Atrial Fibrillation (AFib)

AFib is an abnormal heart rhythm that begins in the top chambers of the heart called the atria. The rhythm is typically chaotic and fast, beating hundreds of times per minute. This can allow blood to pool in the top chamber of the heart and increases the risk of blood clot formation and stroke.

AFib can be caused or triggered by heart problems like coronary artery disease, high blood pressure, heart muscle or valve disorders, or other health conditions like lung disease, sleep apnea, thyroid disease, or viral infections.

Types of Atrial Fibrillation
The three main types of AFib are categorized based on how long they last:

• Paroxysmal: Intermittent and stops on its own in less than a week.
• Persistent: Lasts longer than a week.
• Long-standing persistent: Lasts longer than a year, with no normal rhythm during that time.

Electrocardiogram (EKG)
Small adhesive electrodes placed on the skin record your heart’s electrical activity over a short period of time.

Heart Monitors
Wearable monitors can record your heart rhythm continuously for at least 24 hours, and for up to two weeks. Some only record abnormal heart rhythms when they occur and can be worn for up to 30 days. Wearable heart monitors use electrodes placed on the surface of your skin with an adhesive patch. Insertable loop monitors are surgically implanted under your skin.

Blood Tests
Blood tests measure substances in your blood like electrolytes, hormones, and medications. They can also look for genetic causes of arrhythmias.

Imaging Scans
Imaging scans, like an echocardiogram (an ultrasound of the heart), a CT scan, or cardiac MRI, help your doctors assess your heart’s size, shape, and function. 

Stress Test
Your heart rhythm is evaluated while you exercise on a treadmill or stationary bicycle.

Duke electrophysiologists take time to ensure you understand all your treatment options. We work with you to choose a treatment plan that best meets your needs.

Lifestyle Changes 
Making healthy lifestyle changes can reduce or eliminate AFib episodes, depending on what’s causing your arrhythmia. Your doctor and other Duke specialists can help you lower your blood pressure, improve sleep, exercise regularly, eat healthier, and more.

Medications
Some medications may require you to make periodic clinic visits or even stay at the hospital for a day or two so your doctors can adjust your dose, limit side effects, and ensure you are tolerating the medicine well.

• Blood-thinners, also called anticoagulants, can significantly reduce your risk of stroke. Duke researchers helped develop and test new blood-thinning medications that are more effective and have fewer side effects than older medicines.
• Rate-control medications slow your heart rate to a safe pace. 
• Antiarrhythmic medications help your heart maintain a normal, regular rhythm and prevent AFib episodes.

Left Atrial Appendage Occlusion Device
Left atrial appendage occlusion devices are an alternative to blood thinners, which may be prescribed to help prevent blood clots and strokes. The devices close or seal off part of the top chamber of the heart, known as the left atrial appendage, where blood clots tend to form. Duke was the first hospital in North Carolina to offer left atrial appendage closure after its FDA approval. 

Cardiac Ablation 
This procedure is usually performed using minimally invasive techniques in specialized rooms called electrophysiology (EP) labs. Using a thin, flexible tube inserted in a blood vessel and threaded to the heart, an electrophysiologist selectively destroys the area(s) where irregular heartbeats originate or modifies how electrical impulses move through your atria.

Clinical Trial Participation
Duke electrophysiologists are involved with the latest arrhythmia research. Our providers lead clinical trials studying AFib care, stroke prevention, ablation, device innovation, integrated digital health technologies, and advanced medications. By learning more about how atrial fibrillation works, investigating new treatments, and helping develop clinical guidelines, we can offer the most advanced care. As a Duke patient, you may be eligible to participate in these clinical trials and receive new therapies that are not widely available.

Experienced in Treating Complex AFib
Duke electrophysiologists have decades of experience in treating people with the full range of AFib severity, including those who have other complex health conditions. We performed more than 700 catheter ablation procedures for AFib in 2022. We also collaborate with Duke specialists in heart failure and cardiothoracic surgery to ensure you receive comprehensive care. 

You Receive the Highest Quality Care
Duke participates in national heart rhythm programs designed to ensure people with AFib receive the highest-quality care. Duke University Hospital received a Silver Achievement from the American Heart Association’s “Get With The Guidelines® - AFib” program in 2023, which recognizes our ongoing commitment to quality improvement.