Atrial Fibrillation

Atrial fibrillation (AFib) is the most common heart rhythm problem, affecting up to 5 million Americans. It is caused by irregular electrical activity in the upper chambers of the heart, or atria. It continues when these abnormal electrical “triggers” travel through the heart muscle, resulting in a rapid and irregular heart rate.

Atrial fibrillation can result in blood clots in the heart, significantly increasing the risk of stroke. If left untreated, AFib can also lead to heart failure.

Our cardiology team will perform a detailed history and physical exam to determine if you have AFib, what may be causing it, how long you have had symptoms and what treatments have already been tried. We will do an electrocardiogram (EKG) in the office and may provide a heart rhythm (Holter) monitor at home to confirm the diagnosis.  An ultrasound of the heart (echocardiogram) will also be obtained to check your heart’s size and function.  Some basic labs may also be checked, such as thyroid, kidney, and liver function.

If you are diagnosed with AFIB, our medical team at the Heart and Vascular Institute at University Hospital will work with you to determine a personalized treatment plan.  We have the most experienced team in San Antonio and South Texas offering an advanced hybrid treatment method – a combination of catheter ablation and minimally invasive surgery with a success rate as high as 90 percent.

Most insurance plans require a referral to see a cardiologist. After receiving a referral, our cardiology team can see you fast – usually within 1-5 business days.

Risk Factors

Common risk factors for developing atrial fibrillation include:

  • Age (over 60)
  • Alcohol use
  • Diabetes
  • Chronic lung disease
  • Heart disease
  • High blood pressure
  • Previous open-heart surgery
  • Serious illness or infection
  • Sleep apnea
  • Thyroid disease


Symptoms vary for individuals with atrial fibrillation. Some have no symptoms at all, while others notice things like:

  • Anxiety
  • Fatigue – feeling overtired with little to no energy
  • Irregular heartbeats – switching between fast and slow
  • Shortness of breath
  • Heart palpitations – feeling as though your heart is racing
  • Trouble with daily activities and exercise
  • Pain, tightness or discomfort in your chest
  • Dizziness, lightheadedness or fainting
  • Increased urination

Symptoms depend on your age, existing heart problems and how much AFib affects the pumping of your heart.


Treatment of AFib is aimed at alleviating symptoms, decreasing stroke risk, and preventing heart failure. There are two approaches to treating atrial fibrillation – rate control and rhythm control.

Rate Control – Our physicians collaborate to find the best method of slowing down your heart rate to decrease the risk of heart attack and stroke. This is done through prescribing blood thinning medications and continuous physician follow-up care at your primary care doctor’s office.

Rhythm Control – When rate control methods don’t work, our team will consider using rhythm control methods to treat the more aggressive cases of AFib. These include:

  • Medications – Several classes of drugs are used to convert and maintain your heart in normal rhythm. Blood thinners are also prescribed to decrease the stroke risk.
  • Cardioversion – A controlled shock to the heart that helps it return to its normal rhythm.
  • Catheter Ablation – Using a catheter directed into your heart from a leg vein, radio frequency energy is used to burn the areas inside your heart responsible for causing AFib. This has excellent results in patients with newly diagnosed AFib or for those in whom AFib comes and goes (paroxysmal).
  • Surgical Ablation – The same radio frequency energy is applied to the heart directly during an open “maze” operation. This can be done through a standard open-heart surgery approach, usually in combination with a valve repair or coronary bypass, or through smaller incisions with the heart still beating (minimally invasive/thoracoscopic maze).
  • Hybrid Method – This advanced treatment option is often used for patients with longstanding persistent AFib and/or those with enlarged hearts.  These are the most difficult patients to treat, and the success rate of a single ablation may be as low as 50 percent. However, by combining a minimally invasive thoracoscopic “T-Maze” operation and a catheter ablation, a success rate as high as 90% can be achieved. During this operation, the left atrial appendage, the source of most strokes in patients with AFib, is also clipped.