What is Atrial Fibrillation (AFib)? Know the Signs and Latest Treatment Options
Jan. 29, 2026 - Josh DavisAFib, that chaotic, rapid, and irregular heartbeat caused by malfunctioning electrical signals, is one of those insidious conditions many people don't know about until they think they may have it themselves.
In fact, recent estimates cited by the American Heart Association and CDC indicate atrial fibrillation is becoming significantly more common than once thought. Projections suggest that by 2030 more than 12 million (1 in 22) Americans will be affected by the condition, up from just 5 million a little over a decade ago.
The increased prevalence reinforces the need for people to recognize AFib symptoms, understand the risks and get treated for the condition as early as possible.
We spoke with Dr. Randall Wolf, a cardiothoracic surgeon at Houston Methodist who pioneered an effective minimally invasive procedure to treat AFib, to help you understand more on what causes the condition, why it’s imperative to treat early and what solutions exist today for patients.
What is AFib exactly?
Put simply, AFib is an irregular heartbeat or arrhythmia. Our hearts change rhythm all the time — just think of the last time you got winded climbing up a long flight of stairs or schlepping your groceries from the car to the house. Our bodies automatically increase our breathing and heart rate to keep up with the energy needs of our muscles without conscious thought.
Arrhythmias happen when your heart — for a multitude of reasons — beats too fast, too slow, irregularly, skips a beat, adds an extra beat or “quivers” instead of pumping at a steady cadence. Most arrhythmias are harmless. However, in the case of AFib, the condition increases a person’s risk of stroke, blood clots, heart failure and other heart-related complications.
Moreover, like high blood pressure, most people who have AFib don’t know they have it, according to Dr. Wolf. Studies reveal that only around 50 percent of people with AFib can tell whether their heart is out of rhythm.
What causes AFib?
It’s Dr. Wolf’s hypothesis that AFib is ultimately caused by imbalances in the body’s autonomic nervous system — our body’s involuntary mechanisms that control the heart, lungs, body temperature, blood pressure and digestion. When your heart is in atrial fibrillation, the two upper chambers responsible for receiving blood become out of sync, resulting in a fast and irregular heartbeat that can range anywhere between 100 to 175 beats per minute at rest. For context, a normal heart rate at rest beats 60 to 100 times per minute.
Additionally, AFib often comes and goes, meaning the heart syncs itself back into rhythm, but it’s possible for the condition to become permanent.
“Not all AFib is the same,” says 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, one of the chambers of the heart, is also extremely important. The third thing is to know how long the patient has been continuously out of rhythm. Not in and out of rhythm but continuously out of rhythm.”
Other factors can increase a person’s risk for developing AFib, including:
Abnormal heart valves
High blood pressure
Lung diseases
Overactive thyroid gland
Previous heart attacks
Viral infections
It's these factors Dr. Wolf says help him determine what treatment might be best. For example, if a person’s left atrium is enlarged and the patient has been out of rhythm for over a year, the chances of blood-thinning medication or catheter ablation — two mainstay treatments for AFib — working are “less than ideal,” he says. In these cases, other treatments may be recommended, he adds.
(Related: What Are Heart Palpitations & When to Worry)
What are the symptoms of AFib?
AFib symptoms may include:
Heart palpitations (fast, pounding or fluttering)
Lightheadedness
Extreme fatigue
Irregular heartbeat
AFib can also have no symptoms at all, says Dr. Wolf. The symptoms of AFib can also be very subtle in the beginning, so many people may not notice it or choose not to take immediate action to address it. However, recognizing those symptoms and getting treated as early as possible are key to preventing the condition from getting worse, as Dr. Wolf emphasizes.
How is AFib treated?
“When it comes to treating AFib, there are generally three options for most patients, depending on how long they’ve had AFib and what their rhythm is currently,” says Dr. Wolf. “One is to take medication that can control the heart rate and rhythm. The second option is a catheter ablation, and the third option is the Wolf procedure,” the minimally invasive surgical treatment developed by Wolf.
Medication
AFib causes blood to pool and stagnate in the heart. Because it’s not flowing, this increases the risk that a blood clot can form, potentially leading to a stroke. This is why most patients with AFib who do not undergo the Wolf procedure will likely need to be on some sort of blood thinner.
In addition to addressing blood clots, cardiologists must also address the AFib itself. There are two main treatment strategies when it comes to treating AFib: rhythm control and rate control. A rhythm control strategy aims to address the irregular rhythm that comes with AFib, whereas a rate-control strategy accepts the irregular rhythm and instead aims to slow the heart rate down to normal ranges.
The goal of both strategies is to alleviate the symptoms of AFib, but doctors must decide which one is right for the patient, depending on their condition. Both strategies, however, have the potential to fail in both the short- and long-term.
Catheter ablation
Part of a rhythm-control strategy, catheter ablation is a minimally invasive heart procedure that aims to treat the arrhythmia associated with AFib and is typically suggested when medications called antiarrhythmics that are used to suppress abnormal heart rhythms don’t work.
“Catheter ablation aims to make a scar on the wall of the heart inside of the left atrium primarily,” says Dr. Wolf. “Once that area is scarred, it may not work normally.”
Once the tissue inside of the heart is altered, the idea is that that area of tissue no longer responds to the abnormal electrical signals that are responsible for the irregular heartbeat, thereby restoring normal heart rhythm.
Catheter ablations are shown to have better long-term results for symptomatic AFib patients than medication therapy alone. That said, catheter ablations don’t work all of the time. Some patients require multiple catheter ablations in order to treat their arrhythmia. In other cases, AFib doesn’t respond to either medication or catheter ablations.
Wolf procedure (formerly Wolf Mini Maze)
“The Wolf procedure is a minimally invasive surgical procedure that involves a partial cardiac denervation,” says Dr. Wolf. “A catheter ablation focuses on the inside of the heart, whereas the Wolf procedure focuses on the outside of the heart where the nerves are. By decreasing the number of nerves stimulating the heart on the outside, the autonomic nerves, it can effectively cure AFib. This is a hypothesis that we’ve worked on for over 20 years with over 3,000 surgeries, which have had great results.”
Named after Dr. Wolf himself, the Wolf procedure is estimated to reduce the risk of stroke by 97 percent, and over 90 percent of patients who undergo the Wolf procedure maintain normal sinus rhythm. While most know it as the Wolf Mini Maze, the name was recently changed because it’s not actually a type of Maze procedure, says Dr. Wolf. A Maze procedure is actually a type of ablation and is typically used for open heart surgery.
“At first, most of the patients I saw had multiple failed catheter ablations, but now, over half my patients have had no ablations prior,” he says. “Most patients who undergo the Wolf procedure no longer need to take blood thinners or undergo further catheter ablation.”
In rare cases — specifically in patients who have a very large left atrium — Dr. Wolf says that a catheter ablation may be necessary to address any lingering atrial arrhythmia. This is called a hybrid procedure, he notes.
“In almost all our patients, we also place a subcutaneous monitor called an implantable loop recorder under the skin that allows us to see an EKG every day for five years,” Dr. Wolf says. “If the patient does have an episode of atrial fibrillation or atrial flutter, it will notify us of that episode. I have patients that are 23 years out from the procedure that are still in rhythm.”
What should I do to manage AFib?
If you think you or a loved one may have AFib, it’s important you speak with your doctor or a cardiologist to discuss your symptoms and get the appropriate treatment as early as possible to reduce your risk of blood clots, stroke, heart failure or other complications. With AFib, timing matters.
“Some patients are told they have AFib, but when we evaluate them carefully, they may not have AFib but rather atrial flutter or another type of arrhythmia, which we then refer them to the proper cardiologist, usually an electrophysiologist, who can help them,” says Dr. Wolf. “Our goal is to empower patients to make the most informed decisions possible.”
