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Treatments for AFib focus on two main goals: resetting the heart rhythm and controlling heart rate and preventing blood clots. Your cardiologist will work with you to choose the treatment options that are right for you. These can include cardioversion, surgical treatment options, and medication.
AFib occurs when the upper chambers of the heart (known as the atria) beat irregularly. AFib is an arrhythmia, a condition where the heart beats too quickly, slowly, or irregularly.
AFib treatments that focus on resetting your heart rhythm include cardioversion and various surgical methods. These procedures use drugs, electrical shocks, and other techniques to help restore your heart’s normal rhythm and maintain it. The right treatment for you may depend on the type of AFib you have.
AFib is an abnormal heart rhythm, which can also increase your heart rate. Doctors can reset the heart to its normal rhythm using cardioversion. There are two ways to do this, with medication or with electrical stimulation.
Medicated cardioversion uses special drugs called antiarrhythmics that work to reset your heart rhythm back to normal. This is typically done in a hospital where doctors can continuously monitor your heart rate.
Electrical cardioversion uses electric paddles or patches that give short, electrical shocks to the chest and heart. The goal is to shock your heart back into its normal rhythm. Electrical cardioversion takes less time than medicated cardioversion, and your doctor can instantly see whether the procedure worked or not.
Before the procedure begins, you will be sedated so you do not feel the shocks. You may also be given antiarrhythmic drugs to help reset your heart rhythm.
In cases when cardioversion or drugs do not help control AFib, surgical procedures can be performed. These focus on creating tiny scars in the upper chamber of your heart. In a person with AFib, the area near the pulmonary veins is making abnormal electrical signals, and destroying it can restore the normal heart rhythm. Surgical options for AFib include catheter ablation, the maze procedure, atrioventricular (AV) node ablation, and left atrial appendage closure.
During catheter ablation, long, thin tubes — or catheters — are inserted into the groin and up through the blood vessels to the heart. The tip of the catheter uses extreme cold (cryotherapy), radiofrequency waves, or heat to destroy cells in the atrium that promote arrhythmia. The scar tissue that forms helps the heart return to its normal rhythm.
This procedure is performed if AFib medications have failed or if a person is unable to take the medications. Although a catheter ablation can be initially successful, there is a chance AFib can develop again. If this happens, your doctor may recommend trying the procedure again or may suggest another option.
The maze procedure most often requires open-heart surgery, and the doctor will use a scalpel, radiofrequency waves, or cryotherapy to create lines of scar tissue in the atrium. The maze procedure often accompanies valve replacement or coronary surgery. The procedure is generally successful, but AFib can still come back. This procedure is not recommended for people who have had other heart surgeries in the past.
The maze procedure has an 80 percent to 90 percent success rate, and it offers a long-term solution for treating AFib. It can be used in cases where catheter ablation has failed and in people who have a history of blood clots or stroke.
An AV node ablation targets a different area of electrical signaling than the back-of-the-atrium ablation and maze procedures. AV node ablation destroys the tiny AV node found between the upper and lower chambers of the heart. However, the atria will still quiver after this procedure, so a pacemaker needs to be implanted to keep the heart beating properly.
People with AFib are at a higher risk for stroke due to the formation of blood clots. Oftentimes, these clots form in a small pouch in the top left chamber of the heart, known as the left atrial appendage. To prevent these clots from forming, your doctor may suggest left atrial appendage closure.
In this procedure, your doctor inserts a catheter through a vein in your leg up to your atrium, and a device closes the appendage. This method is best for people with an increased risk of blood clots who cannot take blood thinners and do not have heart valve problems. The left atrial appendage may also be closed during open-heart valve operations or replacements.
Medications are a less invasive way to treat AFib, and they can be used in combination with other treatment methods. There are several types of medication that each work differently, including antiarrhythmics, beta-blockers, calcium channel blockers, and blood thinners.
After cardioversion is performed, your doctor will want to be sure your arrhythmia is under control. You may be prescribed antiarrhythmic drugs to help prevent AFib from developing again. There are two main types of antiarrhythmic drugs that target different ion channels in the heart: potassium channel blockers and sodium channel blockers.
Potassium channel blockers slow the electrical signals sent through the heart, helping control rhythm. Examples include sotalol (Betapace), amiodarone (Cordarone), and dronedarone (Multaq).
Sodium channel blockers slow the heart’s ability to conduct electricity, helping control rhythm. Examples include propafenone (Rythmol SR) and flecainide (Tambocor).
Your doctor may also prescribe beta-blockers. These medications can slow your heart rate, which will most likely be increased for people with AFib. Some examples of beta-blockers include nadolol (Corgard), propranolol (Inderal), and metoprolol (Lopressor).
Digoxin is used to help slow the heart rate and make it easier for the heart to pump blood. It works best for controlling resting heart rate (when you are not active). Digoxin is usually combined with other medications such as beta-blockers or calcium channel blockers.
Calcium channel blockers can have several effects on the heart, including reducing the strength of the heart muscle’s contractions and slowing heart rate. Examples of these drugs include diltiazem (Tiazac) and verapamil (Verelan).
AFib greatly increases your risk of stroke, so your doctor will prescribe medication to prevent blood clots. These drugs are called anticoagulants, or blood thinners. They include warfarin (Coumadin), dabigatran (Pradaxa), and rivaroxaban (Xarelto).
AFib is a heart condition, and maintaining heart health and overall wellness can improve your quality of life. In addition to other treatments, such as surgery and medication, lifestyle changes can help alleviate symptoms and reduce your risk of severe complications. These can include:
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Larry A. Weinrauch, MD, FACC, FACP, FAHA
is an assistant professor of medicine at Harvard Medical School with a focus on cardiovascular disease and clinical outcomes research. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Emily Wagner, M.S.
holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology.
Learn more about her here.
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