Atrial Fibrillation

Treatment

Atrial fibrillation (Afib) is a heart condition that requires careful management by you and your doctor. Fortunately, there are several ways that Afib can be controlled so that it doesn’t disrupt your life. The treatment for Afib has two goals: 1) control your Afib symptoms and 2) prevent stroke. How your Afib is treated depends on your symptoms, how it affects your daily life, and how much your Afib increases your risk for stroke or other serious complications. It’s very likely your doctor will recommend that you make some heart-healthy lifestyle changes and, depending on your situation, may also recommend medications, a medical procedure, or surgery.

Lifestyle changes

If you have Afib, your doctor may recommend making changes to your lifestyle that could reduce or even eliminate your Afib. These recommendations might include the following:

• Eat a heart-healthy diet.
• Engage in daily physical activity.
• Maintain a healthy body weight.
• Control your blood pressure and cholesterol.
• Drink less alcohol.
• Reduce your caffeine intake.
• Quit smoking.
• Refrain from taking recreational drugs.

Medications

To help prevent stroke, doctors prescribe blood-thinning (anticoagulant) medications, which help keep blood flow from slowing down and clotting in the area of the heart called the left atrial appendage (LAA), as can happen during Afib. If you have Afib and high blood pressure (hypertension), diabetes, older age, or a history of stroke or heart failure, your doctor will recommend taking blood-thinning medications. Your risk of bleeding while taking blood thinners is lower than your risk of stroke without blood thinners.

The blood-thinning medications used to help prevent the formation of blood clots include the following:

• Warfarin (Coumadin) – This medication is perhaps the best-known of all blood thinners; however, it does have its drawbacks, including the risk of severe bleeding. Regular blood tests are necessary to monitor how you respond to the medication.
• Dabigatran (Pradaxa) – This medication does not require a blood test but is a shorter-acting medication. This means it does not stay in the bloodstream as long as warfarin.
• Rivaroxaban (Xarelto) – This medication is taken once daily and does not require a regular blood test.
• Apixaban (Eliquis) – This medication has proven very effective at reducing the risk of stroke.

In addition, since the symptoms of Afib are produced by an irregular heart rhythm and often cause a rapid increase in heart rate, your doctor will likely prescribe antiarrhythmic medications aimed at rate control and/or rhythm control. These medications include the following:

• Beta-blockers – These medications are commonly used for heart rate control. They block some of the effects of adrenaline, making the heart beat faster. Metoprolol is an example of a commonly used beta blocker.
• Calcium channel blockers – These medications are also frequently used for heart rate control and affect a channel in the heart's cells that controls the flow of calcium in and out of these cells. Blocking calcium transport through these cells helps slow down the heart rate. Diltiazem is an example of a calcium channel blocker.
• Digoxin – Although an older medication, it’s still used to assist in the overall heart rate control for people with Afib.
• Amiodarone – This medication is prescribed to restore the heart to normal sinus rhythm. It may be used to keep the heart in normal rhythm after a procedure called electrical cardioversion, where the heart is shocked into normal rhythm. Sotalol may be used for rhythm management.
• Class IC medications – These medications affect sodium transport across cell membranes in the heart and are reserved for rhythm control in people whose only heart problem is Afib—people with coronary artery disease (CAD) and/or heart failure are generally not prescribed these medications. Propafenone and flecainide are examples of Class IC medications.
• Quinidine – This medication may be used for rhythm control.
• Dronedarone – This medication may also be used for rhythm control.

Procedures and surgeries

Suppose a combination of lifestyle modifications and medications still can’t keep your Afib under control. In that case, your doctor may recommend a procedure or surgery to help restore your heart to a normal rhythm. These procedures and surgeries include the following:

• Electrical cardioversion – This procedure shocks the heart to send it back into a regular rhythm.
• Catheter ablation – This procedure restores normal rhythm by breaking down small amounts of heart tissue that send the irregular electrical signals that cause Afib. 
• Pacemaker implantation – In some cases, particularly with sick sinus syndrome, implanting a pacemaker—a small electronic device that is implanted into the chest surgically to produce electrical impulses that stimulate the heart to beat at a normal rate—may be recommended to assist in keeping the heart beating in a normal rhythm.
• Atrioventricular (AV) node ablation – This procedure applies radiofrequency energy to the pathway in the heart between the upper heart chambers (atria) and the lower heart chambers (ventricles). The energy is directed at the atrioventricular node to destroy the tiny amount of tissue conducting the irregular Afib impulses to the ventricles. Usually, a small pacemaker is also implanted to help the heart maintain a normal rhythm.
• Surgical maze procedure – If you’re scheduled for open-heart surgery to treat another condition, your heart surgeon may also perform this procedure to treat your Afib. This procedure involves making tiny incisions in the upper chambers of the heart, which heal but leave behind scar tissue. Scar tissue doesn’t carry electrical impulses and disrupts the signals that would otherwise stimulate the heart into Afib.