Just as symptoms of atrial fibrillation vary from person to person, so too do treatments. Your medical team will help you determine the cause of your atrial fibrillation and develop a treatment plan to reduce the frequency of episodes or eliminate them entirely.
There are a variety of factors that can increase the likelihood of atrial fibrillation, including alcohol use, caffeine, smoking, obesity, dehydration, and even being over-tired or stressed. Making lifestyle changes can absolutely help reduce the risk of atrial fibrillation as well as the frequency and duration of episodes. In particular, there is increasingly strong evidence that weight loss can dramatically help reduce atrial fibrillation episodes in patients who are overweight. Treatment of other medical conditions associated with atrial fibrillation, such as high blood pressure, sleep apnea, diabetes, thyroid disease, lung disease, other heart conditions, congestive heart failure, kidney failure, anemia (low blood counts), and electrolyte abnormalities can also help reduce the duration and number of episodes.
There are three different types of medications that your doctor may use to treat your atrial fibrillation. These include blood thinning medications, AV node blocker medications and antiarrhythmic medications.
Blood thinning medications are often given to patients with atrial fibrillation because they are at a higher risk for having a stroke. When the right and left atria are quivering in a disorganized pattern, the blood inside those compartments swirls around in place instead of being pumped forward. When blood sits around too long, small blood clots can form. If a blood clot forms in the top left chamber (the left atrium), then breaks free and gets pumped out of the heart up to the brain, it will cause a stroke. The most effective treatment to reduce the risk of stroke is to take a medication that helps prevent blood from clotting; these medications are known as “anticoagulants” or “blood thinners.” A newer treatment option to reduce the risk of stroke is a procedure called “left atrial appendage occlusion,” which involves placing a small mesh plug permanently inside the heart to block off a blind-end pouch, that is the most common place clots can form.
“AV node blocker” medications can be used to slow down the pulse rate of the bottom chambers of the heart, even while atrial fibrillation is ongoing. A fast pulse rate is responsible for many of the symptoms caused by atrial fibrillation, and if a fast pulse rate occurs for weeks or months at a time, this can sometimes lead to a weakening of the heart, with fluid build-up in the lungs known as “heart failure.” Medications that can slow the pulse (but do not affect the atrial fibrillation in the top chambers) include adrenaline-blockers (called “beta blockers,” such as metoprolol, carvedilol, atenolol, and nadolol), calcium channel blockers (such as diltiazem and verapamil) and digoxin. Sometimes these medications are used in combination to achieve the proper effect on the pulse rate.
“Antiarrhythmic” medications are used to suppress atrial fibrillation and include: flecainide, propafenone, sotalol, dofetilide, amiodarone, procainamide and dronedarone. There are many medical conditions and various medication interactions that your doctor will consider when choosing an antiarrhythmic medication and dose for you. It’s important to note that atrial fibrillation can still occur while taking an antiarrhythmic medication. Therefore, an AV node blocker medication is often prescribed to control the heart rate for breakthrough episodes. A blood thinner medication is usually also prescribed to reduce the risk of stroke from atrial fibrillation.
Procedures, Devices & Surgery
When lifestyle changes and medication fail to correct atrial fibrillation, you may need to undergo a minimally invasive procedure or surgery. This could include any of the following:
Cardioversion is like a quick “reset” of the heart and is very effective for getting the heart back to its normal rhythm. Unfortunately is does not prevent the possibility of future arrhythmias. During this procedure a quick electrical shock is delivered to the heart using two large sticky pads that are placed on the chest and back. The shock also causes the muscles of the chest to suddenly contract, so it is done under anesthesia to avoid any pain or discomfort.
AV node ablation is a simple and highly effective procedure that permanently disables the tiny electrical connection (called the AV node) that allows signals to travel from the top chambers of the heart to the bottom chambers of the heart. During this procedure, a long, thin wire is inserted into a large vein in the groin and is threaded up inside the heart to deliver pinpoint burns to damage this AV node bridge. Because the bottom pumping chambers of the heart will no longer receive any signals to beat, a permanent electrical pacemaker must also be implanted in the body to keep the ventricles beating at a steady pace.
Atrial fibrillation ablation is used to try to “re-wire” the top chambers of the heart and prevent them from going into atrial fibrillation. During this procedure, several long, thin wires are threaded up inside the heart from veins in the groin to create three-dimensional electrical maps inside the heart. Abnormal areas of the top chambers are then either frozen or burned, with the hope that silencing these irritable spots will prevent future atrial fibrillation episodes. On average, about 70% of patients will have a good result after a single procedure, but it is common for more than one procedure to be needed in order to successfully “re-train” the right and left atrium to stay in normal rhythm. Patients whose episodes start and stop on their own (called “paroxysmal” atrial fibrillation) usually have better results with a first procedure than patients who tend to stay in persistent atrial fibrillation. Because there are many different abnormal spots that trigger and sustain atrial fibrillation, different places in the heart are targeted for treatment during this procedure. Atrial fibrillation ablation usually takes a few hours and is done under general anesthesia.
“Maze” surgery is used to manage atrial fibrillation if other approaches aren’t successful or if a patient with atrial fibrillation is undergoing heart surgery to correct another problem. During this procedure, which is similar to atrial fibrillation ablation, the surgeon uses larger tools to directly target regions of the right and left atrium, and “re-wire” it, hoping to prevent future episodes.