Atrial Fibrillation Treatment
Atrial Fibrillation (AFib) is an abnormal heart rhythm that typically creates a pounding or racing sensation in the heart. Symptoms include shortness of breath, palpitations or fluttering, chest pressure, highly variable blood pressure. In some cases, patients may not experience symptoms. Even without symptoms, AFib is a dangerous heart rhythm that needs medical treatment by a cardiologist.
What is AFib?
AFib is a progressive disease, with no cure. The condition starts with short, infrequent episodes of irregular heartbeats, known as paroxysmal AFib. Over time, these episodes begin to occur more frequently and last longer. This stage is known as persistent AFib. If left untreated, some patients will progress to continuous AFib without any periods of normal heart rhythm. Eventually, this can become permanent AFib.
Although it is a common disease, the underlying cause of AFib is unknown.
The treatment of atrial fibrillation focuses on preventing complications, decreasing symptoms, and restoring normal heart rhythm. Common treatments include blood thinners, medications, and ablation.
Joshua Rutland, MD, a cardiologist specializing in heart arrhythmias at CHRISTUS Trinity Clinic in Tyler, provided the following information.
AFib Complications
AFib can lead to various complications, with stroke, dementia, and heart failure being among the most concerning.
- Stroke: In AFib, irregular and rapid heartbeats disrupt the normal blood flow within the heart, forming blood clots. If a clot travels to the brain, it can cause a stroke, resulting in neurological deficits or even death.
- Dementia: AFib has been linked to an increased risk of developing dementia, likely due to reduced blood flow and oxygen supply to the brain over time.
- Heart Failure: The continuous strain on the heart's chambers due to the irregular rhythm can weaken the heart muscle and eventually lead to heart failure, a condition where the heart cannot pump blood effectively to meet the body's demands.
Blood Thinners to Prevent Stroke
AFib greatly increases the risk of blood clots, which can lead to a stroke. Blood thinners are medicines that prevent blood clots from forming. Here are the following blood thinner medications that are commonly recommended for patients with atrial fibrillation.
- Novel oral anticoagulants
- Dabigatran
- Rivaroxaban
- Apixaban
- Edoxaban
- Betrixaban
- Warfarin
Risk factors that typically require blood thinner medications are age, high blood pressure, diabetes, heart disease, artery disease, and coronary artery disease from a prior stroke.
Despite an elevated risk of stroke, some patients with AFib cannot tolerate blood thinners. For these patients, there are alternative strategies to obstruct the left atrial appendage, which is where most blood clots form in the heart. Additionally, if required, there are surgical procedures as well to close or remove the left atrial appendage.
Your cardiologist or electrophysiologist will help you understand and balance the risks associated with blood thinner medications, and other options for treatment.
Decrease Symptoms with AFib Medication
AFib can lead to symptoms of chest pain, shortness of breath, fatigue, dizziness, or fainting spells. These symptoms are typically prevalent when the heart is racing.
Here are common medications that are used to prevent these symptoms by controlling the heart rate during AFib:
- Metoprolol
- Carvedilol
- Diltiazem
- Verapamil
- Digoxin
- Calcium Channel blockers
Rarely, the heart rate cannot be adequately controlled despite these medications. These patients may require an outpatient procedure called an AV Node Ablation and Pacemaker Implant. This procedure disconnects the natural connection between the top and bottom heart chamber, and uses a pacemaker to maintain and control the heart rate to the bottom chambers.
You should always discuss your options with your cardiologist or physician before starting treatment.
Restore Normal Heart Rhythm
Afib cannot be cured. The goal of regular rhythm restoration and the drugs/procedures to try to maintain normal rhythm is to slow the progression of Afib.
Heart Rhythm Medications
Historically, restoration of normal heart rhythm was thought to be only be needed if patients had AFib symptoms. Recent clinical trials now strongly advocate for restoring rhythm control early to prevent complications and risks for things like heart failure, hospitalization, dementia, and fatality.
There are several options to control the heart rhythm. First, medication may be an effective way to treat atrial fibrillation, including:
- Antiarrhythmic medications
- Flecainide
- Core amiodarone
- Digoxin
- Sotalol
Although these anti-arrhythmic medications are modestly effective at maintaining normal heart rhythm, they have been shown to slow the progression of AFib from inconsistent episodes to persistent or permanent. Consult with a cardiologist to determine the best form of treatment.
TEE and DCCV: An Outpatient Procedure
Normal heart rhythm can be acutely restored with a procedure know as a DC Cardioversion (DCCV). This is an outpatient procedure in which patients are sedated and an electrical shock is sent through the heart using pads on the chest and back.
Before the DCCV is performed, a TEE may be done to look for blood clots in the heart. The TEE is an ultrasound of the heart which is done by passing a small probe down through the esophagus into the stomach, allowing the doctors to get detailed, precise images of the heart to look for blood clots before implementing the DCCV.
This combined procedure typically takes less than 1 hour with a same-day discharge. This is a quick solution to temporarily restore normal heart rhythm, although it does not prevent recurrences of AFib.
Ablation
Another outpatient treatment method is ablation, which is a procedure that is used to restore and maintain a normal heart rhythm for as long as possible.
The operation consists of using a catheter to small burn or freeze tissue inside the heart to cause scarring. This scarred tissue helps break up electrical signals at the source that cause irregular heartbeat.
Since the first AFib ablation in 1981, the technology, strategy, and safety for the procedure have advanced rapidly. Ablation is now extremely common with more than 200,000 procedures performed in the U.S. annually.
Multiple clinical trials have shown the procedure to be much more effective at treating atrial fibrillation than medications and at reducing the symptoms of atrial fibrillation.
In addition, ablation has a high success rate and has shown to be effective after a single procedure.
The Procedure
AFib Ablation is an outpatient procedure usually performed under general anesthesia that takes between 2-4 hours, with several hours before and after surgery for pre-operation preparation and post-operation observation.
Ablation is performed by inserting a catheter through the groin and into the top left chamber of the heart. Once inside, the catheter is used to burn or freeze an area of tissue around the pulmonary veins, which are the source of the triggers for AFib. This burning or freezing creates a small line of scar tissue, which acts like an electric fence to trap AFib signals at their source, and prevent them from spreading to the rest of the heart.
The Results
Although ablation has been shown to be an important part of AFib treatment, it is not a cure. Ablation works to:
- Significantly reduce the amount of AFib a patient may experience
- Slow the progression of rare episodes to continuous AFib
- Reduce the need for anti-rhythmic medications
- And in certain patients, may lower the risk of worsening heart failure or fatality
AFib ablation has been shown to reduce the burden of AFib in certain groups by nearly 99%. It is important to understand that although successful, ablation does not eliminate the need for continued blood thinners, even after a successful procedure.
What should to do if you think you have a heart condition
If you have chest pain and think you could be having a heart attack, call 911 immediately.
If you suspect you could have heart disease or atrial fibrillation, take the necessary steps to receive a diagnosis early. Early detection is critical. Talk to your primary care provider to address concerns about your heart and to get referred to a cardiologist if needed.
You can also take the CHRISTUS heart assessment to learn more about your heart health.
Heart Health Assessment
Take a health assessment to measure your heart health. The CHRISTUS Health heart assessment measures your risk of heart disease by asking simple questions.