Atrial fibrillation (AFib)

Your heart’s electrical system controls your heartbeat, ensuring it works in a regular, constant rhythm. An arrhythmia, or heart rhythm disorder, is any change to those electrical impulses, causing the heart to beat irregularly and pump blood less effectively.

While most heart rhythm disorders are minor, some can be life-threatening and increase the risk of complications such as stroke. If you’re experiencing palpitations that feel like skipped heart beats, fluttering, or pounding in the chest, you may have an arrhythmia. Contact one of our heart specialists as soon as possible to make an appointment, discuss your concerns and possible next steps.

What is atrial fibrillation (AFib)?

Atrial fibrillation (AFib) is the most common types of heart rhythm disorder (arrhythmia). Having AFib means the top two chambers of your heart (atria) are beating irregularly due to electrical signal disruptions. Irregular heartbeats can cause blood to pool and clot in the heart, increasing your risk of a stroke. If your heartbeats too fast over a prolonged time it can weaken and lead to congestive heart failure.

What are the symptoms of AFib?

Many people with AFib have no symptoms at all. Some people may experience palpitations and a fast heart rate. Other symptoms include:

  • Shortness of breath
  • Dizziness
  • Fatigue and weakness

In some cases, the symptoms of AFib may mimic the symptoms of a heart attack. Always seek emergency medical care if you’re unsure of the cause of your symptoms.

What causes AFib?

AFib develops due to inflammation, stress, or damage to heart tissue. These include:

How is AFib treated?

SSM Health offers a broad range of treatment options. Your doctor may prescribe one or more treatment options to reduce your symptoms and the risk of serious complications. Treatment options may include:

Medications can help.

Your doctor may prescribe medications to help control your heart rate, as well as blood thinners to reduce the risk of stroke.

What is ablation?

If you are suffering from AFib that hasn’t responded to medication, or if you cannot tolerate your medication, your doctor may recommend the minimally invasive procedure of ablation. Ablation helps patients feel better by returning their heart to a normal rhythm. Restoring a heart's rhythm reduces the patient' s risk of stroke, heart failure, and need for medications.

Before the procedure your physician carefully maps your heart to find the areas causing the arrhythmia. During an ablation a thin, flexible tube is inserted into the heart to identify the tissue causing the rhythm disorder. Using electrical heat energy the tissue causing your AFib is destroyed. The scar lines from the procedure create a maze. This maze redirects electrical impulses to restore your heart rhythm and normal blood flow.

If the affected heart tissue is too close to your heart’s blood supply, or other critical structures, a freezing ablation technique may be used instead. Freezing ablation minimizes the risk to your critical heart structures by using extreme cold to freeze and destroy abnormal tissue. However, with this type of ablation there is a higher risk of recurrence of arrhythmia.

What are my surgical treatment options for AFib?

The primary surgical procedure to treat AFib is called Maze. A surgeon creates scars in the heart tissue to redirect the electrical signals and bring your heart back into rhythm.

Hybrid Maze combines minimally invasive surgery with catheter-based techniques. This offers patients better outcomes and improved recovery times while avoiding the need for open heart surgery.

Hybrid Maze is a two-stage procedure.

  • In the first stage, your surgeon will create a “maze” or scar on your beating heart.
  • In the second stage, an electrophysiologist performs catheter ablation to create more scars inside of the heart.

This procedure reverses AFib by putting your heart back into rhythm, without the need for open heart surgery. It also offers a much quicker recovery.

Please note: the Hybrid Maze procedure is only offered at SSM Health Saint Louis University Hospital and at SSM Health St. Mary's Hospital - Madison.

How can pacemakers and defibrillators help with AFib?

Pacemakers and defibrillator devices treat atrial fibrillation (AFib) by controlling the heart's rhythm.

  • Pacemakers help maintain a regular heartbeat by sending small electrical signals.
  • Defibrillators can correct abnormal heart rhythms with a stronger shock.

Pacemakers and cardioverter defibrillators deliver energy to the heart muscle through a lead. The removal of one or more leads from inside the heart is a procedure called lead extraction.

When is lead extraction necessary?

Lead extraction can be required for several reasons, including:

  • Damage to the inside (fracture) or outside of the lead
  • Malfunctioning leads that cause chronic pain or contribute to an irregular heartbeat Infection at the site of the device and/or lead
  • Other heart complications that interfere with the pacemaker or defibrillator

How is lead extraction performed?

There are two approaches to lead extraction:

  • The subclavian approach is done through an incision in the upper chest over the subclavian vein. This is the most frequently used type of extraction.
  • The femoral approach is where leads are removed through a small puncture in the groin or over the femoral vein. This type of extraction is used when subclavian approach is not possible.

Should a device need to be removed, new leads will also need to be inserted. Because veins have a limited capacity, replacing leads can be challenging. In fact, many physicians who implant devices prefer to avoid removing them due to the potential risks.

Over time, scar tissue builds up around the leads and strongly adheres to the body’s vessels. Historically, physicians would pull leads from the arteries, causing broken lead fragments to be left behind.

What is laser lead extraction?

Laser lead extraction is a minimally invasive procedure. A laser is used to break up scar tissue and free leads for easier extraction in a targeted vein. This restores optimal device functionality to your pacemaker or defibrillator.

The Micra™ is the world’s smallest, leadless pacemaker. The Micra is only about an inch long and is implanted directly into the heart’s right ventricle. The device’s four prongs provide direct electrical pulses to regulate the heartbeat.

What are the benefits of a leadless pacemaker?

Traditional pacemakers using leads can create complications over time, including:

  • Arteries can cling to the leads
  • Leads can become dislodged
  • Leads can become infected
  • The more leads placed overtime can potentially limit natural blood flow

Leadless pacemakers have fewer major complications and fewer hospital stays. Other benefits of a leadless pacemaker include:

  • Reduced long-term complications because there are no leads
  • Procedure takes less time to perform than traditional pacemaker placement
  • No visible chest scarring because the device is placed using a catheter
  • No bump or physical reminder of a pacemaker under the skin
  • Fewer post-implant activity restrictions

Leadless pacemakers are not appropriate for all patients. Schedule an appointment with a heart specialist to learn whether a leadless pacemaker is the best treatment for you.

Reducing an AFib patient's risk of stroke is important.

AFib increases the risk of stroke. A key goal of any patient's treatment plan is taking steps to reduce this risk. The most common treatment is to prescribe patient's blood thinners.

What is the WATCHMANTM procedure?

If you cannot take blood thinners long term, your doctor may recommend a stroke preventing procedure, like the WATCHMANTM procedure.

  • WATCHMANTM is a minimally invasive procedure where a mesh device is placed in the left atrial appendage to permanently close it off.
  • The left atrial appendage is where 90% of stroke-causing blood clots commonly form.
  • WATCHMANTM is a onetime procedure and is an effective tool for preventing strokes in AFib patients.

What are the health risks related to AFIb?

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