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Atrial Fibrillation

Atrial fibrillation, or AFib, is a type of abnormal heart rhythm. At the Washington University and Barnes-Jewish Heart & Vascular Center in St. Louis, our experts diagnose and treat AFib to preserve your health and quality of life.

The experts of the Heart & Vascular Center arrhythmia team diagnose and treat atrial fibrillation in hundreds of patients each year. To develop the right treatment plan for you, we talk with you about your lifestyle and wishes. Our care includes new innovations to bring you the latest AFib treatments.

What Is Atrial Fibrillation?

Atrial fibrillation is the most common cardiac (heart) arrhythmia, or irregularity in your heart’s electrical system. AFib originates in the upper chambers of your heart (the atria). Most often, it begins in the left atrium.

During fibrillation, your heart beats irregularly and often rapidly, instead of in a steady rhythm. This change causes the heart’s chambers to quiver (fibrillate). AFib treatment can restore a regular rhythm and relieve uncomfortable symptoms.

How Is Atrial Fibrillation Diagnosed?

If you experience signs of AFib or atrial flutter, your doctors will run some tests to understand what is causing those symptoms. Your primary care doctor might make the initial diagnosis. Or you might see a specialist, such as one of our cardiologists or electrophysiologists (physicians who specialize in heart rhythm disorders).

First, your doctor will ask you about your symptoms and do a physical exam. Your doctor may order blood tests to check for issues such as thyroid conditions, diabetes or other issues that could cause atrial fibrillation or related symptoms.

AFib testing 

Your atrial fibrillation diagnosis and testing may include one or more noninvasive tests: 

  • Fitness trackers: While not a specialized medical tool, many smartwatches can detect AFib. If your smartwatch or fitness tracker warns you about an irregular heartbeat, see your doctor.
  • Electrocardiogram (ECG or EKG): For this painless test, a technician attaches sticky electrodes to your skin. The ECG machine creates a graph that shows your heart’s rhythm. ECG testing can identify arrhythmia that occurs while you’re in our clinic.
  • Stress test: You have tests (usually an ECG) that check your heart’s performance while you exercise. You may walk or run on a treadmill. If exercise is too much, we can use medications that raise your heart rate safely.
  • Chest X-ray: Your doctor may order an X-ray to check the condition of your heart and lungs. An X-ray can also reveal signs of other issues that could be causing symptoms.
  • Echocardiogram: An echo test is an imaging test that uses sound waves to create moving pictures of your heart. Most often, a technician holds a transducer (a wand-like device) on your chest. An echo test for arrhythmia is often called a transthoracic echocardiogram (TTE).
  • Transesophageal echocardiogram (TEE): A technician guides a flexible tube down your throat to your esophagus (tube that connects your mouth and stomach). A transducer goes through the tube, behind your heart, to provide clear images of your heart. TEE can check for blood clots or valve problems. You have sedation to make this test more comfortable.

Take-home AFib monitors

In some cases, your physician needs more information to understand your atrial fibrillation symptoms. If the arrhythmia occurs sporadically, you may need to take a monitor with you. 

At-home monitoring may include: 

  • Holter monitor:  A Holter monitor records your heart rhythm over one to three days. Like an ECG, you have electrodes and wires attached to your skin while you carry the portable monitor with you. When you come back, we remove the electrodes and analyze the results.
  • Implantable cardiac monitor (ICM): Surgeons implant this small monitoring device in your chest, just below the skin. The ICM (also called a loop recorder) tracks your heart’s electrical activity day and night for up to three years. The ICM sends information to your doctor wirelessly so we can monitor your heart’s rhythm.
  • Mobile cardiac telemetry (MCT): MCT monitoring involves a small, wearable device. The telemetry device monitors your heart as you go about your usual activities. A wireless signal uploads information and transmits it to your doctor.
  • Transtelephonic monitor: You take this monitor with you and use it when you notice AFib symptoms happening. You use a finger electrode, special bracelets or a chest plate to record your heart rhythm. As you do so, you connect the monitor to your phone, which sends a recording to your doctor’s office.

Symptoms of Atrial Fibrillation

It’s common to mistake signs of AFib for another heart disorder. Some people don’t experience any signs of AFib. If you do have symptoms, you may notice:

  • chest discomfort or anxiety
  • fatigue
  • inability to exercise
  • irregular or fast heartbeat
  • lightheadedness
  • shortness of breath

Risk Factors for Atrial Fibrillation

Most of the time, AFib develops when other conditions affect the heart’s structure. Our arrhythmia experts may be able to prevent or treat AFib by managing these conditions:

  • Diabetes: A disease you can have from childhood or develop later in life, diabetes causes blood sugar changes. These changes affect heart cells and stiffen the heart muscle.
  • High blood pressure: Also known as hypertension, high blood pressure eventually stiffens the heart muscle. As a result, the heart can no longer pump blood efficiently.
  • Overweight and obesity: Being overweight puts pressure on the heart. The pressure can cause abnormal relaxation and enlargement of the left atrium. Scarring can result, leading to an erratic heartbeat.
  • Sleep apnea: People with sleep apnea wake up repeatedly during the night. The interruptions reduce your body’s oxygen levels and raise blood pressure, which strains the heart.

What Are AFib Complications?

AFib is treatable and generally not life-threatening. Still, it’s important to get an accurate diagnosis and individualized treatment plan. The condition can cause several problems, some of them serious:

  • blood pooling in the atria, increasing your risk of blood clots and stroke
  • congestive heart failure
  • inefficient blood circulation
  • palpitations, resulting in discomfort and anxiety

You may be at particular risk if you also have other heart problems such as valvular heart disease (damage to one of the four heart valves).

Contact Us

We invite you to complete our atrial fibrillation treatment options form so our doctors can create your personalized treatment plan.  

Or, to make an appointment with a Washington University AFib specialist at Barnes-Jewish Hospital in St. Louis, call 314-747-1518.