Atrial Fibrillation

About Atrial Fibrillation

Atrial fibrillation is the most common type of abnormal heart rhythm. Erratic electrical impulses start in the upper chambers of the heart (atria), which affect the normal electrical pathway through the rest of the heart. The heart beats too fast, resulting in a lower blood flow to the body and a higher risk for clots, stroke or heart failure. Proper treatment reduces the risk for serious problems.

The University of Chicago Approach

At the University of Chicago Medicine, our team of electrophysiologists, cardiac surgeons, cardiac nurses and other heart care specialists provide the full spectrum of diagnostic and treatment options for people with atrial fibrillation. Our heart experts regularly care for people who have complex arrhythmias or co-existing heart or medical conditions.

We offer solutions that can cure or greatly reduce the occurrence of atrial fibrillation. If a procedure or surgery is required, it can typically be performed through very small incisions -- either in our state-of-the art electrophysiology lab, or through the use of minimally invasive surgical techniques.

Full Range of Treatment Options for Atrial Fibrillation

The goal of atrial fibrillation treatment is to return the heart to a normal rhythm and to reduce the risk for complications associated with the arrhythmia, such as blood clots or stroke.

Our physicians assess each patient's case to determine optimal treatment, taking into account several factors, such as the onset of atrial fibrillation, the severity of the condition and symptoms, the existence of other medical conditions, and the patient's medical history. Treatment options include:

Medications

University of Chicago electrophysiologists have years of experience determining the right medicines and dosages for people with atrial fibrillation. Medications are typically the first-line treatment for the condition. Antiarrhythmic medicines can be used to restore and maintain a normal rhythm and to slow the fast heart rate commonly associated with atrial fibrillation. Blood thinners (also called anticoagulants) are often prescribed to prevent blood clots, therefore reducing the risk for stroke.

For some people with atrial fibrillation, antiarrhythmic drugs are ineffective or can lose effectiveness over time. Also, some people may not be able to take the medicines because of side effects. In those cases, other treatment options are considered, such as ablation therapy, cardioversion or a pacemaker.

Electrical Cardioversion

Electrical cardioversion is a treatment that involves delivering a short electrical shock to the chest which helps reset the heart to a normal heart rhythm. A special external defibrillation machine is used. This treatment is performed while the patient is under sedation in our electrophysiology lab. Patients can typically go home the same day of the procedure after being monitored. Our heart rhythm experts have experience with special external defibrillators and intravenous medications that can be used, if necessary, to improve the success rate of electrical cardioversion.

3D CT scan of ablation map Three-dimensional CT scan. This CT scan provides a view from within the heart to help the physician guide placement of ablation lesions during a catheter ablation procedure. The red dots depict the ablation sites around the opening of a pulmonary vein in the left atrium.

Radiofrequency Catheter Ablation

Radiofrequency catheter ablation is a treatment that uses high frequency radio waves to destroy the tissue source of atrial fibrillation. Catheter ablation can cure atrial fibrillation--especially in patients with paroxysmal atrial fibrillation (patients who are not in atrial fibrillation all of the time) -- with success rates reaching 70-80 percent.

The procedure involves the use of a specially designed catheter that is threaded through the leg and into the heart. While in the heart, the catheter is directed to the arrhythmia source, which most often originates from the pulmonary veins. The catheter emits high frequency radio waves to create lesions on the abnormal tissue. These lesions are designed to block the pathway of erratic impulses of atrial fibrillation, thereby restoring a more normal heart rhythm.

Benefits of catheter ablation:

  • 70-80% success rate in curing paroxysmal atrial fibrillation
  • Fewer or no symptoms associated with atrial fibrillation
  • Better ability to exercise more frequently and for longer periods of time
  • Improved quality of life
  • Reduction in the need for antiarrhythmic drugs
  • No large incisions -- just a small incision that leaves little to no scarring

Catheter ablation procedures are performed in our state-of-the-art electrophysiology lab. This lab is equipped with advanced imaging and electrical mapping tools that give physicians a very detailed view of the heart. For example, our team is now using a new high-tech catheterization system that relies on giant computer-controlled magnets to guide catheters into place. Instead of the doctor manually manipulating the catheter to multiple locations within the heart, a magnetic field gently steers the catheter tip through a predetermined path within the heart.

In most cases, catheter ablation procedures take approximately four to five hours. Patients typically stay for one night in the hospital.

University of Chicago electrophysiologists are international leaders in the field of catheter ablation. They have many years of experience performing this procedure to treat atrial fibrillation and other types of arrhythmias. Our heart rhythm specialists are also studying new devices and methods to perform catheter ablation, and remain at the forefront of this important research. Opportunities exist for patients with atrial fibrillation to participate in clinical trials under way to evaluate new ablation tools and heart rhythm medications for the treatment of atrial fibrillation.

Surgical Ablation Treatment

Some people with atrial fibrillation may have other heart conditions, such as mitral valve disease that requires valve repair/replacement or atherosclerosis that necessitates coronary bypass surgery. In select cases, physicians may determine that a surgical approach is the best method to treat the arrhythmia because of the patient's anatomy, prior unsuccessful catheter treatments or other concerns.

At the University of Chicago Medicine, our cardiac surgeons perform the modified Maze procedure that delivers radiofrequency energy to heart tissue to redirect the electrical pathways through the heart. This treatment is performed during open-heart surgery or using minimally invasive techniques done through small incisions in the chest. »Learn more about surgical treatment of atrial fibrillation

Pacemakers

A pacemaker is a small device that monitors heartbeats and emits electrical impulses to regulate heart rhythm. The sophisticated device is implanted under the skin near the collarbone. People with atrial fibrillation may need a pacemaker after having certain types of ablation therapy, or when heart medicines may cause the heart to beat too slowly. Pacemaker insertion is typically done in the electrophysiology lab.

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