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Atrial Fibrillation (AFib)

AFib — an irregular or quivering heartbeat — affects more than 2.2 million Americans. It's the most common type of heart arrhythmia.

At the UPMC Heart and Vascular Institute's Center for Atrial Fibrillation, we believe finding and treating AFib early lead to better results.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

What Is Atrial Fibrillation (AFib)?

AFib (or “AF”) is an irregular, quick heart rate.

During AFib, the heart's two upper chambers (the atria) quiver and are out of sync with the two lower chambers (the ventricles).

This may lead to symptoms such as:

  • Heart palpitations
  • Shortness of breath
  • Weakness

For some people, symptoms of AFib come and go (paroxysmal). For others, the condition doesn't go away (persistent).

Causes of atrial fibrillation

Changes in your heart — due to heart disease or high blood pressure — can often cause AFib.

AFib risks

AFib is common, notably among people over 60.

At any age, your AFib risk increases if you have a history of:

  • High blood pressure
  • Coronary artery disease or heart attack
  • Abnormal heart valves
  • Diabetes
  • Sleep apnea
  • Obesity

Atrial fibrillation complications

Although AFib isn't often life-threatening, it can lead to serious health problems like stroke.

It causes the heart to improperly pump blood, resulting in pooling or clotting. If a blood clot moves to an artery in the brain, it can lead to stroke.

In fact, about 15 percent of all strokes occur in people who have AFib.

Untreated AFib can also lead to other serious, even life-threatening, conditions such as:

Your visit to the UPMC Atrial Fibrillation Center

When you arrive for your first appointment, you'll meet with a nurse practitioner or physician assistant. He or she will ask about your medical history and AFib.

We'll give you a:

  • Complete education session about AFib symptoms, risks, and treatments.
  • A tailored patient education packet for you to take home.

Next, you'll meet with one of our doctors. The doctor will explain your treatment options based on how long you've had AFib, your symptoms, and past health history.

Together, you will design and agree on a care plan.

Certain treatments may require:

  • Blood tests, an echocardiogram, or other tests.
  • A stay in the hospital. We'll schedule your admission before you leave the office.

Why choose UPMC for atrial fibrillation care?

  • The UPMC Heart and Vascular Institute provides the latest AFib research and treatment options.
  • The Center for Atrial Fibrillation is a UPMC Center of Excellence. It's the first in western Pa. established to further the study of AFib and teach patients and families about the condition.
  • The UPMC Cardiac Electrophysiology Program offers the full range of treatments for AFib and other heart arrhythmias.

Atrial Fibrillation Symptoms and Diagnosis

The heart is a pump. Like any pump, it requires a timer. AFib happens when the timer inefficiently beats faster.

Though AFib often isn't a direct cause of death, you should take it seriously. It may cause life-altering illnesses, such as stroke.

AFib symptoms

AFib symptoms can be chronic or can come and go over time. Chronic AFib causes the heart rhythm to consistently stay abnormal.

AFib can cause a fast heartbeat, sometimes as high as 170 beats per minute. The most common symptom is a fluttering, quivering feeling in the chest.

Some people may not notice any symptoms at all.

Others may notice signs and symptoms including:

  • Heart palpitations, including the feel of racing or fluttering within your chest
  • Chest pain
  • Shortness of breath
  • Fatigue
  • Reduced ability to exercise
  • Lightheadedness
  • Dizziness
  • Confusion

Diagnosing atrial fibrillation

AFib is a complex disease often missed in routine exams. Many times, a diagnosis uncovers other heart–related problems.

Feeling your pulse may be enough for your doctor at the UPMC Heart and Vascular Institute to suspect AFib. But you'll still need to have a thorough physical exam.

After your exam, your doctor may order tests to help confirm a diagnosis of AFib such as:

  • Blood work
  • Chest x-rays
  • An electrocardiogram
  • An echocardiogram
  • A holter monitor
  • An event recorder
  • An electrophysiology (EP) study

Your doctor or nurse will tell you when to expect your test results and will call you when they're ready.

Preventing atrial fibrillation

A healthy lifestyle can help prevent or lessen the risk of many heart conditions.

To reduce your risk of AFib:

  • Eat a balanced diet with lots of heart-healthy foods.
  • Work out and stay active on a routine basis.
  • Drink in moderation and quit smoking.
  • Maintain a healthy weight.
  • Check your blood pressure and cholesterol levels.
  • Take your medicine as prescribed and have regular follow-ups with your doctor.

Atrial Fibrillation Treatment

Each case of AFib is unique and requires customized treatment. Your treatment will likely depend on how severe your symptoms and how long you've had the condition.

The goals of AFib treatment are to:

  • Normalize and control your heart rate.
  • Prevent blood clots.
  • Decrease symptoms.

At the UPMC Heart and Vascular Institute's Center for Atrial Fibrillation, we're certain we can find the right treatment for you.

AFib treatments on this page

Your doctor may suggest one or more of the following to treat your AFib:

  • Medicine
  • Cardioversion
  • Implantable devices, such as pacemakers and defibrillators
  • Surgery
  • Catheter-based procedures
  • The Watchman device

Medicine to treat atrial fibrillation

Doctors can control some less severe cases of AFib with drugs. Different drugs produce different results.

Blood thinners to prevent clots from forming and help reduce risk of stroke include:

  • Warfarin (Coumadin®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
  • Dabigatran (Pradaxa®)
  • Edoxaban (Savaysa®)
  • Aspirin

Rate control drugs to slow the heart rate, such as:

  • Digitalis or Digoxin
  • Verapamil
  • Diltiazem (Cardizem®)
  • Metoprolol (Lopressor® or Toprol-XL®)
  • Atenolol

Rhythm control drugs to maintain a regular heart rhythm:

  • Sotalol (Betapace®)
  • Dofetilide (Tikosyn®)
  • Flecainide (Tambocor®)
  • Propafenone (Rhythmol®)
  • Amiodarone (Pacerone® or Cordarone®)
  • Dronaderone (Multaq®)

Based on your unique case, our AFib experts can decide if medical management is right for you.

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Cardioversion for atrial fibrillation

Cardioversion is a noninvasive treatment that restores the heart's normal rhythm with a shock or drug.

Electrical shock cardioversion:

  • Sends a jolt of electricity through the chest wall to the heart.
  • Interrupts the abnormal heart rhythm of AFib and often sets it right.

Most often, doctors will give you anesthesia before having this outpatient treatment.

Chemical cardioversion uses medicine to achieve the same effect.

The Cardiac Electrophysiology Program at UPMC's Heart and Vascular Institute offers both types for AFib and other heart arrhythmias.

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Implantable devices for atrial fibrillation

Some cases of AFib need regulation of the heart's functions.

Your UPMC doctor may suggest implanting one of the following devices to help control how the heart beats:

  • Pacemakers adjust the heart's electrical impulses to improve pumping.
  • Defibrillators give the heart a small electrical jolt that resets the rhythm if it strays from normal.

In both options, an electrophysiologist implants the device and connects its electrodes to the heart.

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Surgery for atrial fibrillation

If you have severe AFib and haven't responded to other treatments, the experts at UPMC's Center for Atrial Fibrillation may suggest surgery.

Surgery may be a more favorable choice for better long-term results when:

  • Less invasive AFib treatments haven't worked.
  • Changes to the heart's structure exist — such as enlarged heart chambers or a leaking valve.

Open MAZE surgery

MAZE surgery is the gold standard open approach to treat AFib.

During MAZE surgery, surgeons make tiny cuts in the heart to create a maze-like pattern of scars in the atria. These scars block the transmission of erratic electrical impulses.

Surgeons at UPMC's Center for Atrial Fibrillation are experts in the MAZE procedure. Our research and practice have helped evolve this treatment for AFib.

Minimally invasive MAZE surgery

For some people, surgeons use a minimally invasive approach that doesn't involve opening the breast bone.

Minimally invasive MAZE surgery for AFib:

  • Offers the exclusion of the heart's left atrial appendage — the main region responsible for causing stroke in people with AFib.
  • Allows many people to safely go off of long-term Warfarin (Coumadin®).

Isolated left atrial appendage ligation

Surgeons may suggest this type of surgery if you aren't a good candidate for MAZE surgery and can't take blood thinners. This minimally invasive approach closes off or ligates the left atrial appendage.

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Catheter-based ablation for atrial fibrillation

Ablation is minimally invasive and can help the heart achieve and maintain a normal rhythm. It removes or destroys (ablates) a small amount of tissue causing the abnormal heart rhythm of AFib.

At the Center for Atrial Fibrillation, our experts at ablation techniques have authored and published book chapters and research on the subject.

Types of ablation

  • Radiofrequency ablation uses radio energy to apply heat to the tip of the catheter to burn the heart tissue.
  • Cryoablation uses extreme cold to freeze and scar the heart tissue.

What to expect during ablation

Your doctor:

  • Inserts a small tube or thin wire (catheter) in the veins to gain access to your heart's electrical conduction system.
  • Uses advanced imaging techniques to observe and guide the treatment.
  • Applies either heat or cold to the heart tissue.

Watchman™ device

The Watchman device offers a choice over blood thinners to lower the risk of stroke in some people with AFib.

The Watchman is a parachute-shaped, implanted device that closes off the left atrial appendage. This is the part of the heart most commonly linked to clot formation that could lead to stroke in people with AFib.

Many people take blood thinners to lower their stroke risk, but they aren't safe for everyone.

Some people who might benefit from the Watchman including those who:

  • Have AFib not caused by heart valve disease.
  • Have an increased risk of stroke and can't safely take blood thinners.

During a Watchman procedure, your doctor:

  • Finds a vein in your leg.
  • Uses special moving x-ray imaging, called fluoroscopy, to guide a catheter holding the device to your heart.
  • Places the device in your left atrial appendage to close it off using ultrasound and x-ray guidance.

In most cases, a Watchman implant takes a little more than an hour. Over time, scar tissue forms around the device and closes off the left atrial appendage forever.

Finding new treatments for atrial fibrillation

Doctors around the world recognize our experts at the UPMC Heart and Vascular Institute for their research into the causes of arrhythmia. And in using their findings to design improved methods for diagnosing and treating AFib and other arrhythmias. 

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Atrial Fibrillation Educational Materials

When you find out you have atrial fibrillation (AFib), you can turn to the UPMC Center for Atrial Fibrillation to learn more. We believe strongly that education makes a difference in recovery.

We'll help you navigate the options of modern atrial fibrillation medicines and understand what you can do to protect yourself.

By understanding your condition, you can move into a more proactive role, where you can make changes and actively participate in your treatment.

Personalized atrial fibrillation information

Whether you prefer a face-to-face visit with an atrial fibrillation specialist, a videoconferencing consultation, or a video presentation, we'll work with you, your family, and your trusted personal doctor to provide materials and answers tailored to your particular situation.

During your visit with us, you'll receive a binder full of information about atrial fibrillation — not just about the condition in general, but about your particular situation.

You can use this information to talk with your doctor and your family so that you can better manage your condition.

Customized atrial fibrillation education is the key to a better outcome and quality of life.

Online atrial fibrillation resources

The UPMC Heart and Vascular Institute offers general atrial fibrillation materials, links, and videos.

Many people find these resources helpful in answering their questions about atrial fibrillation and preparing them for their procedure or diagnostic test.

The links below will open a new browser window.

From the American Heart Association

From our Health Library at