How Is Atrial Fibrillation Treated?
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
Treatment of AF is designed to:
- Prevent blood clots from forming, and thereby
reduce the risk for stroke.
- Control 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.
- Restore the heart to a normal rhythm. This is
called rhythm control. Rhythm control allows the atria and ventricles to work
together again to efficiently pump blood to the body.
- Treat any underlying disorder thats causing
or raising the risk of AFfor example, hyperthyroidism.
Who Needs Treatment for Atrial Fibrillation?
People with no symptoms and no related heart
problems may not need treatment. AF may even go back to a permanent normal
heart rhythm on its own. In some people who have AF for the first time, doctors
may choose to use an electrical procedure or medicine to restore the heart
rhythm to normal.
Repeated episodes of AF tend to cause changes to the
electrical system of the heart, leading to persistent or permanent AF. Most
people with persistent or permanent AF need treatment to control their heart
rate and prevent complications.
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
the formation of blood clots is probably the most important part of treating
AF. Doctors prescribe blood-thinning medicines to prevent blood clots. These
medicines include warfarin (Coumadin®), heparin, and aspirin.
Warfarin is the most effective medicine in people
with risk factors for stroke. People taking warfarin must have regular blood
tests to check how well the medicine is working.
Rate Control
Doctors also prescribe medicines to slow down the
rate at which the ventricles are beating. These medicines help bring the heart
rate to a normal level.
Rate control is the recommended strategy for most
patients with AF, even though the heart rhythm continues to be abnormal and the
heart doesnt work as efficiently as it could. Most people feel better and
can function well if their heart rate is well controlled.
Medicines used to control the heart rate include
beta blockers (for example, metoprolol and atenolol), calcium channel blockers
(diltiazem and verapamil), and digitalis (digoxin). Several other medicines
also are available.
Rhythm Control
Doctors use medicines or procedures to restore and
maintain the hearts rhythm. This treatment approach is recommended for
people who arent functioning well with rate control treatment or who have
only recently started having AF.
The longer you have AF, the less likely it is that
an abnormal heart rhythm can be restored to a normal heart rhythm. This is
especially true for people who have had AF for 6 months or more.
Restoring a normal rhythm also becomes less likely
if the atria become enlarged or if any underlying heart disease becomes more
severe. In these situations, the chance that AF will recur is high, even if
youre taking a medicine to help convert AF to a normal rhythm.
Medicines. Medicines used to
control a persons heart rhythm include amiodarone, sotalol, flecainide,
propafenone, dofetilide, ibutilide, and occasionally older medicines such as
quinidine, procainamide, and disopyramide.
Medicines must be carefully tailored to the person
taking them because they can cause a different kind of irregular, slow, or
rapid heartbeat (arrhythmia)
or can be harmful in people who have underlying diseases of the heart or other
organs. This is particularly true for those patients who have an unusual heart
rhythm problem called
Wolff-Parkinson-White
syndrome.
To convert AF to a normal heart rhythm, people can
be given AF medicines regularly by injection at a doctors office, clinic,
or hospital. Or, to try to control AF or prevent recurrences, people may take
pills on an ongoing basis. If the doctor knows how a person will react to a
medicine, a specific dose may be prescribed according to the pill in the
pocket technique. This means that a patient takes a specific dose of a
medicine as needed only if he or she has an episode of AF, but not on a
regular, daily basis.
Procedures. Doctors use several
procedures to restore a normal heart rhythm, including:
- Electrical cardioversion, which is a jolt of
electricity delivered to the heart to "convert" the rhythm from AF back to a
normal heart rhythm. This shock can break the pattern of abnormal electrical
signals and restore a normal rhythm. Electrical cardioversion isnt the
same as the emergency heart shocking procedure often seen on TV programs.
Its planned in advance and done under carefully controlled conditions
with the person heavily sedated.
- Before doing electrical
cardioversion, the doctor may recommend a transesophageal echocardiogram (TEE)
to rule out the presence of blood clots in the atria. If clots are present, the
patient may need to receive blood-thinning medicines to help eliminate the
clots before the electrical cardioversion.
- Radiofrequency ablation, which is used to restore
a normal heart rhythm when medicines or electrical cardioversion dont
work. In this procedure, a wire is inserted through a vein in the leg or arm
and threaded to the heart. Radiowave energy is sent through the wire to destroy
abnormal tissue thats believed to be disrupting the normal flow of
electrical signals. This procedure is usually done in the hospital and is
performed by an electrophysiologist.
- Maze procedure, in which a surgeon makes small
cuts or burns in the atria to reduce the chances of chaotic electrical activity
happening in the atria. This procedure requires open-heart surgery, so
its usually performed when a person requires heart surgery for other
reasons, such as for valve disease, which can increase the risk of AF.
Approaches To Treating Underlying Causes and
Reducing Risk Factors
The doctor also may suggest other approaches
designed to treat the underlying condition that may be causing AF or to reduce
risk factors for AF. These approaches include prescribing medicines to treat an
overactive thyroid, reduce blood pressure and
overweight,
or treat other underlying causes of AF.
The doctor also may recommended lifestyle changes,
such as reducing stress, quitting smoking, reducing salt intake (to help lower
blood pressure), and eating healthily. Limiting or avoiding stress as well as
alcohol, caffeine, or other stimulants that may increase your heart rate also
may help to reduce the risk of AF. |