Section: Barnabas Health Heart Center News

It's Electric: an Overview of Atrial Fibrillation


What is atrial fibrillation?

Normally, the heart pumps in a coordinated fashion. The two upper chambers (atria) contract first, followed by the two lower chambers (ventricles). This synchronous pumping is controlled 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 atrial signals fire rapidly and chaotically. This causes the atria to quiver instead of contracting normally. The signals then reach the ventricles, causing them to contract fast and irregularly too. Over time, this can weaken the heart and lead to heart failure. Plus, when the atria do not contract effectively, blood may pool in the heart, increasing the risk that a blood clot may form in the atrium 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 may also cause a reduction of 20 percent of cardiac output.

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 (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. It may also occur without organic heart disease.

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
  • 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.

Catheter ablation. In this procedure, a catheter is guided through a blood vessel to the heart. Here energy is sent through the catheter to isolate 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 isolated to create a "maze" of scar tissue that prevents the erratic electrical signals from passing through the heart. A Hybrid Maze procedure is also available - this is a minimally invasive procedure that often involves shorter recovery times.

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

For a referral to a RWJBarnabas Health cardiac specialist, call 888-724-7123.

For more information about atrial fibrillation, visit

RWJBarnabas Health – Treating More Cases of AF Than Any Other Program in New Jersey

The Atrial Fibrillation Center, located at Newark Beth Israel Medical Center in Newark and Saint Barnabas Medical Center in Livingston, is New Jersey's finest and most comprehensive program dedicated to the treatment of atrial fibrillation Our experienced team of specialists offers the most sophisticated cardiac diagnostic imaging technology, as well as the most effective therapies and advanced treatments.

As New Jersey's leader in cardiac services, we treat more cases of atrial fibrillation than any other program in New Jersey.

The treatment of atrial fibrillation is multi-faceted. Our experienced team of physicians offers the clinical expertise that patients need for precise diagnosis and optimal treatment. This customized care begins with referral from a patient's cardiologist or primary care physician. After receiving the patient's medical records and cardiac test results, our team of cardiothoracic surgeons and electrophysiologists consult with the referring physician in a complete clinical assessment.

This collaborative review also addresses problems that may otherwise be overlooked – problems that may be contributing to Afib or affecting overall cardiac health. As a result, each patient receives a comprehensive assessment of cardiac health, and is assured of the most appropriate treatment plan, with the most effective options for his/her particular situation.

For more information about the Atrial Fibrillation Center, call 1.866.549.AFIB (1.866.549.2342).

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