About

There are numerous ways to control and treat atrial fibrillation, including medicines and interventions done by your cardiologist with a catheter. There is also surgery. The surgical intervention to treat atrial fibrillation is called the MAZE procedure. The goal of the MAZE procedure is to do the following:

  • Wear away the arrhythmia
  • Restore synchrony between the atria and the ventricles
  • Preserve organized atrial contraction

Through the strategic placement of incisions in both atria, the circular electrical patterns that are responsible for this arrhythmia are interrupted and consequently the formation and conduction of errant electrical impulses is stopped. Scar tissue generated by the incisions permanently blocks the travel routes of the erroneous electrical impulses that cause atrial fibrillation eliminating the arrhythmia. The heart's natural pacemaker originating in the SA node will resume with the normal electrical impulse.

Treatments

Cardiac Ablation

Other Cardiac Surgery Procedures

Here at University of Utah Health Care this procedure is performed in conjunction with other cardiac surgery procedures like the following:

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.

Cardiothoracic Surgeons

David A. Bull, M.D.

Patient Rating:

4.8

4.8 out of 5

David Bull, MD, is a member of the Thoracic Oncology Program, a joint effort between Huntsman Cancer Institute and the University of Utah Hospitals and Clinics. The program was developed to offer consultation, diagnosis, and treatment for all chest cancers. Bull is a professor in the Department of Surgery, Division of Cardiothoracic Surgery; progra... Read More

Phillip T. Burch, M.D.

Dr. Burch performs repairs for a wide variety of congenital cardaic anomalies. In additon to clinical responsibilities, Dr. Burch has research interests in single ventricle physiology as well as in derangements in normal neonatal metabolism caused by cardiac surgery.... Read More

Specialties:

Cardiothoracic Surgery, Pediatric Cardiothoracic Surgery

Locations:

Primary Children's Hospital (801) 662-5577

Aaron W. Eckhauser, M.D., M.S.C.I

I joined the University of Utah, Division of Pediatric Cardiothoracic Surgery in 2012. I am board certified by the American Board of Surgery and the American Board of Thoracic Surgery. My clinical interests are focused on caring for all patients, from neonates to adults, with congenital heart defects. I have a special interest in pediatric heart... Read More

Specialties:

Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Ganesh S. Kumpati, M.D.

Dr Kumpati performs adult cardiac surgery, thoracic surgery, and vascular surgery. Dr Kumpati has significant experience in both surgical and endovascular management of aortic disease, including endovascular aneurysm repair. Prior to joining the University of Utah in August 2011, Dr Kumpati was in private practice in Milwaukee, Wisconsin, for 5 y... Read More

Specialties:

Cardiothoracic Surgery

Locations:

University Hospital
Cardiovascular Center
(801) 581-5311
Veterans Administration Medical Center (801) 582-1565

Stephen McKellar, M.D., M.Sc.

Dr. McKellar is a native of Salt Lake City and received his Bachelor of Arts from the University of Utah and his Doctor of Medicine from the George Washington University School of Medicine. He completed his General Surgical and Cardiothoracic Surgical training at the Mayo Clinic in Rochester, Minnesota in a combined, integrated training program. ... Read More

Amit N. Patel, M.D.

Patient Rating:

4.9

4.9 out of 5

Amit Patel, MD, MS, is an associate professor in the Division of Cardiothoracic Surgery at the University of Utah School of Medicine and Director of Clinical Regenerative Medicine and Tissue Engineering at the University of Utah. His clinical interests include heart surgery for coronary disease, valve repair and replacement, heart failure, aortic s... Read More

Craig H. Selzman, M.D.

Patient Rating:

4.8

4.8 out of 5

Dr. Craig Selzman is a Professor of Surgery and Chief of the Division of Cardiothoracic Surgery at the University of Utah who specializes in the care of patients requiring heart surgery. He earned his undergraduate degree at Amherst College and medical degree at Baylor College of Medicine. He received his General and Cardiothoracic Surgery training... Read More

Thomas K. Varghese Jr., M.D., M.S.

Patient Rating:

4.9

4.9 out of 5

Thomas Varghese Jr. MD, MS has specialized expertise in the treatment of diseases of the lungs, esophagus, chest wall and mediastinum. He is board certified in both Surgery and Thoracic Surgery. His main clinical focus is in the use of minimally invasive surgery in the management of patients with tumors in the chest. He has integrated a health serv... Read More

Specialties:

Cardiothoracic Surgery, Nurse Practitioner

Locations:

Eccles Primary Children’s Outpatient Services Building (801) 662-1000
University Hospital
Cardiovascular Center
(801) 581-0434

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

A location has not yet been added by this physician.

Nathan C. Sontum, PA-C, M.H.S.

PA-C for department of CT surgery 2010-Present... Read More

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Scott A. Tatum, PA-C

Scott came to the University almost 9 years ago from private practice. As a trainer and consultant for Endoscopic Vein harvesting, he has effectively introduced and incorporated new technology and procedures into the University healthcare system. As the senior physician assistant in the division of cardiothoracic surgery, Scott has 17 years experie... Read More

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

University Hospital (801) 581-2121

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
Veterans Administration Medical Center
500 Foothill Drive
Salt Lake City, UT 84148
(801) 582-1565