What Are My Treatment Options for AFib?
Atrial fibrillation (AFib) is the most common type of serious heart arrhythmia. Caused by abnormal electrical impulses in the heart, AFib produces a fibrillation or quivering in the atria, the heart’s upper chambers. In some cases of AFib, the fibrillation causes a rapid beat in the ventricles, the lower chambers. This is called a rapid ventricular rate (RVR), and is responsible for serious complications associated with AFib.
Complications of AFib
Some people with AFib will never have symptoms or serious complications, but for many others there are dangerous consequences. Blood that pools in your atria can cause clots that travel to your brain, leading to a stroke. People with AFib have five times the risk of having a stroke and double the change of dying prematurely, according to Harvard Medical School. AFib can also make heart conditions, such as congestive heart failure, worse.
The Goals of Treatment
The RVR aspect of AFib produces symptoms and contributes to the potential complications. For this reason, if you have RVR, the first goal of treatment is to restore a slower ventricular beat.
The next most important goal of treating AFib is to reduce the risk of having a stroke. Once those two aspects are under control, the final goal of treatment is to restore a normal heart rhythm, which is also called sinus rhythm.
Medications for RVR
Medications are the first line of treatment for restoring your ventricular rate. Beta blockers, like Atenolol, Carvedilol, Propranolol, and others can slow the heart rate. Calcium channel blockers, such as Dilitiazem and Verapamil, are another class of drug used to slow the beating of the ventricles, but they also affect the contraction of the heart’s muscle cells. Digoxin is another medication that can slow down the ventricular rate.
Surgery for RVR
If your ventricular rate does not respond to medications, you may need to have a pacemaker surgically installed. A pacemaker is an electronic device that regulates the heartbeat to correct RVR. Pacemakers are most often used for people who have Afib and a slow heartbeat.
This is only a last resort after medications fail to work, as heart surgery comes with a lot of risks and potential complications. Using medications is always the preferred option as long as they are effective and do not produce significant side effects.
Preventing Blood Clots
The increased risk of stroke is a very serious AFib complication, and one of the major contributors to premature death in AFib patients. To reduce the risk of a clot forming and causing a stroke, your doctor will likely prescribe you blood thinning medications. Your doctor will check your blood regularly to make sure the medications are working.
Restoring Sinus Rhythm
Once your RVR is restored and your risk of stroke has been lowered by blood thinners, your doctor will begin treatments to restore the normal rhythm of your heart. The medications for RVR only affect the rate of your heartbeat, not the rhythm.
Drugs that help to restore the heart’s rhythm include sodium channel blockers, like Fecainide and Quinidine, or potassium channel blockers, like Amiodarone. Both types of medication slow down electrical signals in the heart, allowing it to restore a proper rhythm.
Sometimes medications cannot restore sinus rhythm, or they produce too many side effects. In this case, you may have an electrical cardioversion, which involves giving your heart a shock to reset it and restore a normal beat.
Electrical cardioversion often works, but it is not usually permanent. It may be used to reset your heart, after which you need medications to maintain the new, regular heartbeat.
Another option for restoring sinus rhythm, when medications fail, is a procedure called catheter ablation. This involves destroying a small amount of tissue in your heart. A scar forms on the spot and prevents the abnormal electrical signals that cause AFib. The scar can take a couple of months to develop and to stop the signals. With the abnormal signal blocked, the normal signal can take over and create sinus rhythm.
The Maze Procedure
A final invasive treatment, called the Maze procedure, may be used to treat AFib when medications and other procedures have failed. It is open heart surgery, so the Maze procedure is more likely to be used if you have another heart condition requiring surgery.
The procedure involves making incisions in the atria that restrict the abnormal electrical impulses to a certain area. It prevents the impulses from getting to the atria and causing the fibrillation.
In addition to medical treatments and procedures, making lifestyle changes is important to correcting the course of AFib and reducing the risk of complications from the arrhythmia.
If you have AFib, you should stop smoking and limit your intake of alcohol and caffeine. Stimulants often found in cough and cold medications should be avoided. Make note of any activities that produce or worsen your AFib symptoms and speak to your doctor about them.
Atrial Fibrillation is Serious, But Treatment
Options Continue to Grow, from Harvard’s Men’s Health Watch. (2011, November). Harvard Medical School. Retrieved
October 17, 2013, from http://www.health.harvard.edu/press_releases/atrial-fibrillation-is-serious-but-treatment-options-continue-to-grow
● Atrial Fibrillation Medications. (2012, May 30). American Heat Association. Retrieved October 17, 2013, from http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial-Fibrillation-Medications_UCM_423781_Article.jsp
● How is Atrial Fibrillation Treated? (2011, July 1). National Institutes of Health. Retrieved October 17, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/af/treatment.html
● What is Atrial Fibrillation? (2013). Cleveland Clinic. Retrieved October 17, 2013, from http://my.clevelandclinic.org/heart/atrial_fibrillation/afib.aspx#treated