnostic procedures.

Why choose UPMC for atrial fibrillation care?

The UPMC Heart and Vascular Institute's specialty centers and programs provide the latest research and treatment options for people with atrial fibrillation.

  • The Center for Atrial Fibrillation is a UPMC Center of Excellence, and the first in western Pennsylvania established to further the study of atrial fibrillation and educate patients and families about the condition.
  • The UPMC Cardiac Electrophysiology Program offers the full range of treatments for atrial fibrillation and other heart arrhythmias.

To make an appointment with an atrial fibrillation specialist at the UPMC Heart and Vascular Institute, complete an appointment request form, call 1-844-HVI-AFIB (484-2342), or send an email to CenterforAFib@upmc.edu.

Atrial Fibrillation Symptoms and Diagnosis

The heart is a pump. Like any pump, it requires a timer. Atrial fibrillation happens when the timer inefficiently beats faster.

Episodes of atrial fibrillation (AFib) can be chronic or can come and go.

Although it usually isn't a direct cause of death, atrial fibrillation should be taken seriously. It may cause serious life-altering illness, such as stroke.

Atrial fibrillation symptoms

AFib can cause a fast heartbeat, sometimes reaching as high as 170 beats per minute.

Atrial fibrillation may be occasional, or paroxysmal, with symptoms coming and going over time. Persistent atrial fibrillation causes the heart rhythm to consistently remain abnormal. Some people may not notice symptoms of AFib at all.

A fluttering, quivering feeling in the chest is common in people with atrial fibrillation. Others may experience signs and symptoms including:

  • Heart palpitations, including sensation of racing or fluttering within your chest
  • Chest pain
  • Shortness of breath
  • Fatigue
  • Reduced ability to exercise
  • Lightheadedness
  • Dizziness
  • Confusion

Diagnosing atrial fibrillation

Atrial fibrillation is a complex disease often missed in routine exams. Many times, a diagnosis uncovers other heart–related problems.

Although feeling your pulse may be enough for your doctor at the UPMC Heart and Vascular Institute to suspect atrial fibrillation, you’ll still need to undergo a thorough physical exam and evaluation.

Following your exam, your doctor may order additional tests and procedures to help confirm a diagnosis of atrial fibrillation.

Diagnostic tests for atrial fibrillation may include:

  • Blood tests
  • Chest x-rays
  • An electrocardiogram
  • An echocardiogram
  • A holter monitor
  • An event recorder
  • An electrophysiology (EP) study

Testing results
Your doctor or nurse will tell you when to expect your test results and will call you when they're available.

Preventing atrial fibrillation

A healthy lifestyle can help prevent or minimize many heart conditions. To reduce your risk of atrial fibrillation:

  • Eat a healthy diet and heart healthy foods.
  • Exercise and stay active on a regular basis.
  • Drink in moderation and quit smoking.
  • Maintain a healthy weight.
  • Monitor your blood pressure and cholesterol levels.
  • Take medications as prescribed and have regular follow-ups with your doctor.
  • To make an appointment with an atrial fibrillation specialist at the UPMC Heart and Vascular Institute, complete an appointment request form, call 1-844-HVI-AFIB (484-2342), or send an email to CenterforAFib@upmc.edu.

Atrial Fibrillation Treatment

Each case of atrial fibrillation is unique and requires personalized treatment. Your atrial fibrillation treatment will likely depend on the severity of your symptoms and how long you've had the condition. The goals of treatment include:

  • Normalizinge and controlling your heart rate.
  • Preventing blood clots.
  • Minimizinge uncomfortable symptoms.

At the UPMC Heart and Vascular Institute's Center for Atrial Fibrillation, we are confident we can find the right treatment for you.

On this page

Your doctor may suggest one or more of the following treatment options:


Medical management of atrial fibrillation

Doctors can control some less severe cases of atrial fibrillation with medicine. Different medicines produce different results.

Anticoagulants or blood thinners used to prevent clot formation and help reduce risk of stroke:

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

Rate control medicines used to slow the heart rate, such as:

  • Digitalis or Digoxin
  • Verapamil
  • Diltiazem (Cardizem®)
  • Metoprolol (Lopressor® or Toprol-XL®)
  • Atenolol

Rhythm control medicines used to maintain a regular heart rhythm:

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

Depending on your individual case, our experts at the UPMC Center for Atrial Fibrillation can determine whether medical management is right for you.

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Cardioversion for atrial fibrillation

Cardioversion is a noninvasive procedure that restores the heart's normal rhythm with electrical shock or chemical intervention.

The Cardiac Electrophysiology Program at UPMC's Heart and Vascular Institute performs electrical and chemical cardioversion procedures for atrial fibrillation and other heart arrhythmias.

Electrical cardioversion:

  • Delivers a jolt of electricity through the chest wall to the heart.
  • Interrupts the abnormal heart rhythm of atrial fibrillation and often sets it right.
  • Is delivered under anesthesia, most often as an outpatient procedure.

Chemical cardioversion uses medicine to achieve the same effect.

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Implantable devices for atrial fibrillation

Some cases of atrial fibrillation require regulation of the heart's functions. Pacemakers and defibrillators are small devices that help control how the heart beats.

Your UPMC doctor may recommend implanting one of these devices to treat your atrial fibrillation.

  • Pacemakers regulate the heart's electrical impulses to produce effective pumping.
  • Defibrillators deliver a small electrical jolt that resets the heart's rhythm if it suddenly strays from normal.
  • In both devices, an electrophysiologist implants the device and connects its electrodes to the heart.

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Surgical procedures for atrial fibrillation

If you have severe atrial fibrillation and have not responded to other treatments, the experts at UPMC's Center for Atrial Fibrillation may recommend surgery.

When other less invasive therapies have been unable to effectively treat atrial fibrillation, or when structural changes of the heart exist — such as enlarged heart chambers or the presence of a leaking valve — surgery may be a more favorable option for long term outcome.

Open MAZE surgical procedure

The MAZE procedure is the gold standard open surgical approach to treat atrial fibrillation.

In the MAZE procedure, surgeons use tiny incisions in the heart to create a maze-like pattern of scars in the atria. These scars block the transmission of erratic electrical impulses.

Our surgeons are known for their expertise in the MAZE procedure. Our research and practice have helped evolve this form of therapy for atrial fibrillation.

Minimally invasive MAZE surgery

For selected patients, surgeons perform the MAZE procedure using a minimally invasive approach that does not involve opening the breast bone.

Important benefits of minimally invasive surgery for atrial fibrillation:

  • Offers the exclusion of the main region of the heart that has been responsible for stroke in atrial fibrillation — the left atrial appendage (appendix of the heart).
  • Allows many patients to be safely taken off of long term Warfarin (Coumadin®) following the MAZE procedure.

Isolated left atrial appendage ligation

For selected patients who may not be candidates for MAZE surgery and medically cannot take anticoagulants, such as Warfarin (Coumadin®), surgeons perform a minimally invasive approach to close off or ligate the left atrial appendage (or the appendix of the heart).

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Catheter-based ablation procedures for atrial fibrillation

A minimally invasive procedure called ablation can help the heart achieve and maintain a normal rhythm.

Ablation removes or destroys (ablates) a small amount of tissue responsible for the abnormal heart rhythm of atrial fibrillation.

Specialists at the Center for Atrial Fibrillation are experts at ablation techniques and have authored book chapters and research publications on the subject.

Types of ablation

  • Radiofrequency ablation uses radio energy to apply heat to the tip of the catheter to cauterize the heart tissue.
  • Cryoablation uses extreme cold to freeze and scar the heart tissue.

What to expect during an ablation procedure

During ablation therapy, the doctor:

  • Inserts a small tube or thin wire (catheter) in the veins to gain access to your heart's electrical conduction system.
  • Uses advanced imaging techniques to observe and guide the procedure.
  • Applies either heat (radiofrequency ablation) or cold (cryoablation) to the heart tissue.

Watchman™ device

The Watchman device offers an alternative to blood thinner medications to lower the risk of stroke in some people with AFib.

The Watchman is a parachute-shaped, implanted device that closes off the left atrial appendage, the area of the heart most commonly linked to clot formation that could lead to stroke in people with AFib.

Many people take blood thinner medications to lower their stroke risk, but blood thinners are not safe for everyone. Some people, including those with AFib not caused be heart valve disease, who have an increased risk of stroke and who cannot safely take blood thinners, may be candidates for the Watchman device.

During a Watchman procedure, your doctor:

  • Accesses a vein in your leg
  • Uses special moving x-ray imaging, called fluroscopy, to guide a catheter containing the device to your heart
  • Places the device in your left atrial appendage to close it off using ultrasound and fluroscopy guidance

The procedure typically takes a little more than an hour to perform. Over time, scar tissue forms around the device, permanently closing off the left atrial appendage.


Exploring new treatments for atrial fibrillation

Our doctors also are internationally recognized for their research into the underlying causes of arrhythmia and in using their discoveries to develop improved methods for diagnosing and treating atrial fibrillation and other arrhythmias.

To make an appointment with an atrial fibrillation specialist at the UPMC Heart and Vascular Institute, complete an appointment request form, call 1-844-HVI-AFIB (484-2342), or send an email to CenterforAFib@upmc.edu.

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Atrial Fibrillation Educational Materials

When you find out you have atrial fibrillation (AFib), you can turn to the UPMC Center for Atrial Fibrillation to learn more. We believe strongly that education makes a difference in recovery.

We'll help you navigate the options of modern atrial fibrillation medicines and understand what you can do to protect yourself.

By understanding your condition, you can move into a more proactive role, where you can make changes and actively participate in your treatment.

Personalized atrial fibrillation information

Whether you prefer a face-to-face visit with an atrial fibrillation specialist, a videoconferencing consultation, or a video presentation, we'll work with you, your family, and your trusted personal doctor to provide materials and answers tailored to your particular situation.

During your visit with us, you'll receive a binder full of information about atrial fibrillation — not just about the condition in general, but about your particular situation.

You can use this information to talk with your doctor and your family so that you can better manage your condition.

Customized atrial fibrillation education is the key to a better outcome and quality of life.

Online atrial fibrillation resources

The UPMC Heart and Vascular Institute offers general atrial fibrillation materials, links, and videos.

Many people find these resources helpful in answering their questions about atrial fibrillation and preparing them for their procedure or diagnostic test.

The links below will open a new browser window.

UPMC Patient Education Materials

From the American Heart Association

Emmi ™ Patient Education Videos

From our Health Library at UPMC.com

To make an appointment with an atrial fibrillation specialist at the UPMC Heart and Vascular Institute, complete an appointment request form, call 1-844-HVI-AFIB (484-2342), or send an email to CenterforAFib@upmc.edu.