Why we might never find just one cause for AFib: A Q&A with Dr. Roderick Tung

heart diagram

September is atrial fibrillation awareness month. UChicago Medicine asked Roderick Tung, MD, associate professor of medicine and medical director of the Center for Arrhythmia Care at the University of Chicago Medicine's Heart and Vascular Center, about the common heart condition, which affects about 6 million people in the U.S. alone.

UChicagoMed: What is atrial fibrillation, and how common is it?

Roderick Tung: Atrial fibrillation is an abnormal heart rhythm that occurs when rapid, erratic pulses originate in the upper heart chambers. It is the most common type of abnormal heart rhythm in adults worldwide. About 150,000 new cases are diagnosed each year.

What causes AFib?

We have not yet identified a single cause for atrial fibrillation and we don't believe there ever will be. It's what we call a "heterogeneous condition," which means we see it across all age groups and in patients both with and without heart disease. However, there are a number of risk factors and symptoms that are commonly seen in conjunction with the condition: high blood pressure, sleep apnea (when you briefly stop breathing while sleeping), obesity and structural heart disease. You should see a physician if you are experiencing an irregular heartbeat, chest pain, fatigue, dizziness or shortness of breath. People with existing heart and lung conditions (such as coronary artery disease, cardiomyopathy and valvular heart disease) are at an increased risk for atrial fibrillation.

Is it treatable?

Yes. Physicians and other specialists can manage symptoms of atrial fibrillation after evaluating each case and selecting the best treatment strategy for each patient's diagnosis. The severity of the condition varies from patient to patient, which is why treatments differ.

At UChicago Medicine, we offer the full spectrum of treatment options, which include rhythm medications, electrical cardioversion (when we use electrical currents to reset the heart rhythm), minimally invasive ablation procedures and implantable devices like pacemakers. For advanced cases, we are the only program in Chicago that performs hybrid robotic surgery with standard ablation in the same procedure. While there is not yet a cure for atrial fibrillation, our treatment options can effectively help a vast majority of patients control their arrhythmia and help them live active, full lives.

How do ablation treatments work?

At UChicago Medicine, we offer a minimally invasive, non-surgical procedure to treat AFib called a catheter ablation. This involves threading specially designed tubes, or catheters, through a patient's leg into their heart. The catheter is positioned at the source of the irregular heartbeat and then we cauterize the tissue. We also offer a surgical version of ablation, which we performed through small incisions in the chest for more advanced cases. Our team uses special catheters that allow us to know how much force is being applied onto the tissue. We also use magnetically guided robotic arms to maneuver the cauterization tool. We're especially proud that we're the only center in the Chicago that routinely uses three commercially available mapping systems (Rhythmia, Ensite Precision, CARTO), which allows us to create a 3-D reconstruction of the heart and customize the procedure for each patient.

How is this different from atrial flutter?

When the heart's chamber fibrillates, it quivers or shakes, rather than having an organized contraction. This may produce similar symptoms to atrial flutter, which produces a fixed loop that revolves around the top right chamber of the heart. In atrial flutter, the heart's top chamber does not empty effectively. That makes it out of sync with the contraction of the main pumping chamber of the heart. The presence of this rapid rhythm, which typically happens every two to three times down the lower chamber, increases the risk for developing a blood clot in the heart and consequently increases a patient's risk for stroke.

How can I schedule a consultation?

To schedule a next-day or same-week appointment for consultation, call our atrial fibrillation nurse at 773-834-AFIB.