Question: What is atrial fibrillation?

Answer: It’s the most common heart rhythm problem. It’s an irregular problem in the top chamber of the heart. Normally, the top chambers fire first and there’s a slight pause, and the bottom chambers fire. In atrial fibrillation, that contraction pretty much goes away and the upper chambers sit there and kind of vibrate. Instead of actively moving blood, they just sit there and become a reservoir.

It increases with age. By the eighth decade, this can show up in up to 10 to 15 percent of people.

Q: Is this a constant problem?

A: It can come and go initially. Then it comes and stays a little longer. Then it comes and stays all the time. Often this is picked up when folks are in the hospital or are hooked up to a heart monitor for another reason. It can be asymptomatic where folks don’t notice it’s there.

But most folks will notice an irregular heartbeat, getting out of breath, chest pain, dizziness.

Because the top chamber is not emptying blood properly, the blood can clot up there, and if the clots break loose, this can cause stroke.

If it drives the heart rate very fast for a long period of time, it can wear the heart muscle out and cause heart failure.

Q: What causes this?

A: We don’t have a great understanding of what it takes to initiate and maintain atrial fibrillation. Sometimes there’s very mild fibrosis in the top chambers of heart, but in at least 10 percent of the hearts of people who have this, there’s no abnormality whatsoever that we can see.

(Some triggers can be) exercise, lack of sleep, caffeine, red wine and chocolate. The two main risk factors are age and a history of hypertension.

Q: How do you treat it?

A: We have to make a decision whether we’re going to try to make the rhythm go away or just say that the atrial fibrillation is going to be here and we just need to make sure the heart doesn’t go too fast.

One of the triggers is rapid heartbeat from the top chambers of the heart that come from the veins. We can electrically isolate those parts from the pulmonary veins from the rest of the heart through surgery or a catheter-based procedure through the legs.