Atrial Fibrillation (AFib)

Saint Luke’s Mid America Heart Institute provides region-leading comprehensive management for atrial fibrillation at all stages of the disease, beginning with our comprehensive AFib Prevention Program. The only program of its kind in the region, the Saint Luke’s Atrial Fibrillation Prevention Clinic helps patients modify their risk through weight loss, treatment of sleep apnea, daily moderate exercise, limiting alcohol intake, and treating other risk factors, including hypertension and diabetes.  

Patients with known atrial fibrillation are similarly encouraged to work together with our clinicians to modify their risk factors and improve their likelihood of long-term maintenance of sinus rhythm following other treatments such as antiarrhythmic therapy or catheter ablation.

Saint Luke’s Atrial Fibrillation Clinic 

Saint Luke’s Atrial Fibrillation Clinic features a highly specialized team of electrophysiologists, electrophysiology nurses, and nurse practitioners who specialize in treating patients with atrial fibrillation, also called heart arrhythmia or irregular heart rhythm.

Saint Luke’s is often the region’s only hospital to offer patients advanced investigational treatments. For example, our patients can benefit from the Watchman® device, an alternative to warfarin used to prevent stroke in atrial fibrillation.

Call 816-751-8415 for a consultation.

What is Atrial Flutter/Atrial Fibrillation?

What Is Atrial Flutter/Atrial Fibrillation?

Cross section of heart showing atrial flutter.

Cross section of heart showing atrial fibrillation.

The heart has its own electrical system. This system makes the signals that start each heartbeat. The heartbeat begins in 1 of the 2 upper chambers of the heart (atria). A problem can make the atria beat faster than normal. The atria may beat fast but still evenly. This problem is called atrial flutter. If the atria beat very fast and also unevenly, it is called atrial fibrillation (AFib).

Causes of Atrial Flutter and Atrial Fibrillation

Causes of these problems can include:

  • Previous heart attack

  • High blood pressure

  • Thyroid problems

In many cases, the cause is unknown.

When the Atria Beat Too Fast

The atria may beat fast only once in a while. This is called a paroxysmal heart rhythm problem. If they beat fast all the time, it is a chronic problem.

Atrial Flutter

With atrial flutter, electrical signals travel around and around inside the atria. These circling signals make the atria beat too fast:

  • Atrial flutter can cause symptoms similar to AFib. It can also lead to the even faster, uneven rhythms of AFib.

Atrial Fibrillation (AFib)

With AFib, cells in the atria send extra electrical signals. These extra signals make the atria beat very fast. They also beat unevenly:

  • The atria beat so fast and unevenly that they may quiver instead of contracting. If the atria don’t contract, they don’t move enough blood into the 2 lower chambers of the heart (ventricles). This can cause you to feel dizzy or weak.

  • Blood that doesn’t keep moving can pool and form clots in the atria. These clots can move into other parts of the body and cause serious problems such as a stroke. 

Symptoms of Atrial Flutter and AFib

These symptoms include the following:

  • Palpitations (a fluttering, fast heartbeat)

  • Weakness or tiredness

  • Shortness of breath

  • Chest pain or tightness

  • Dizziness or lightheadedness

  • Fainting spells

Understanding Atrial Fibrillation

Understanding Atrial Fibrillation

Cross section of heart showing atrial fibrillation.

An arrhythmia is any problem with the speed or pattern of the heartbeat. Atrial fibrillation (AFib) is a common type of arrhythmia. It causes fast, chaotic electrical signals in the atria. This leads to poor functioning of the heart. It also affects how much blood your heart can pump out to the body.

Afib may occur once in a while and go away on its own. Or it may continue for longer periods and need treatment.

AFib can lead to serious problems, such as stroke. Your healthcare provider will need to monitor and manage it.

What happens during atrial fibrillation? 

The heart has an electrical system that sends signals to control the heartbeat. As signals move through the heart, they tell the heart’s upper chambers (atria) and lower chambers (ventricles) when to squeeze (contract) and relax. This lets blood move through the heart and out to the body and lungs.

With AFib, the atria receive abnormal signals. This causes them to contract in a fast and irregular way, and out of sync with the ventricles. When this happens, the atria also have a harder time moving blood into the ventricles. Blood may then pool in the atria, which increases the risk for blood clots and stroke. The ventricles also may contract too quickly and irregularly. As a result, they may not pump blood to the body and lungs as well as they should. This can weaken the heart muscle over time and cause heart failure.

What causes atrial fibrillation?

AFib is more common in older adults. It has many possible causes including:

  • Coronary artery disease

  • Heart valve disease

  • Heart attack

  • Heart surgery

  • High blood pressure

  • Thyroid disease

  • Diabetes

  • Lung disease

  • Sleep apnea

  • Heavy alcohol use

In some cases of AFib, doctors do not know the cause.

What are the symptoms of atrial fibrillation?

AFib may or may not cause symptoms. If symptoms do occur, they may include:

  • A fast, pounding, irregular heartbeat

  • Shortness of breath

  • Tiredness

  • Dizziness or fainting

  • Chest pain

How is atrial fibrillation treated?

Treatments for AFib can include any of the options below.

  • Medicines. You may be prescribed:

    • Heart rate medicines to help slow down the heartbeat

    • Heart rhythm medicines to help the heart beat more regularly

    • Anti-clotting medicines to help reduce the risk for blood clots and stroke

  • Electrical cardioversion. Your healthcare provider uses special pads or paddles to send one or more brief electrical shocks to the heart. This can help reset the heartbeat to normal.

  • Ablation. Long, thin tubes called catheters are threaded through a blood vessel to the heart. There, the catheters send out hot or cold energy to the areas causing the abnormal signals. This energy destroys the problem tissue or cells. This improves the chances that your heart will stay in normal rhythm without using medicines. If your heart rate and rhythm can’t be controlled, you may need ablation and a pacemaker. These will help control the heart rate and regularity of the heartbeat.

  • Surgery. During surgery, your healthcare provider may use different methods to create scar tissue in the areas of the heart causing the abnormal signals. The scar tissue disrupts the abnormal signals and may stop AFib from occurring.

What are the complications of atrial fibrillation?

These can include:

  • Blood clots

  • Stroke

  • Heart failure. This problem occurs when the heart muscle weakens so much that it can no longer pump blood well.

When should I call my healthcare provider?

Call your healthcare provider right away if you have any of these:

  • Symptoms that don’t get better with treatment, or get worse

  • New symptoms

What is electrical cardioversion?

Cardioversion is a procedure used to return an abnormal heartbeat to a normal rhythm. This procedure is used when the heart is beating very fast or irregular. This is called an arrhythmia. Arrhythmias can cause problems such as fainting, stroke, heart attack, and even sudden cardiac death. With electrical cardioversion, a high-energy shock is sent to the heart to reset a normal rhythm. It is different from chemical cardioversion, in which medicines are used to try to restore a normal rhythm.

Normally, a special group of cells begin the electrical signal to start your heartbeat. These cells are in the sinoatrial (SA) node. This node is in the right atrium, the upper right chamber of the heart. The signal quickly travels down the heart’s conducting system on the way to the ventricles, the two lower chambers of the heart. As it travels, the signal triggers nearby parts of the heart to contract. This organized pattern helps the heart contract in a coordinated way.

Various problems can disrupt this signaling pathway and lead to abnormal heart rhythms. The heart might beat very quickly, not leaving it enough time to fill with blood between beats. This can prevent your heart from pumping enough blood to the body. Some abnormal heart rhythms raise your risk of stroke. Some also raise the risk of life-threatening rhythms that can lead to sudden death. Cardioversion upsets the abnormal signaling and lets the heart to reset itself back into a normal rhythm.

Cardioversion is usually a scheduled procedure. But sometimes healthcare providers need to do it as an emergency . This is done if symptoms are severe. You will be given medicine to put you to sleep before delivering the shocks. Cardioversion is not the same as defibrillation. Both use shocks to reset the heart. But defibrillation uses a stronger shock to stop very severe rhythms that can cause sudden death.

Why might I need an electrical cardioversion?

Electrical cardioversion can help treat several different abnormal heart rhythms. It is commonly used to treat atrial fibrillation (AFib). With this condition, the atria of the heart quiver instead of beating the right way. Symptoms of AFib may include shortness of breath, fatigue, and a very fast heartbeat. It can also increase risk for stroke.

If this is your first time having AFib, your healthcare provider may be more likely to suggest cardioversion. He or she may also want you to have it if you have ongoing AFib, especially if it gives you severe symptoms. Electrical cardioversion works better and is used more often than chemical cardioversion.

Your healthcare provider may not want you to have cardioversion if you have minor symptoms. It also may not be recommended if you are elderly, if you have had AFib a long time, or if you have other major medical problems. Other treatments might be better for you, like heart rate control with medicines.

Electrical cardioversion is also useful for treating other abnormal heart rhythms, like atrial flutter, which is similar to AFib. It can also be used to treat certain kinds of supraventricular tachycardias and ventricular tachycardia (VT). These types of heart rhythms can cause heart rates that are too fast. This can prevent the heart from pumping enough blood.

Before trying electrical cardioversion, your healthcare provider may try to reset the heart rate in other ways. This might include the Valsalva maneuver. This is a method where you hold your breath and increase the pressure in your belly. This can help bring the heart rate down. Your healthcare provider may then try medicines to change the rhythm to normal. If these methods don’t work, electrical cardioversion is often the next step. In other cases electrical cardioversion is the first recommended step.

You may need an emergency electrical cardioversion right away if you have severe symptoms from your heart rhythm.

What are the risks for electrical cardioversion?

Although most people have a successful electrical cardioversion, it does have certain risks. Your own risks may vary based on your age, the type of abnormal heart rhythm you have, and your other medical conditions. Ask your healthcare provider about your risks.

Rarely, the procedure causes a more dangerous heart rhythm. If that happens, someone will give you medicines or a stronger electric shock to stop this rhythm. Some other risks are:

  • Other less dangerous abnormal rhythms
  • Temporary low blood pressure
  • Heart damage (usually temporary and without symptoms)
  • Heart failure
  • Skin damage
  • Dislodged blood clot, which can cause stroke, pulmonary embolism, or other problems

In certain situations, healthcare providers lower this last risk by giving medicines to help prevent clots (blood thinners). They give people these medicines before and after the procedure for some types of abnormal rhythms.

In some cases, the cardioversion may not reset a normal heart rhythm. There is also a risk that you might go back to your abnormal rhythm shortly after your cardioversion. Some people take medicine before and after the procedure to help prevent this.

How do I prepare for an electrical cardioversion?

Talk with your healthcare provider about what you should do to get ready for your electrical cardioversion. You may need to avoid eating or drinking anything before midnight of the day of your procedure.

Follow your healthcare provider’s instructions about what medicines to take before the procedure. This includes any medicines to prevent abnormal rhythms. Don’t stop taking any medicine unless your healthcare provider tells you to do so. You might need blood tests before the procedure to make sure the procedure is safe to do.

If you are at higher risk of blood clots, your healthcare provider may want you to take anti-clotting medicine. These are commonly taken for several weeks before and after the procedure. Not everyone needs this medicine, but some people do. You are likely to need anti-clotting medicine if your abnormal rhythm has lasted more than 48 hours or if you have had a blood clot in the past.

Your healthcare provider may want a transesophageal echocardiography test before the procedure. This test is a special kind of ultrasound. A thin, flexible tube is put down your throat and into your esophagus. Here, the tube is close to your heart. It lets your healthcare provider see if you have any blood clots in the heart. Your cardioversion will be delayed if a clot is found. You’ll likely need to take blood thinner medicine for a while until your risk of clots is low. It’s important to take this medicine (such as warfarin) exactly as your healthcare provider tells you.

What happens during an electrical cardioversion?

Talk with your healthcare provider about what to expect during your procedure. It may differ if you need emergency electrical cardioversion. In general, you can expect the following:

  • Soft electrode pads are placed on your chest and maybe on your back. You might need some areas of skin shaved to get the electrode pads to stick.
  • These electrodes will connect to a cardioversion machine.
  • You will receive medicine through a vein in your arm to make you fall asleep.
  • Using the cardioversion machine, a programmed high-energy shock is sent to your heart. This should convert your heart back to a normal rhythm.
  • Your team will closely monitor your heart rhythm. They will watch for any signs of complications.
  • The procedure only takes a few minutes. When it is done, you will wake up.

What happens after an electrical cardioversion?

Ask your healthcare provider about what to expect. You will likely:

  • Wake up 5 to 10 minutes after the procedure
  • Be closely watched for signs of complications for several hours
  • Feel sleepy for several hours after the cardioversion. Arrange to have someone drive you home
  • Go home the same day as the procedure
  • Have some redness or soreness on your chest that lasts for a few days

Ask your healthcare provider about what medicines you’ll need to take when you get home. Many people need to take an anti-clotting medicine like warfarin or another blood thinner. Some people also need medicines to prevent abnormal heart rhythms. Take all your medicines exactly as your healthcare provider tells you. Tell your healthcare provider right away if any of your symptoms come back.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Saint Luke's Cardiovascular Consultants

A leader in cardiac care, Saint Luke’s Cardiovascular Consultants treats patients throughout the Kansas City area and surrounding communities. Our medical team consists of both board-certified clinical cardiologists as well as physicians certified in specialty areas of cardiology including interventional cardiology, echocardiography, nuclear cardiology, preventive cardiology, and electrophysiology.