ATRIAL FIBRILLATION-THERAPY & MANAGEMENT

ATRIAL FIBRILLATION

Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm. An irregular heart rhythm is called an arrhythmia. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart’s upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness.

Episodes of atrial fibrillation may come and go, or they may be persistent. AFib itself usually isn’t life-threatening. But it’s a serious medical condition that needs proper treatment to prevent stroke.

Treatment for atrial fibrillation may include medicines, therapy to shock the heart back to a regular rhythm and procedures to block faulty heart signals.

A person with atrial fibrillation also may have a related heart rhythm problem called atrial flutter. The treatments for AFib and atrial flutter are similar.

Symptoms of AFib may include:

  • Feelings of a fast, fluttering or pounding heartbeat, called palpitations.
  • Chest pain.
  • Dizziness.
  • Fatigue.
  • Lightheadedness.
  • Reduced ability to exercise.
  • Shortness of breath.
  • Weakness.

    Causes of atrial fibrillation

    Problems with the heart’s structure are the most common cause of atrial fibrillation (AFib).

    Heart diseases and health problems that can cause AFib include:

    • A heart problem you’re born with, called a congenital heart defect.
    • A problem with the heart’s natural pacemaker, called sick sinus syndrome.
    • A sleep disorder called obstructive sleep apnea.
    • Heart attack.
    • Heart valve disease.
    • High blood pressure.
    • Lung diseases, including pneumonia.
    • Narrowed or blocked arteries, called coronary artery disease.
    • Thyroid disease such as an overactive thyroid.
    • Infections from viruses.

    Heart surgery or stress due to surgery or sickness may also cause AFib. Some people who have atrial fibrillation have no known heart disease or heart damage.

    THERAPY & MANAGEMENT

    Treatment

    The goals of atrial fibrillation treatment are to reset and control the heartbeat and prevent blood clots.

    Treatment depends on:

    • How long you’ve had AFib.
    • Your symptoms.
    • The cause of the irregular heartbeat.

    Atrial fibrillation treatment may involve:

    • Medicine.
    • Therapy to reset the heart rhythm, called cardioversion.
    • Surgery or catheter procedures.

    Together, you and your health care team discuss the best treatment option for you. It’s important to follow your atrial fibrillation treatment plan. If AFib isn’t well controlled, it may lead to other complications, including stroke and heart failure.

    Medications

    Treatment for atrial fibrillation may include medicines to do the following:

    • Control the speed of the heartbeat.
    • Restore the heart rhythm.
    • Prevent blood clots, a dangerous complication of AFib.

    Medicines that may be used include:

    Beta blockers. These medicines help slow the heart rate.

    Calcium channel blockers. These medicines control the heart rate but may need to be avoided by those who have heart failure or low blood pressure.

    Digoxin. This medicine may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medicines, such as calcium channel blockers or beta blockers.

    Medicines to control the heart rate and rhythm. Also called anti-arrhythmics, this type of medicine is used sparingly. They tend to have more side effects than other medicines to control the heart rate.

    Blood thinners. Also called anticoagulants, these medicines help prevent blood clots and reduce the risk of stroke. Blood thinners include warfarin (Jantoven), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto). If you take warfarin, you’ll need to have regular blood tests to monitor the medicine’s effects.

    Cardioversion therapy

    If atrial fibrillation symptoms are bothersome or if this is the first AFib episode, a doctor may try to reset the heart rhythm using a procedure called cardioversion.

    Cardioversion can be done in two ways:

    Electrical cardioversion. This method to reset the heart rhythm is done by sending electric shocks to the heart through paddles or patches placed on the chest.

    Drug cardioversion. Medicines given through an IV or by mouth are used to reset the heart rhythm.

    Cardioversion is usually done in a hospital as a scheduled procedure. However, it may be done in emergency situations. If it’s scheduled, a blood thinner such as warfarin (Jantoven) may need to be taken for a few weeks before the procedure. The medicine reduces the risk of blood clots and strokes.

    After electrical cardioversion, medicines to control the heart rhythm may be needed for life to prevent future episodes of atrial fibrillation. Even with medicine, AFib could return.

    Surgery or catheter procedures

     

    If AFib doesn’t get better with medicine or other treatments, a procedure called cardiac ablation may be necessary. Sometimes ablation is the first treatment.

    Cardiac ablation uses heat or cold energy to create tiny scars in the heart. The scars disrupt irregular heart signals and restore a typical heartbeat. A doctor inserts a flexible tube called a catheter through a blood vessel, usually in your groin, and into your heart. More than one catheter may be used. Sensors on the tip of the catheter apply the cold or heat energy.

    Less commonly, ablation is done using a scalpel during open-heart surgery.

    There are several types of cardiac ablation. The type used to treat atrial fibrillation depends on your specific symptoms, overall health and whether you’re having another heart surgery.

    Atrioventricular (AV) node ablation. Heat energy is usually applied to the heart tissue at the AV node to destroy the electrical signaling connection. After this treatment, a pacemaker is needed for life.

    Maze procedure. A doctor uses heat or cold energy or a scalpel to create a pattern — or maze – of scar tissue in the upper chambers of the heart. Scar tissue doesn’t send electrical signals. So the maze interferes with the stray heart signals that cause atrial fibrillation.

    If a scalpel is used to create the maze pattern, open-heart surgery is necessary. This is called the surgical maze procedure. It’s the preferred AFib treatment in those who need another heart surgery, such as coronary artery bypass surgery or heart valve repair.

    Hybrid atrial fibrillation ablation. This therapy combines ablation with surgery. It is used to treat long-standing persistent atrial fibrillation.

    Atrial fibrillation may return after cardiac ablation. If this happens, another ablation or heart treatment may be recommended. After cardiac ablation, lifelong blood thinners may be needed to prevent strokes.

    If you have AFib but can’t take blood thinners, you may need a procedure to seal a small sac in the left upper heart chamber. This sac, called an appendage, is where most AFib related clots form. This procedure is called left atrial appendage closure. A closure device is gently guided through a catheter to the sac. Once the device is in place, the catheter is removed. The device stays in permanently. Surgery to close the left atrial appendage also is an option for some people with AFib who are having another heart surgery.