Atrial fibrillation (AFib), a heart condition marked by an irregular and often rapid heartbeat, is becoming increasingly common in the United States. According to recent data from the American Heart Association and the Centers for Disease Control and Prevention, projections estimate that by 2030, more than 12 million Americans—about one in every 22 people—will be affected by AFib. This marks a significant rise from just over 5 million cases a little more than ten years ago.
The growing prevalence of AFib highlights the importance of recognizing its symptoms, understanding its associated risks, and seeking timely treatment. Dr. Randall Wolf, a cardiothoracic surgeon at Houston Methodist who developed a minimally invasive surgical procedure for AFib, discussed what causes the condition and current approaches to managing it.
AFib is classified as an arrhythmia or abnormal heartbeat. While many arrhythmias are harmless, AFib increases the risk of stroke, blood clots, heart failure, and other complications. Dr. Wolf noted that “only around 50 percent of people with AFib can tell whether their heart is out of rhythm,” which makes early detection challenging.
Dr. Wolf believes that imbalances in the body’s autonomic nervous system can lead to AFib. When this occurs, the upper chambers of the heart lose coordination with each other, resulting in a resting heart rate between 100 and 175 beats per minute—much higher than the normal range of 60 to 100 beats per minute.
Other factors contributing to increased risk include abnormal heart valves, congenital defects, coronary artery disease, high blood pressure, lung diseases, overactive thyroid gland, previous heart attacks, sleep apnea, and viral infections.
“Not all AFib is the same,” said Dr. Wolf. “Knowing the duration of the disease is important. Some people I’ve seen have had AFib for a year, while others have had it for 15 years. The size of a person’s left atrium…is also extremely important. The third thing is to know how long the patient has been continuously out of rhythm.”
Symptoms can include shortness of breath, chest pain, palpitations (fast or fluttering heartbeat), lightheadedness, fatigue, or an irregular heartbeat; however, some patients experience no symptoms at all.
Treatment options depend on how long someone has had AFib and their current heart rhythm status:
“When it comes to treating AFib,” said Dr. Wolf,“there are generally three options for most patients…One is to take medication that can control the heart rate and rhythm.The second option is catheter ablation,and the third option is the Wolf procedure.”
Medications are often used both to reduce stroke risk—by preventing blood clots—and either control rhythm or simply slow down an elevated heart rate into normal ranges.
Catheter ablation uses minimally invasive techniques inside the left atrium to create scar tissue that blocks faulty electrical signals causing arrhythmia.“Catheter ablation aims to make a scar on the wall of the heart inside of the left atrium primarily,” explained Dr.Wolf.“Once that area is scarred,it may not work normally.” This approach may require multiple attempts if initial treatments do not succeed.
The Wolf procedure—a minimally invasive surgery pioneered by Dr.Wolf—involves partially disrupting nerves on the outside surface of the heart.“By decreasing…the autonomic nerves,it can effectively cure AFib.This is a hypothesis we’ve worked on for over 20 years with over 3 ,000 surgeries ,which have had great results.” The procedure reportedly reduces stroke risk by up to 97 percent,and more than nine out of ten patients maintain normal sinus rhythm afterward.Most no longer need blood thinners or further ablations.Dr.Wolf added,“At first,many patients I saw had multiple failed catheter ablations,but now ,over half my patients have had no ablations prior.”
Some cases involving an enlarged left atrium may require both surgical and catheter-based approaches—a hybrid treatment.In nearly all procedures,a subcutaneous monitor called an implantable loop recorder allows continuous monitoring for several years after surgery.“If …an episode [of arrhythmia] occurs,it will notify us…I have patients that are 23 years out from [the] procedure that are still in rhythm.”
Dr.Wolf advised anyone who suspects they might have AFib—or whose loved ones show symptoms—to consult with their doctor or cardiologist promptly:“Our goal is to empower patients to make informed decisions possible.”
