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With about 150,000 new cases diagnosed each year, atrial fibrillation, or AFib, is the most common type of heart rhythm disturbance (or arrhythmia) affecting people worldwide. It happens when the upper heart chambers experience rapid, erratic pulses. Although there are numerous risk factors associated with AFib, including age, high blood pressure, obesity, and obstructive sleep apnea, it remains a complex condition without a single identifiable cause and may affect patients across a broad range of patient ages.
Cardiologist Gaurav Upadhyay, MD, specializes in detecting AFib and works with a diverse team of electrophysiologists and surgeons who see these cases all the time. Upadhyay breaks down what to know if you or a loved one is diagnosed with this condition.
What is AFib?
This is always one of the first questions that comes up for us. Was it something I did? The key here is to reassure people that AFib is the most common arrhythmia that affects people, and the single biggest risk factor is just getting older. People often think it’s related to their diet, but that’s a misconception. AFib is a problem of the electrical signals of the heart — I like to say it’s a problem with the wiring system, as opposed to a problem with plumbing. A lot of people feel like if they have heart disease they must have blockages in their arteries — that’s not the case with this arrhythmia.
When should someone see a doctor if they think they might have AFib?
The most common symptom people have is they feel a skipped or an 'extra' heartbeat. Other people will say that their heart is pounding or racing. Others might use the word palpitation, which can include some of or all of these sensations. The key here is that people having AFib, particularly if it’s fast, feel uncomfortable. Sometimes as AFib progresses, patients simply report feeling drawn out and fatigued with activities that they could previously do without difficulty. Examples might include getting winded walking up a flight of stairs, traveling from the car to the entrance of a long parking lot, or feeling lightheaded doing basic housework. If you’re having these symptoms, it’s a good place to start with your primary care doctor. Since some of these symptoms are vague, it is important to undergo a confirmatory test like an Electrocardiogram (EKG). An EKG is a simple noninvasive test that can be performed in the office. We also may recommend you wear an event or Holter monitor at home (which is a wearable EKG for the outpatient setting).
How do you manage AFib?
There are two main ways we manage AFib. The goals of management are to reduce the risk of stroke and to control symptoms. The increased risk of stroke with AFib is clearly established and is five times more likely for patients with AFib relative to their peers. The good news is that we have numerous options to reduce this risk. This involves using blood thinners. Modern blood thinners are simpler to use and safer than what we had previously.
The second goal is to control symptoms. That can be pursued with one of two strategies: rate control or rhythm control. The strategy of rate control actually allows patients to stay in AFib, but focuses instead on controlling heart rate — since most patients feel less tired when their heart rate can be controlled. This can be achieved using oral medications like beta blockers or calcium channel blockers. These are often once daily medications that moderate the heart rate and protect against heart attacks. AFib itself is not associated with a greater risk for heart attacks per se, but people who have heart attacks are more likely to have AFib later on.
The second strategy is to pursue rhythm control. In rhythm control, we strive to restore the heart’s normal rhythm, or the regular heart rhythm we were born with. Particularly over the last two decades, we’ve come a long way with treatment options to achieve rhythm control. Rhythm control can be achieved with medications or with a procedure or surgery called an ablation. The physicians who help specialize in helping make these choices are called electrophysiologists. Electrophysiologists are cardiologists who have specialized in heart rhythm disorders and their treatments.
Do people with AFib need surgery?
Some people, but not all, need surgery to treat their AFib. UChicago Medicine is unique because we have an integrated program that coordinates electrophysiologists and surgeons. This allows us to have an array of options for people, whether it’s a first case, or something complex, such as patients who recur despite an initial — or multiple — other procedures or prior surgeries. Part of what we like to focus on is patients with difficult to control, recurrent arrhythmias or challenging anatomy. We take advantage of the resources and colleagues at our program, including a world class imaging group as well as a cutting edge ablation suite to take challenging cases.
What is an ablation?
Ablation is the word we use to refer to making a controlled “burn” inside the heart. We do this to change the heart’s electrical architecture by walling off electrically active areas by making scar tissue with ablations, or burns, in the heart muscle. We offer several types of ablation procedures. Broadly speaking, this can involve two different approaches: radiofrequency (RF) energy ablation which is heating type burn, or cryo-ablation, which is like making a freezer burn. The way we get our tools to the heart typically involves making a tiny incision near the groin and inserting long thin wires called catheters up into the heart. This is called an endocardial ablation. We can then find and eliminate the source or trigger of the arrhythmia. This approach is effective and has a fast recovery time; we want people to be up and out of bed 4-6 hours after the procedure.
Our surgical colleague, Dr. Husam Balkhy, has also pioneered an approach using minimally invasive robotic surgery. Rather than having open heart surgery, which is invasive and has a longer healing time, this procedure uses three small ports in the body to insert tools into the heart. The surgeon is able to operate remotely using a robotic device across the room from the patient, while the surgery team assists at the table.
Part of what makes UChicago unique is that we collaborate to determine a cohesive approach for patients, whether that involves a traditional endocardial ablation, an epicardial ablation, a minimally invasive robotic approach or a combination of approaches.
After getting short-of-breath, Michael finally went to UChicago Medicine Ingalls Memorial and soon cardiologist Abed Dehnee, MD, diagnosed him with congestive heart failure and identified a blood clot in his lung.