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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 an 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 upper chambers (atria) of the heart. 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 21st 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. 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 the lower chambers (ventricles) of your heart 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. Electrocardiogram, echocardiogram, and bloodwork may also be performed.

The aim of Afib treatments is 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 atria to ventricles. This makes it necessary to implant a pacemaker for heart rate regulation.
  • Restore normal heart rhythm: If a doctor seeks to pursue re-establishing 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, a large part of the reason that patients experience Afib is due to lifestyle choices. Modifications 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.

There are several lifestyle choices and conditions that can increase the risk of Afib:

  • Cardiovascular disease: heart failure, coronary artery disease, valvular heart disease, rheumatic heart disease, cardiomyopathy.
  • Previous heart surgery: the risk is particularly 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 work to stop unusual electrical signals that cause uneven heartbeats, a condition referred to as 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 is done either through traditional surgery, or through minimally invasive, catheter-based procedures.

Surgical Cardiac Ablation

This 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: 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: Combining catheter ablation and a mini maze, this method involves internal and external application of radiofrequency energy to regulate the heartbeat, 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. It then destroys the cells causing the arrythmia, helping to restore 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 area of tissue, causing localized heating and destruction of abnormal cells or tissues — providing pain relief or tumor reduction.

Because it is done via a small incision, catheter ablation has a number of benefits. 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 type of cardiac ablation therapy is right for you. This will depend on the cause and symptoms of your Afib, as well as any other conditions you might have.

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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

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Call 302-733-1000