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Atrial fibrillation is a type of cardiac arrhythmia (abnormal heart rate and/or rhythm). Atrial fibrillation produces a rapid and irregular heartbeat, during which the atria (the upper two chambers of the heart that receive blood) quiver (or fibrillate) instead of beating normally.
During a normal heartbeat, the electrical impulses that cause the atria to contract begin in the sinus node, a small area of the right atrium. During atrial fibrillation, however, these impulses come from all over the atria, triggering 300 to 500 contractions per minute within the heart's upper chambers.
Initially, treatment will vary based on the cause of your atrial fibrillation. If your physician suspects coronary artery disease, they may recommend angioplasty or coronary artery bypass surgery. Should they find excessive amounts of thyroid hormones in your body (a condition known as thyrotoxicosis), you'll probably be given medication. If a damaged heart valve is the culprit, it can be repaired by surgery.
While the underlying cause is receiving treatment, your doctor will prescribe medication which will work to slow the heart rate. Should the medications prove ineffective, your physician may recommend surgery to destroy an area of tissue in the heart which will prevent excessive electrical impulses from the atria to the ventricles. Often, the result of this surgery is complete blockage of all electrical impulses. Your heart rate and rhythm will then need to be controlled by a pacemaker.
Treating atrial fibrillation (AF) can be difficult since every patient is different - treatment requires closely working your doctor to weigh the risks and benefits of each treatment.
There are two key steps to treating atrial fibrillation (AF) - resetting the rhythm or controlling the heart rate and preventing clots. Resetting the rhythm can be done with medications or by a short procedure called electrical cardioversion.
Electrical cardioversion is where an electrical shock is delivered to your heart through paddles or patches placed on your chest.
If atrial fibrillation can't be converted back to a normal heart rhythm, then goal is to slow the heart rate (rate control) using medication.
Sometimes medications or cardioversion to control atrial fibrillation doesn't work. In those cases, your doctor may recommend a procedure called ablation. Ablation destroys the area of heart tissue responsible for the erratic electrical signals and restore your heart to a normal rhythm.
Most people who have atrial fibrillation or who are undergoing certain treatment for atrial fibrillation are at a high risk of blood clots that can lead to stroke. Doctors often prescribe blood-thinning medications (anticoagulants), such as warfarin (Coumadin) or aspirin, in addition to medications to treat your irregular heartbeat. These blood-thinking medications reduce your chance of having blood clot that leads to stroke.
Fundamentally, there are three ways to treat atrial fibrillation. A specialist may employ these individually or in combination depending on a person’s unique circumstances.
Rate Control: If you have no symptoms and you’re otherwise doing okay with AF, we will simply put you on a blood thinner to reduce the risk of stroke. This is considered a safe approach as long as your heart rate isn’t too fast. Medicines can be used to slow the rate when necessary.
Rhythm Control: We put you on a medicine, a specialized heart rhythm drug called an antiarrhythmic, to coax your heart to stay in normal rhythm and suppress the atrial fibrillation.
Ablation: This is also a rhythm control option. Several years ago, we learned that ablation of AF was an effective alternative. Ablation means a heart rhythm specialist like myself will bring you to a lab, put you under sedation, place catheters in your heart to find the areas that trigger your AF. We’ll then target those areas by using freezing or cauterizing techniques. Ablations have a success rate of about 70% or better with one treatment. They are invasive but widely considered more effective at restoring and maintaining normal rhythm.
One of the main components of atrial fibrillation (AF) treatment is to keep the heart rate normal, at less than 100 beats per minute. Another part of treatment involves trying to control the irregularity of the heartbeat. Atrial fibrillation increases the risk of stroke, and therefore medications to thin the blood are important to prevent this as well.
People who have atrial fibrillation and score higher than two on the CHADS-VASC scale are usually directed to use a prescription blood thinner to reduce their stroke risk. Coumadin has been the prescribed blood thinner of choice. While Coumadin is effective, it can lead to increased bruising and bleeding, requires weekly tests to ensure the blood is not too thin or too thick and includes some dietary restrictions.
Two alternative blood thinners, Pradaxa and Xarelto, are equivalent to Coumadin in reducing stroke risk but do not require weekly blood tests or dietary restrictions. However, Coumadin is the only one with a proven reversal agent -- if the blood becomes too thin, treatment is available to immediately resolve the problem.
A potential option for people with atrial fibrillation who do not want to take blood thinners is a minimally invasive surgery that blocks the heart’sleft atrial appendage, where blood is most likely to stagnate and clot.
Two devices are used for this procedure. The Watchman is a plug that seals the appendage from inside the heart. The Lariat ties off the appendage from outside the heart. Both procedures are done through small punctures, require an overnight stay in the hospital and pose very little risk. Following the procedures, people with atrial fibrillation no longer need blood thinners.
The Watchman and Lariat are available to people with atrial fibrillation who meet certain qualifications. People should consult their doctors for more information.
Medications and procedures such as cardioversion can restore abnormal heart rhythms caused by atrial fibrillation. There are also many anti-arrhythmia medications with variable levels of effectiveness. Beta-blockers are often used to slow the heart rate down, which is an important aspect of treatment but not the only one. Surgical procedures such as catheter ablation are about 75% effective in well-selected cases, and a full Cox maze procedure is about 95% effective. Nothing is 100% effective.
There are different ways doctors treat atrial fibrillation. The standard treatment is a combination of medications, including anti-coagulants (such as Coumadin) to prevent blood clots; medications to slow the heart rate (beta blockers, calcium channel blockers, and other medications); and medications to convert the heart rhythm back to normal.
If these medications do not stop atrial fibrillation, the doctor may try electrical cardioversion, an outpatient procedure that uses a cardioverter (defibrillator) to shock the heart with low doses of electricity to stop the irregular rhythm and bring back the normal rhythm. Cardioversion has a high success rate, although some people may need two or three cardioversions to achieve a normal sinus rhythm. If the combination of medications and/or cardioversion does not stop the atrial fibrillation, your doctor may recommend catheter ablation, a heart procedure that uses radio wave energy to destroy abnormal heart tissue that is interrupting the normal flow of electrical signals.
Your treatment plan may also include making lifestyle changes, losing weight, stopping cigarette smoking, and reducing alcohol intake.
Atrial fibrillation can be treated with medications to prevent blood clots and to control the heart rate. In some cases, surgery may be required. Treatment depends on the underlying cause, your symptoms, and your medical history.
Medication or cardioversion may relieve symptoms. However, a procedure called cardiac ablation often is a cure. This involves creating a lesion in the heart area that fires abnormal electrical impulses.
Atrial fibrillation can be treated with medication, says Thomas Lambert, MD, a cardiologist at MountainView Hospital. In this video he describes a procedure that also treats the condition.
Atrial fibrillation can be treated in many ways. In this video, cardiologist Joseph Baker, MD at Capital Regional Medical Center describes treatments such as medications for slowing the heart rate, shocks to the heart and chronic anticoagulation.
The first and most important aspect to atrial fibrillation treatment centers on the prevention of clot formation in the heart because this could lead stroke. This is accomplished through the use of various blood thinners and is dependent upon your other risk factors for the development of a stroke. Beyond stroke prevention, the symptoms of atrial fibrillation are usually managed first with rhythm drugs to suppress the formation of atrial fibrillation and to aid in its termination should it occur. If medications prove inadequate to control the atrial fibrillation, or if the patient feels medications are inappropriate as a first line strategy, we generally proceed to ablation therapy. Patients with no symptoms associated with their atrial fibrillation can generally be managed with medications to keep the heart rate slow when they are in atrial fibrillation or with the placement of a pacemaker should those medications prove intolerable or inadequate to control the rate.
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Here is a brief overview of the treatment options for atrial fibrillation (AF):
- The MAZE Procedure. The MAZE Procedure is a surgical approach that treats atrial fibrillation by interrupting the electrical impulses that cause abnormal heart rhythm. The surgery typically involves the placement of incisions in both atria; however, it can be modified to suit a given patient's condition. When the incisions heal, scar tissue forms and prevents abnormal electrical impulses from passing through the heart. This technique is highly effective in curing atrial fibrillation. However, potential complications of the procedure include fluid retention and other risks associated with open heart surgery such as bleeding, infection, stroke, and pneumonia. For these reasons, and because the classical MAZE procedure requires a breastbone splitting incision, use of the heart-lung machine, and multiple incisions in the heart, this procedure has not been embraced by many patients and physicians.
- Surgical Atrial Fibrillation Ablation (SAFA). To reduce the risks and trauma associated with the classic MAZE operation, surgeons at Columbia University Medical Center Heart Institute have developed modification of the MAZE, known as Surgical Atrial Fibrillation Ablation (SAFA). In these procedures, a variety of energy sources such as radiofrequency, microwave, or laser, are used to create a limited number of scars in the left atrium, avoiding the need for many incisions in the heart. Furthermore, Columbia surgeons have developed minimally invasive versions of SAFA, in which left atrial lesions can be made without opening the breastbone or using the heart-lung machine.
- Totally Endoscopic Beating Heart Atrial Fibrillation Ablation. The Columbia team has developed a totally endoscopic, beating-heart version of surgical atrial fibrillation ablation. In this minimally invasive, robotic operation, the ablation is performed through small puncture wounds in the chest and without stopping the heart or using the heart-lung machine. This approach is used as a clinical option for treatment of lone atrial fibrillation.
Strict heart rate control for patients with atrial fibrillation (AFib), which often requires strong and expensive medications, as well as procedures to reach lower target heart rates, doesn't seem to lead to better outcomes than control that allows for slightly higher heart rates. One study showed that patients with an average heart rate of about 110 beats per minute do as well as those with an average heart rate of 80 beats per minute. Using this knowledge, individual patients with AFib may require less medication, and in some cases it may reduce the likelihood of a patient needing a pacemaker.
Guidelines also suggest that for selected patients, chronic AFib may be prevented by anti-arrhythmic drugs such as dronedarone (Multaq) and certain invasive procedures.
Warfarin (Coumadin) is an anticoagulant medication prescribed to patients at a higher risk for blood clots, such as those with AFib or deep vein thrombosis. Clopidogrel (Plavix) and aspirin may be an effective therapy for patients unable to take warfarin. In patients at the lowest level of risk for stroke, aspirin alone may be recommended. A new, but expensive, warfarin alternative called dabigatran (Pradaxa) was approved for AFib patients.
If you have AFib:
- Follow your doctor's advice on managing hypertension, diabetes and other stroke risk factors.
- Report any feelings such as a racing heart or shortness of breath to your doctor, and try to describe what was happening when the feelings came on and how they subsided.
- Adhere to your prescribed medications, but tell your doctor of any side effects.
The management of atrial fibrillation (AF) is a large and controversial topic that requires individual consultation with an experienced cardiologist or arrhythmia specialist (a cardiologist trained in electrophysiology).
The first step is to seek and treat underlying triggers, including high levels of thyroid hormone, heart failure, heart valve disease, and alcohol or drug use. Under some circumstances, patients and their cardiologists may choose to control the heart rate with medication (and usually anticoagulants) rather than with an attempt to restore normal rhythm. In symptomatic patients, restoring and maintaining a normal rhythm may be preferable. Medications (antiarrhythmics) are usually the first approach to achieve this goal.
An invasive treatment known as "ablation" is an option for individuals who tolerate atrial fibrillation poorly and who do not achieve adequate control with medication. The procedure involves passing wires into the heart through the veins in the legs and isolating the source of the abnormal rhythm. In very experienced hands, it is a quite effective and fairly safe procedure, but it does not always provide permanent protection from recurrence of the arrhythmia, and it has some risks.
Several treatments can be used to help your heart’s upper and lower chambers work together normally. This type of treatment might be used to reduce palpitations.
• Medication can help restore a normal heart rhythm. You might take
medication regularly, or your doctor might have you carry a pill that
you take only if you have symptoms.
• Cardioversion: your doctor may use paddles or patches with an
electrical current to “reset” your heart to a normal rhythm. This is
most often used if medication isn’t working and symptoms are
severe, particularly in young patients. As part of this treatment,
you’ll have a TEE (transesophageal echocardiogram). The TEE test
shows whether your heart has developed blood clots.
• Cath lab and surgical procedures: In some cases, your doctor can
treat the abnormal heart cells that are causing the problem. In an
ablation, a catheter (small, flexible tube) is threaded through a blood
vessel to your heart. A device on the catheter is used to make a
tiny scar so the abnormal cells can’t send faulty signals. A maze
procedure creates scar tissue to keep abnormal electrical impulses
from traveling through your heart. This procedure is done in
Treatment for atrial fibrillation (AF) depends on how severe or frequent the symptoms are and whether you already have heart disease. General treatment options include medicines, medical procedures, and lifestyle changes.
Goals of Treatment
The goals of treating AF include the following:
- Preventing blood clots from forming, thereby reducing the risk of stroke.
- Controlling how many times a minute the ventricles contract. This is called rate control. Rate control is important because it allows the ventricles enough time to completely fill with blood. With this approach, the irregular heart rhythm continues, but the person feels better and has fewer symptoms.
- Restoring a normal heart rhythm. This is called rhythm control. Rhythm control allows the atria and ventricles to work together to efficiently pump blood to the body.
- Treating any underlying disorder that's causing or raising the risk of AF—for example, hyperthyroidism (too much thyroid hormone).
Specific Types of Treatment
Blood Clot Prevention
The risk of a blood clot traveling from the heart to the brain and causing a stroke is increased in people who have AF. Preventing blood clots from forming is probably the most important part of treating AF. This can be treated with medicines or medical procedures.
Doctors prescribe medicines to slow down the rate at which the ventricles are beating. These medicines help bring the heart rate to a normal level.
Doctors use medicines or procedures to restore and maintain the heart's rhythm. This treatment approach is recommended for people who aren't functioning well with rate control treatment or who have only recently started having AF.
This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.
The first step in treating atrial fibrillation (AF) is to determine why you have it and what the appropriate goal is:
- To control the heart rate, or
- To restore your normal rhythm.
Treatment is patient specific. A plan of care will address things like your heart rate (pulse rate) and blood pressure. Treatment will be modified if you have heart disease, heart failure, kidney disease, liver disease, abnormal thyroid function or other conditions. So the first efforts to treat AF will be identifying and trying to correct or control primary causes of AF, like thyroid disease.
Simple lifestyle changes can help some people. For example, eliminating caffeine and stimulants or getting treatment for sleep apnea can sometimes reduce the frequency or severity of some episodes.
Treatment for AF is tailored to the stage that each patient is in at the time. Some people have AF episodes that come and go on their own. These episodes are called paroxysms. A first-line treatment at this stage is usually medication. Some people have episodes of AF that do not stop unless something is specifically done to treat the problem. This stage is called persistent AF.
One conventional treatment for AF is heart rate control. Medications are used to slow the heart rate. Some of these medications are beta-blockers, calcium channel blockers and digoxin. These medications try to block some of the chaotic impulses of AF from traveling into the lower chambers. Although these drugs may relieve symptoms by slowing down the heart rate, it is important to remember that they do not prevent AF from occurring. There is still risk of stroke and a need for a blood thinner.
Another treatment for AF involves cardioversion and heart rhythm control. Normal sinus rhythm may be restored using either medication or electrical cardioversion. Medications belonging to a group called antiarrhythmics change the natural electrical properties of the heart. These medications can also help you stay in the normal rhythm after you convert. It is important to continue them unless you are specifically told not to do so.
If you have atrial fibrillation (Afib), your doctor will set up a treatment plan based on your specific medical situation. Treatments include medications and procedures to:
- Prevent blood clots
- Control your heart rate
- Help your heart beat at a more normal rhythm
- Treat other conditions that might be causing the Afib or making it worse
Treatment options for atrial fibrillation focus on preventing blood clots. Because of the risk of blood clots and stroke, anti-coagulant drugs are prescribed to thin the blood. Some medications control the heart rate and others control the heart's rhythm.
Also, treatment is prescribed to treat any underlying diseases and conditions such as obesity, heart disease, hypertension, hyperthyroidism, mitral valve regurgitation, and other problems. If the heart is still in atrial fibrillation after taking the proper medications, electrical cardioversion may be recommended to convert the heart to a normal sinus rhythm.
There are several options for treatment of atrial fibrillation:
- Radiofrequency Ablation
- Epicardial Ablation
- Alternative Ablation Techniques or Energy Sources
- Antiarrhythmic Medications
- Direct Current Cardioversion
- Heart Rate Control
- Antiarrhythmic Medications
- Pacemakers to Control Slow Heart Rates
The greatest risk associated with atrial fibrillation is stroke. When the atrium loses organized contractile function during atrial fibrillation, blood clots may form in the left atrial appendage and travel to the brain causing a stroke. The standard therapy to prevent stroke in atrial fibrillation is anticoagulation with warfarin (Coumadin) or dabigitran (Pradaxa). For patients who cannot or wish to not take anticoagulant medications, newer options of left atrial appendage closure are being investigated as an alternative to warfarin to prevent stroke among patients with atrial fibrillation.
Treatment options for atrial fibrillation may include medication, procedures that use electric shocks or other energy, and surgery. The goal of atrial fibrillation treatment is to slow down your pulse, restore a healthy heart rate, and prevent blood clots that could cause a stroke. If doctors know that your atrial fibrillation is caused by another treatable condition, such as a heart defect, heart valve disorder, or thyroid disorder, successful treatment of the disorder may fix your atrial fibrillation. Your treatment options will vary according to your specific condition. Talk to your doctor about your options.
Therapy with anti-arrhythmia drugs is the first line of treatment for patients with atrial fibrillation that causes symptoms. Patients may receive digoxin, beta blockers (atenolol, metoprolol, or propranolol), or calcium antagonists (verapamil or diltiazem) to control the rate of beating of the heart ventricles. Drugs that can suppress atrial fibrillation include flecainide, propafenone, sotalol, dofetilide, dronedarone, and amiodarone. Today cardiac electrophysiologists are increasingly using catheter ablation to treat patients with atrial fibrillation that persists despite anti-arrhythmic medication.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.