Conditions & Treatments

Atrial Fibrillation

Atrial fibrillation is a type of arrhythmia where the electrical signals in the atria (the two small chambers of the heart) are fired in a very fast and uncontrolled manner.

Atrial Fibrillation

What is atrial fibrillation?

Normally, the heart pumps in a well-timed fashion. The two upper chambers (atria) contract first followed by the two lower chambers (ventricles). This coordinated pumping is powered by the heart's own electrical system and efficiently pumps blood out to the body and back. In atrial fibrillation (AF), a type of arrhythmia, the electrical signals fire rapidly and chaotically. This causes the atria to quiver instead of contracting normally. Many of the signals also reach the ventricles, causing them to contract irregularly too. This results in a fast and irregular heart rhythm. Over time, this can weaken the heart and lead to heart failure. Plus, when the atria do not contract effectively, the blood may pool in the heart. This increases the risk that a blood clot may form and travel to the brain causing a stroke. People with AF are 5 to 7 times more likely to have a stroke than people who do not have AF.

 

AF is more common in people who are over 65 and is seen more often in men than women.

What are the symptoms of atrial fibrillation?

You may not have symptoms with AF. But, when ventricles are not able to pump enough blood out to the lungs and body, it can cause these symptoms:

  • Heart palpitations or fluttering in the chest

  • Chest pain

  • Shortness of breath

  • Fatigue

  • Anxiety

  • Dizziness and faintness

Some people with AF have intermittent episodes (intermittent or paroxysmal AF). Others have chronic or persistent AF.

What causes atrial fibrillation?

AF can develop when someone who has underlying heart disease, such as heart valve disease, heart attack, or heart failure. High blood pressure, thyroid problems, excess alcohol use, sleep apnea, and certain lung diseases can also cause AF.

 

How is atrial fibrillation treated?

Some people with atrial fibrillation will return to normal rhythm without treatment. They will "convert" on their own back to normal rhythm. Treatment decisions depend in part on whether symptoms are bothersome and how long your heart has been in AF. For most people, treatment of AF involves attempts to restore (reset) the heart back to its normal rhythm (rhythm control) or to control the heart rate (rate control). Sometimes surgery or a procedure called catheter ablation is used. In addition, a person with AF is given medications to prevent blood clots to reduce the risk of stroke.  

 

Rhythm control

Rhythm control is an attempt to reset the heart back to its normal rhythm. It can be done with medications or electrical shock.

  • Anti-arrhythmic medications, such as sodium channel blockers or potassium channel blockers, slow the heart's ability to send electrical signals.

  • Electrical cardioversion involves sending an electrical shock through paddles placed on the chest. Usually doctors will want you to take blood thinners for a period of time before electrical cardioversion to reduce the risk of a stroke from a dislodged blood clot.

 

Rate control

Medications to help control the heart rate include

  • Beta blockers, such as atenolol or metoprolol. These drugs slow the heart rate.

  • Calcium channel blockers, such as diltiazem or verapamil. These drugs slow the heart rate.

  • Digoxin. This drug slows the electrical currents between the upper and lower chambers.

 

Catheter ablation

In this procedure, a catheter is guided through a blood vessel to the heart. Here energy is sent through the catheter to destroy small areas of heart tissue responsible for the arrhythmia. It may be an option when medications are not working.

 

Maze procedure

This is a surgical procedure in which areas of the heart are cut to create a "maze" of scar tissue that prevents the erratic electrical signals from passing through the heart.  

 

Treatment to prevent blood clots

People with AF will be prescribed blood thinners to reduce the risk for stroke. This may include aspirin, clopidogrel, warfarin, dabigatran, or rivaroxaban. Your doctor will have a detailed discussion with you about which blood-thinning medications are most appropriate for you.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Heart Center

  • Atrial Fibrillation Program
    The Corrigan Minehan Heart Center's Atrial Fibrillation Program provides advanced care for atrial fibrillation (afib or AF) using catheter ablation with a variety of energy sources, including radiofrequency ablation, cryoablation and laser.
  • Corrigan Women's Heart Health Program
    The Elizabeth Anne and Karen Barlow Corrigan Women's Heart Health Program at the Massachusetts General Hospital Corrigan Minehan Heart Center cares for women of all ages through prevention and early detection of heart disease.
  • Cardiac Arrhythmia Service
    The Cardiac Arrhythmia Service at the Massachusetts General Hospital Corrigan Minehan Heart Center offers the very latest diagnostic and treatment options to manage heart rhythm conditions.
Imaging

  • Heart Imaging
    The Heart Imaging Program at Massachusetts General Hospital Imaging provides comprehensive diagnostic cardiac imaging, using state-of-the-art CT and MRI technology and with expert interpretation by specialty-trained cardiovascular radiologists.
Benson Henry Institute for Mind Body Medicine

  • Cardiac Wellness Program: Reduce Cardiac Risk
    Heart disease is the number one cause of death in the U.S. for both men and women. Although genetics plays a role in the development of heart disease, lifestyle choices have been proven to significantly influence the health of your heart. The more risk factors you have, the greater your chance of having a heart attack or stroke. This program is held at MGH West in Waltham, MA.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

Heart device may replace the need for long-term blood thinning medications

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Watchman Device May Offer an Alternative to Warfarin for Atrial Fibrillation Patients

Advances Spring 2011 Issue. Atrial fibrillation (AF) is the most common type of sustained irregular heartbeat. It affects approximately 6 million U.S. adults, mainly those ages 65 and older.

Integrated Model Speeds Understanding of Atrial Fibrillation and Stroke

The Mass General Institute for Heart, Vascular, and Stroke Care integrates services to accelerate advances in stroke-related atrial fibrillation research and patient care.

New Procedure Treats Atrial Fibrillation Without Blood Thinners

Ed Cleary came to Massachusetts General Hospital in June 2012 to get his AFib treated. He had tried taking a blood thinner to help manage his AFib, but bled too much. Fortunately, he qualified for a new procedure now being used for the first time in New England by Mass General Hospital.

Study combines two minimally invasive procedures to treat atrial fibrillation

A new clinical trial is now underway at the MGH to investigate whether combining two catheter-based procedures will improve the long-term outcome in the treatment of atrial fibrillation, the most common heart rhythm disorder. The MGH is the first hospital in New England – and only the second in the nation – to pair renal artery sympathetic denervation with pulmonary vein isolation (PVI) for patients with atrial fibrillation and hypertension.

The Watchman at work

Mass General Heart Center physicians offer a new technique to prevent blood clots in the part of the heart called the left atrial appendage. This innovative procedure shows promise in preventing strokes in patients with atrial fibrillation, freeing them from dependence on blood thinning medications.

Ask Yourself -- Ellinor

Patrick Ellinor, MD, discusses atrial fibrillation (AFib), its connection to stroke, and the new treatment options available at Mass General.

Innovative care at the Corrigan Minehan Heart Center

Learn more about the latest treatment options for this condition at the Corrigan Minehan Heart Center.