Electrophysiology

Atrial Fibrillation

Irregular and sometimes rapid heart rhythm

About AFib AFib Types Cardiac Ablation Contact Us

About Atrial Fibrillation

Atrial fibrillation (AFib or AF) is an arrhythmia (abnormal heart rhythm) characterized by irregular and sometimes rapid heart rates. It can lead to blood clots in the heart and increases the risk of stroke, heart failure and other heart-related complications. The irregular heart rhythms associated with AFib originate in the heart's upper chambers (atria). When AFib occurs, the heart's normal electrical impulses are interrupted, causing fast and chaotic heart rhythms and impairing blood flow from the top to the bottom of the heart.

Some experts have labeled AFib as the emerging cardiovascular epidemic of the 21^st century. It is increasingly common in older adults and results in almost half a million hospitalizations each year in the U.S.

What are the Different Types of Atrial Fibrillation?

Atrial fibrillation (AFib) can mean several different cardiac irregularities. Understanding the various types is crucial for effective treatment and risk assessment. Here are the primary classifications:

Paroxysmal AFib: Characterized by sudden, brief episodes lasting less than one week. It can stop on its own without treatment.
Persistent AFib: Episodes extend beyond seven days, necessitating medical intervention.
Long-standing Persistent AFib: Episodes endure for over 12 months, often challenging to treat effectively.
Permanent AFib: Episodes persist despite attempts to restore normalcy, prompting treatment to focus on controlling heart rate.

AFib episodes often start with short bursts of rapid and irregular heartbeats. These irregular heartbeats sometimes go away on their own, and no medical intervention is needed. However, if the condition progresses, the episodes continue and become more frequent and long-lasting.

Depending on how fast your heart's lower chambers (ventricles) are beating, your symptoms may vary — with about 20% of patients having little to no symptoms at all. As your heart rates increase persistently over a longer period, you will often notice symptoms. These symptoms could include:

Palpitations: the feeling of your heart pounding, fluttering, skipping beats or beating rapidly.
Rapid heart rate: 100-160+ beats per minute.
Fatigue.
Light-headedness.
Shortness of breath.
Weakness.
Dizziness.
Chest pain or discomfort.
Fogginess.
Feeling excessively fatigued during exercise.

To diagnose atrial fibrillation (AFib), your doctor will review your medical history, conduct a physical examination and perform diagnostic tests. The physical exam typically involves checking your pulse for irregularities. An electrocardiogram, echocardiogram and bloodwork may also be performed.

AFib treatments aim to restore a patient’s normal heart rate or rhythm, reduce symptoms, stop symptoms from worsening and prevent a stroke. Treatment procedures can vary and include:

Stroke Prevention: Blood thinners are often given to a patient to reduce the risk of blood clots forming, lowering the risk of a stroke. If the patients are unable to tolerate blood thinners, a simple procedure (left atrial appendage occlusion device insertion) can be performed to reduce the risk of stroke.
Controlling and lowering heart rate: Medications such as beta-blockers, calcium channel blockers and digoxin can slow the heart rate in AFib patients. If ineffective, catheter ablation with AV node ablation may be necessary. During this procedure, a catheter delivers energy to block the electrical flow from the atria to the ventricles. This makes it necessary to implant a pacemaker for heart rate regulation.
Restore normal heart rhythm: If a doctor seeks to re-establish a normal heart rhythm over a normal heart rate, this can be achieved through anti-arrhythmic drugs, catheter ablation, surgical ablation or electrical cardioversion. During electrical cardioversion, electrodes placed on the chest and/or back deliver a precise electrical shock to the heart at a specific moment in its beating cycle.
Lifestyle modifications: Often, many patients experience AFib due to lifestyle choices. Alterations to their lifestyle regarding diet, exercise and stress management may be sufficient to manage AFib symptoms. Speak to your doctor about what lifestyle changes could reduce and slow the progression of AFib.

Lifestyle choices and medical conditions can increase the risk of AFib.

Cardiovascular disease, including heart failure, coronary artery disease, valvular heart disease, rheumatic heart disease and cardiomyopathy.
Previous heart surgery. The risk is increased in the first few days following surgery.
Increasing age.
Family history of AFib.
High blood pressure.
Obstructive sleep apnea.
Obesity.
Diabetes.
Chronic kidney disease.
Hyperthyroidism.
Excessive alcohol consumption.
Cigarette smoking.

Cardiac Ablation

A Key Treatment Method for AFib

Cardiac ablation is a procedure that uses energy to create small scars in your heart tissue. In turn, the scars stop unusual electrical signals that cause uneven heartbeats, a condition called arrhythmia. Not everyone with a heart arrhythmia needs a catheter ablation. It’s usually recommended for people with arrhythmias that can’t be controlled by medication. Ablation can be administered through traditional surgery or minimally invasive, catheter-based procedures.

Surgical Cardiac Ablation

Surgical cardiac ablation is done through traditional open surgery of the chest cavity. There are three main types of surgical cardiac ablation:

Maze procedure: Typically done during open heart surgery, small incisions are made in the upper heart to form scar tissue and correct abnormal signals.
Mini-maze procedure: A less invasive alternative to open heart surgery, small incisions between the ribs are made for catheter ablation, sometimes assisted by robotic technology, to create scar tissue and regulate the heartbeat.
Convergent procedure: This method involves the internal and external application of radiofrequency energy to regulate the heartbeat by combining catheter ablation and a mini-maze procedure. This procedure is usually performed through small incisions during surgery.

Catheter-based Ablation

These procedures thread a thin, flexible tube (catheter) into your heart through a blood vessel. Energy destroys the cells causing arrythmia, helping to restore a regular heartbeat. There are two main types of catheter ablation:

Cryoablation: A catheter fitted with a balloon tip infused with a freezing substance creates tissue on the problematic cells, prompting scar formation.
Radiofrequency ablation: Radiofrequency energy, similar to microwave heat, is sent into the targeted tissue area, causing localized heating and destruction of abnormal cells or tissues — providing pain relief or tumor reduction.

Catheter ablation has benefits because it is done via a small incision. Patients typically require a shorter hospital stay, faster recovery, and reduced risk of complications like blood clots, heart failure or stroke.

Your doctor can help you decide which cardiac ablation therapy is right for you. This will depend on the cause and symptoms of your AFib and any other conditions you might have.

Contact Us

If you believe you may have AFib, are unsure or have it and need help managing it, we can help. Request an appointment with a ChristianaCare provider.

ChristianaCare Center for Heart & Vascular Health

Christiana Hospital
4755 Ogletown-Stanton Road
Newark, DE 19718

Get directions and find out more

Call 302-733-1000