Atrial Fibrillation

Heart specialists at UT Southwestern Medical Center have extensive expertise in the most advanced care for heart rhythm disorders. As a leading center for research and patient care for atrial fibrillation, we bring the latest findings directly to our patients for the best possible outcomes.

Research-Based Care for Atrial Fibrillation

Atrial fibrillation (AFib) is a common type of arrhythmia, or abnormal heartbeat, that causes a rapid, irregular heart rhythm. Arrhythmias result from disturbances in the heart’s electrical system, which regulates heart rate and rhythm. If left untreated, AFib can increase the risk of heart failure, stroke, and other complications. 

At UT Southwestern, our specialists are experts in minimally invasive procedures, such as catheter ablation, that treat AFib and other heart rhythm disorders. We use advanced techniques such as cryoablation (freezing small areas of heart tissue) and pressure-sensitive catheters for better precision.

Our Heart Rhythm Management team is conducting numerous clinical trials of new treatments and devices, which means our patients have access to the latest technologies.

Causes of Atrial Fibrillation

AFib occurs when disturbances in the heart’s electrical rhythm cause the atria (the heart’s upper chambers) to beat so fast that they quiver and are unable to pump blood to the ventricles (the heart’s lower chambers). As a result, AFib prevents the heart from efficiently pumping blood to the body.

Some known causes of AFib include:

• Heart valve disorders or other structural heart problems
• Coronary artery disease
  
• Congenital heart disease (present since birth)
• Consumption of stimulants, such as medications, caffeine, tobacco, or alcohol
  
• Heart conditions such as heart attack or congestive heart failure
• High blood pressure (hypertension)
  
• Lung diseases
  
• Overactive thyroid gland
  
• Previous heart surgery, such as coronary artery bypass graft
  
• Sick sinus syndrome (dysfunction of the sinus node, an area in the atria that regulates heartbeat)
  
• Sleep apnea
  
• Stress caused by pneumonia, surgery, or other illnesses
  
• Viral infections
  

Risk Factors of Atrial Fibrillation

Some people have certain factors that can increase the risk of developing AFib. Not everyone with risk factors will develop AFib, and people without risk factors can develop the condition.

Risk factors include:

• Age: Most people who develop AFib are older than 60.
• Heart disease: Conditions such as heart valve problems, congenital heart disease, congestive heart failure, coronary artery disease, or previous heart attack or previous heart surgery can increase the risk.
• High blood pressure: Hypertension, especially if not well-controlled, can increase the risk.
• Alcohol use: Drinking alcohol, especially binge drinking, can trigger AFib in some people.
• Obesity
• Family history
• Sleep apnea
• Other chronic conditions: Thyroid problems, metabolic syndrome, diabetes, chronic kidney disease, or lung disease increase the risk.

Symptoms of Atrial Fibrillation

AFib does not always cause symptoms, and sometimes symptoms can come and go suddenly. People can have the condition without realizing it.

When people do have symptoms, they can include:

• Chest pain
• Confusion
• Decreased ability to exercise
• Dizziness or lightheadedness
• Fainting (syncope)
• Fatigue or weakness
• Pulse that feels too fast, too slow, pounding, fluttering, or irregular
• Sensation of an abnormal heartbeat (palpitations)
• Shortness of breath

Diagnosis of Atrial Fibrillation

At UT Southwestern, our experienced heart specialists begin with a thorough evaluation, which will include a:

• Physical exam
• Discussion of personal and family medical history
• Discussion of symptoms and risk factors
• Review of test results

Depending on each patient’s individual case, our doctors might recommend one or more tests, such as:

• Blood tests: Tests to check for thyroid problems or other substances that can indicate or rule out AFib
• Chest X-ray: Imaging that doctors use to check for heart or lung abnormalities or look for other possible causes of symptoms
• Echocardiogram: A noninvasive imaging study using ultrasound (sound waves) to produce video images of the heart to check heart structures such as valves
• Electrocardiogram (ECG or EKG): A noninvasive test in which electrodes are attached to the chest to record the heart’s electrical activity to check for abnormal heart rhythms
• Event monitor: A portable ECG device that patients activate when experiencing a rapid heartbeat, to record the heart’s electrical activity over a few weeks
• Holter monitor: A portable ECG device that automatically records the heart’s electrical activity over a 24-hour period
• Stress test: An EKG and other tests conducted while the patient is performing physical activity or has taken medication to increase the heart rate, to evaluate heart function and check for abnormal heart rhythms

Treatment for Atrial Fibrillation

Treatment goals for AFib are to:

• Control heart rate or restore a normal rhythm
• Prevent blood clots
• Reduce the risk of strokes

Our heart specialists develop a personalized treatment plan depending on whether patients have other heart problems and are able to take medications to control heart rate and rhythm. Treatment options can include one or more of the following:

• Medications: We prescribe medications as needed to regulate heartbeat and rhythm, lower blood pressure, and prevent blood clots.
• Electrical cardioversion: Doctors perform this procedure on patients under sedation, using paddles or patches placed on the chest to deliver an electric shock to the heart to restore its rhythm.
• Cardiac ablation: This procedure uses cardiac catheterization, a minimally invasive procedure that uses a catheter (long, thin, flexible tube) inserted through a tiny incision into an artery to access the heart. Doctors use special tips on the catheters to deliver either extreme heat or cold to tiny areas of heart tissue that are disrupting the electric signals that control heart rate. Ablation neutralizes the erratic electrical signals to restore a normal heartbeat.
• Maze procedure: Our heart surgeons perform open-heart surgery to neutralize the erratic electrical signals on the heart using either a scalpel or ablation.
• Left atrial appendage (LAA) closure: The LAA is a small pouch in the left atrium where blood can pool in people with AFib, increasing the risk of blood clots. Clots from the heart can detach, travel through the blood stream, and cause a stroke. Removing or cutting off blood flow into the LAA with a device might reduce the risk of stroke. Anticoagulants (blood thinners) prevent blood clots, but some people cannot take these drugs long-term due to history of bleeding or major bleeding risk. For those patients, our heart specialists perform a catheterization procedure to close the LAA. We implant a small, basket-shaped device called a Watchman™ into the LAA to close it off permanently. Our heart specialists have particular expertise in using the Watchman device with patients who have AFib and are at increased risk for stroke but have issues taking anticoagulants.

At UT Southwestern, our heart specialists also often recommend healthy lifestyle choices that can prevent or treat heart disease. Learn more about our Preventive Cardiology program that provides patients with personalized plans.

Support Services

UT Southwestern’s cardiac rehabilitation specialists create customized plans that integrate proper nutrition, exercise, and, if necessary, nicotine cessation into patients’ lifestyles to improve their cardiovascular health.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease. 

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.