About

Founded in 2006, the Cardiovascular Center's Atrial Fibrillation Program refines and defines management of this disease by using ablation to cure it. Averaging 15 patients a week, 60 percent of who come from out of the state, the success rate is more than 90 percent. That means within three months of ablation, patients are cured of the arrhythmia and off medication.

As a patient, you will receive care from some of the world's leading specialists as many of our physicians have participated in the research and development of the newest treatments, including the latest in cardiac ablation. We also offer access to the most advanced techniques and technology, giving patients a complete range of treatment and drug options for atrial fibrillation.

Treatments

Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation, or AFib, is a kind of abnormal heart rhythm or arrhythmia. Normally, a specific group of cells begin the signal to start your heartbeat. These cells are in the sinoatrial (SA) node. This node is in the right atrium, the upper right chamber of the heart. The signal quickly travels down the heart’s conducting system. It travels to the left and right ventricle, the 2 lower chambers of the heart. As it travels, the signal triggers the chambers of the heart to contract. The atria contract with each heartbeat to move blood into the ventricles.

During AFib, the signal to start the heartbeat is disorganized. This causes the atria to quiver or “fibrillate.” The disorganized signals are then transmitted to the ventricles. It causes them to contract irregularly and sometimes quickly. The contraction of the atria and the ventricles is no longer coordinated, and the amount of blood pumped out to the body will vary with each heartbeat. The ventricles may not be able to pump blood efficiently to the body.

The quivering atria can lead to blood pooling. This increases the risk of forming blood clots. These clots can then travel to the brain, causing a stroke. This is why AFib significantly increases the risk for stroke.

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Sometimes AFib occurs briefly and then goes away. This is called paroxysmal atrial fibrillation. AFib that lasts for 7 days or longer is called persistent atrial fibrillation. AFib that lasts longer than a year is called long-standing persistent atrial fibrillation. Persistent AFib may be called permanent atrial fibrillation when a decision is made to no longer control the heart’s rhythm or despite best efforts, normal rhythm can't be restored.

AFib is common in adults. The risk increases with age. It is more common in men than women.

What causes atrial fibrillation?

AFib can happen from any type of problem that changes the way the heart handles electricity. Sometimes the cause is unknown. There is a range of things that can increase this risk. Some of the risks include:

  • Older age
  • High blood pressure
  • Coronary artery disease
  • Heart failure
  • Rheumatic heart disease (from previous Streptococcus infection)
  • Heart valve defects (like mitral valve prolapse)
  • Pericarditis
  • Congenital heart defects
  • Sick sinus syndrome
  • Hyperthyroidism
  • Obesity
  • Diabetes
  • Lung disease
  • Obstructive sleep apnea
  • Metabolic syndrome
  • High-dose steroid therapy

AFib is also more likely to happen during an infection or right after surgery. Stress, caffeine, and alcohol may also set off attacks.

People who do vigorous endurance exercises, such as running marathons, can develop atrial fibrillation.

Certain people may be at greater risk of developing AFib. This is due to differences in genes they inherited from their parents. This is not yet fully understood, however.

Who is at risk for atrial fibrillation?

AF is more common in people who are over 65. It’s also more common in men than women. Underlying heart disease, high blood pressure, thyroid problems, excess alcohol use, sleep apnea and certain lung disease put people at risk for atrial fibrillation.

What are the symptoms of atrial fibrillation?

AFib can cause different symptoms. This is especially true when it is not treated. These can include:

  • Heart palpitations — it might feel like your heart is skipping beats or beating too hard
  • Shortness of breath
  • Chest pain
  • Dizziness or fainting
  • Weakness and fatigue
  • Confusion
  • Swelling in the feet, ankles, and legs

Sometimes AFib has no symptoms.

How is atrial fibrillation diagnosed?

Diagnosis starts with a medical history and physical exam. An internist or primary care healthcare provider will often makes the diagnosis. You may be sent to a cardiologist for further evaluation and treatment.

An electrocardiogram (ECG) is very important for a diagnosis. Healthcare providers use this test to study the heart signal and rhythm. A skilled reader can find AFib using this test alone. If the AFib comes and goes, you might need an electrocardiogram over a longer period with a holter monitor or an event recorder to pick up the rhythm.

Other tests might be used to help plan treatment. These might include:

  • Echocardiogram, to check the hearts structure and function
  • Cardiac stress testing, to check the blood flow in the heart
  • Blood work, to check for thyroid levels, diabetes, and possible medical conditions

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How is atrial fibrillation treated?

Your healthcare providers will work with you to create a specific treatment strategy. Treatment options vary according to your medical history, your symptoms, and your preferences. Some people who don’t have any symptoms may not need a large amount of treatment. Some general categories of treatment include:

  • Anticoagulation medicines (blood thinners) or aspirin, to help prevent stroke
  • Medicines to slow the heartbeat, like beta-blockers and calcium channel blockers
  • Medicines to help prevent AFib (antiarrhythmics)
  • Treatment for the main cause of AFib, if known
  • Medicines to treat heart failure (if present), like ACE inhibitors

 

Before other treatment is started, you may first need a procedure called an electrical cardioversion. This can help get the heart back into a normal rhythm. It involves delivering a low-energy shock to the heart to stop the signal that is making the atria quiver.

Procedures such as catheter ablation or maze surgery may be used to restore normal rhythm if medicines and electrical cardioversion have not worked. Catheter ablation uses either radio wave energy sent through a wire or a freezing balloon to destroy the small patch of heart tissue that causes AFib. Maze surgery uses cuts or burns in the atria to prevent AFib.

In some cases, the conduction node between the atria and the ventricles (AV node) will be destroyed using catheter ablation. This prevents the problem signals from passing to the ventricles. A pacemaker is then put in to control heart rhythm.

In the long term, treatment focuses on either controlling the heart rate or preventing the abnormal rhythm.

You may be prescribed some type of anticoagulant. What you are prescribed will depend on your risk for stroke. If you are at low risk, you may take daily aspirin. If you are at high risk, you will need a stronger blood thinner.

You will need regular follow-up for your AFib. Certain anticoagulants call for more frequent blood tests. Tests such as a prothrombin time (PT) will be needed if you take warfarin. This test measures the time it takes for your blood to clot. It records your reading as an international normalized ratio (INR). Your healthcare provider can change your medicine if needed. Newer anticoagulant medicines may call for periodic monitoring of your kidney function.

A medical device is now available that may be considered to prevent stroke if you can't take blood thinners. Called left atrial appendage closure device, it is designed to close off an area in the atrium where most blood clots form that cause stroke.


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What are the complications of atrial fibrillation?

Stroke and heart failure are the major complications of AFib. Blood can pool in the atria during AFib. This can cause a clot. This clot can travel to the brain and block a vessel there, causing a stroke. Blood-thinning medicines help reduce this risk.

AFib also sometimes causes heart failure. Because the ventricles are beating so irregularly, they can’t fill normally. The atria also can’t squeeze appropriately, which also reduces filling in the ventricles. In some cases, this means the heart can’t pump enough blood to the body, causing heart failure. A rapid heart rate in AFib, left untreated, will increase the risk of heart failure. Heart failure is treated with lifestyle changes, medicine, procedures, or surgery. Medicines that lower the heart rate will also help prevent heart failure.

Can atrial fibrillation be prevented?

Controlling risk factors for atrial fibrillation may prevent AFib from developing. This includes managing underlying heart disease, high blood pressure, thyroid problems, sleep apnea and lung diseases. Risk factor control also means making healthy lifestyle choices. These choices include eating a healthy diet, exercising regularly, maintaining a healthy weight, and not smoking.  Drink only in moderation. If you have an alcohol abuse problem, consider getting help.

How can I manage atrial fibrillation?

There are steps you can take to help you manage your AFib and maintain a healthy lifestyle. 

  • Keep your intake of certain foods consistent, like green leafy vegetables, if you have been prescribed warfarin.
  • Eat a heart healthy diet.
  • Don't smoke.
  • Be physically active and maintain a healthy weight.
  • Keep your cholesterol at healthy levels with lifestyle and medicine.
  • Avoid the use of alcohol and caffeine (which can trigger abnormal heart rhythms).
  • Avoid certain over-the-counter medicines (which can trigger abnormal heart rhythms).
  • Make sure all your healthcare providers, dentists, and pharmacists know if you are taking a medicine to prevent blood clots.
  • If you miss a dose of a blood-thinning medicine, do not double up your dose. Ask your healthcare provider what you should do.

When should I call my healthcare provider?

Get emergency medical care if you have severe symptoms like chest pain or sudden shortness of breath. Also get help if you have signs of severe bleeding.

See your healthcare provider soon if your symptoms are gradually increasing, or if you have any new mild symptoms or side effects.

Key points about atrial fibrillation

  • AFib is the most common abnormal heart rhythm. The atria quiver instead of contracting the way they should. The heart rate usually increases. It is a serious condition, but most people with AFib can lead normal, active lives. You will need to be checked regularly.
  • Follow all of your healthcare provider’s instructions about medicines, lifestyle, and monitoring.
  • You may be treated with medicine to control your heart rate or rhythm.
  • You may need anticoagulation medicine to help prevent a stroke.
  • If you receive certain anticoagulation medicines, you will need frequent blood tests and monitoring.
  • Go to all your healthcare provider appointments.

 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Atrial Fibrillation Diagnosis, Management, and Follow-up

Patient information about atrial fibrillation, diagnosis, management, and follow upIf you you or someone you know has recently been diagnosed with atrial fibrillation, please feel free to download this informational brochure. It is produced by the Cardiovascular Center of University of Utah Health Care and is intended to help you better understand the diagnosis and treatment of atrial fibrillation. It is important to read through all of the information carefully and discuss any further questions you may have with a doctor.

Research

The Comprehensive Arrhythmia Reserach & Management Center works as a uniquely multifaceted and comprehensive program, collaborating with research partners to further develop the technology, research, and clinical management for the advancement of superior, world-class medical treatment of atrial arrhythmias.

Procedures

Cardiologists

Mihail G. Chelu, M.D., Ph.D., FHRS

Dr. Chelu is an Assistant Professor in the Department of Medicine. He obtained his undergraduate and master degrees in physics from Babes-Bolyai University and his medical degree from Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca. Subsequently, he joined Baylor College of Medicine in Houston for his doctoral degree. After compl... Read More

Specialties:

Cardiac Electrophysiology, Cardiology

Locations:

Redwood Health Center (801) 213-9990
Stansbury Health Center (435) 843-3096
University Hospital
Cardiovascular Center
(801) 585-7676

Roger A. Freedman, M.D.

Patient Rating:

4.8

4.8 out of 5

Roger A. Freedman, M.D. has been a faculty member at the University of Utah for over 20 years. He specializes in the treatment of cardiac arrhythmias, particularly in the implantation and management of implanted pacemakers and defibrillators. Pacemaker and defibrillator lead extraction is a highly specialized technique in which Dr. Freedman is gre... Read More

Specialties:

Cardiac Electrophysiology, Cardiology, Pacemaker and Defibrillator Implantation, Pacemaker and Defibrillator Lead Extraction

Locations:

Idaho Heart Institute (801) 585-1935
Memorial Hospital of Sweetwater County (801) 585-7676
Star Valley Medical Center (801) 585-7676
University Hospital
Cardiovascular Center
(801) 585-7676
William B. Ririe Hospital & Rural Health Clinic (801) 585-7676

Frederick T. Han, FACC, M.D., FHRS

Patient Rating:

4.7

4.7 out of 5

Dr. Frederick Han is an Assistant Professor in the Department of Medicine. Dr. Han strives to give excellent care to his patients by providing open communication and individualized treatment. He makes every effort to provide evidenced-based care while also striving to ensure patient satisfaction.He obtained his undergraduate and medical degrees fro... Read More

Specialties:

Cardiac Electrophysiology, Cardiology

Locations:

Memorial Hospital of Sweetwater County (801) 585-7676
South Jordan Health Center (801) 585-7676
University Hospital
Cardiovascular Center
(801) 585-7676
William B. Ririe Hospital & Rural Health Clinic (801) 585-7676

Nassir F. Marrouche, M.D.

Patient Rating:

4.6

4.6 out of 5

Dr. Marrouche has dedicated his career to developing innovative research and clinical practices to advance patient care, diagnosis and treatment of heart arrhythmias. In 2009, at the University of Utah, he created the Comprehensive Arrhythmia Research and Management Center (CARMA) bringing together a cross-departmental team of physicians, scientis... Read More

Specialties:

Cardiac Arrhythmia Management, Cardiac Electrophysiology, Cardiology

Locations:

University Hospital
Cardiovascular Center
(801) 585-7676

Ravi Ranjan, M.D., Ph.D.

Patient Rating:

4.6

4.6 out of 5

Ravi Ranjan, M.D., Ph.D., is a cardiologist specializing in cardiac electrophysiology. His clinical interests include ablation of complex cardiac arrhythmias like atrial fibrillation, ventricular tachycardias and supra-ventricular tachycardias. He also has keen interest in cardiac device based therapy like cardiac resynchronization therapy, ICDs an... Read More

Specialties:

Cardiac Electrophysiology, Cardiology

Locations:

University Hospital (801) 585-7676

T. Scott Wall, M.D.

Dr. Wall is an Assistant Professor of Medicine at the University of Utah. He received a Bachelor of Science in Physics from University of Texas at Austin and received his medical degree from University of Texas Southwestern. Dr. Wall completed his Internal Medicine Residency at University of North Carolina Chapel Hill where he proceeded to complete... Read More

Specialties:

Cardiac Electrophysiology, Cardiology

Locations:

A location has not yet been added by this physician.

Brenda I. Fish, APRN, CCDS, M.S.N.

Brenda Fish, APRN, is a nurse Practitioner in Cardiology, specializing in arrhythmias and devices such as pacemakers, implantable defibrillators. She is licensed to practice in Utah, Idaho, Wyoming and Nevada and participated in our Outreach clinics in these states. Brenda received her undergraduate and advanced degrees from the University of Ut... Read More

Specialties:

Cardiac Electrophysiology, Cardiology, Nurse Practitioner

Locations:

East Falls Orthopaedics Clinic (801) 585-1935
Idaho Heart Institute (801) 585-1935
University Hospital
Cardiovascular Center
(801) 585-7676

Paulina K. Gudgell, M.S.N., APRN, ACNP-BC

Paulina Gudgell, MSN, APRN, ACNP-BC has been practicing in the department of Cardiology as a Nurse Practitioner (NP) since 2010. She began practicing in the specialty of Cardiac Electrophysiology, where she practiced for 1.5 years treating patients with a variety of atrial and ventricular arrhythmias, with a special focus on atrial fibrillation, al... Read More

Specialties:

Acute Care Nurse Practitioner, Cardiac Electrophysiology, Cardiology, General Cardiology, Preventive Cardiology

Locations:

Redwood Health Center
University Hospital
Cardiovascular Center
(801) 587-5888

Charles S. King, PA-C, M.P.A.S.

Mr. King’s clinical interests are in the care of adults and children with cardiac congenital diseases and cardiac arrhythmias. He actively participates in research efforts in collaboration with the Department of Pediatric/Pediatric Cardiology, Division, Department of Internal Medicine/Division of Cardiology, Department of Fetal and Maternal Medicin... Read More

Specialties:

Adult Congenital Heart Disease, Cardiac Electrophysiology, Pediatric Cardiology, Physician Assistant

Locations:

Primary Children's Hospital
Pediatric Cardiology
(801) 662-5400

Nancy M. Veit, APRN

Nancy M. Veit, FNP BC is a nurse practitioner in the Adult Congenital Cardiology Clinic at the University of Utah. As a cardiology nurse practitioner her clinical interests include interventional cardiology, electrophysiology and congenital cardiology. Nancy received her undergraduate degree in nursing from the University of Utah. She recieved her ... Read More

Locations

University Campus
University Hospital
50 N Medical Drive
Salt Lake City, UT 84132
Map
(801) 581-2121
Primary Children's Hospital
100 N Mario Capecchi Dr
Salt Lake City, UT 84132
(801) 662-1000

Patient Experience

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While hiking in Peru with her husband and children, Michele Straube stopped at every switchback, wheezing and feeling dizzy. Although she was trim and athletic, uphill climbs proved especially difficult for her, often leaving her lagging behind the group or requiring her to stop and catch her breath....

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Clinical Trials