Atrial Fibrillations: Treatment Options

Medically Reviewed by Dr. K on 20 May 2022

Table of Contents:

  1. Atrial Fibrillation
  2. Medications
  3. Medical Procedures
  4. Surgical Procedures
  5. Treating the Causes of AF
  6. Complementary Treatments
  7. Lifestyle Changes

Atrial Fibrillation

 

Atrial fibrillation (AF) is a concern with the electrical activity of your heart. If your symptoms become too serious, you and your doctor have medical options.

AF causes your heart to quiver, beat irregularly, or skips beats. It can't pump blood as efficiently as it should through its chambers and out to your body. Blood can pool and form clots in the heart, which can lead to a stroke.

Medication, nonsurgical treatments, and surgery will all help to regulate the pulse and return it to a normal rhythm, where possible. Treatments for AF will also help avoid clots and keep the heart safe.

Medications

 

These will help you avoid blood clots and strokes, as well as slow your heart rate and regulate your heart rhythm, where possible.

 

Blood Thinners

 

These medications thin your blood to reduce your chances of developing those issues. However, they may increase the risk of bleeding, so you will need to limit any behaviours that can cause injury. The following are the most common:

 

  • Apixaban (Eliquis)
  • Aspirin
  • Dabigatran (Pradaxa)
  • Enoxaparin (Lovenox)
  • Heparin
  • Rivaroxaban (Xarelto)
  • Warfarin (Coumadin, Jantoven)

 

Blood thinners can make you more prone to bruises and excessive bleeding. Every month, you should see your doctor for a blood test to ensure that the medication is working and that you are on the right dosage.

Heart Rate Medicines

 

Medications that regulate the pulse are the most popular treatment for atrial fibrillation. These reduce your fast heart rate, allowing your heart to pump more efficiently.

 

Other medications may be needed. Beta-blockers are a form of medication. They also have the effect of lowering your heart rate. Here are a few examples:

  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta, Ziac),
  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol)
  • Propranolol (Inderal, Innopran)
  • Timolol (Betimol, Istalol)

 

Calcium channel blockers are another form of medication. They lower your heart rate and relax your muscles. These include:

  • Diltiazem (Cardizem, Dilacor)
  • Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)

 

Heart Rhythm Medicines 

 

They delay the electrical signals to restore a natural sinus rhythm to your heartbeat. Chemical cardioversion is a term used to describe these treatments:

 

Sodium channel blockers, which reduce the capacity of your heart to conduct electricity. The following are examples:

  • Flecainide (Tambocor)
  • Propafenone (Rythmol)
  • Quinidine

 

Blockers of potassium channels, which slow electrical signals that trigger AF. These are:

  • Amiodarone (Cordarone, Nexterone Pacerone),
  • Dofetilide (Tikosyn)
  • Sotalol (Betapace, Sorine, Sotylize)

 

They are available at the doctor’s clinic or a hospital. Your doctor will keep an eye on you to ensure that the drug is working properly.

Medical Procedures 

You should try one of two procedures called cardioversion or ablation if medications don't function or cause side effects. There are non-surgical treatments for AF.

To control your pulse, the doctor administers a shock to your heart. They'll use paddles or electrode patches to apply to your chest.

First, you'll be given medication to help you sleep. The paddles will then be placed on your chest and, in some cases, on your back. These will provide a slight electrical shock to your heart to restore its natural rhythm.

The majority of people only require one. You won't recall being surprised because you'll be sedated. The majority of the time, you will return home the same day.

Your skin can become irritated where the paddles came into contact with it. Your doctor will recommend a lotion to help with pain or scratching.

  • Cardiac ablation

There are two main alternatives:

Catheter ablation, also known as radiofrequency ablation or pulmonary vein ablation, is a less invasive alternative to surgery. A thin, flexible tube is inserted into a blood vessel in your leg or neck by your doctor. After that, they lead it to your core. It sends out electrical signals that kill the cells that are causing the arrhythmia when it enters the region that is causing the arrhythmia. The tissue that has been treated aids in the restoration of a normal heartbeat.

Catheter ablation can be divided into two types:

    • Radiofrequency ablation: The doctor uses catheters to deliver radiofrequency energy (similar to microwave heat) to each vein or group of veins, creating circular scars.
  • Cryoablation: A single catheter delivers a balloon containing a fluid that freezes the tissues, resulting in a scar.

 

Surgical Procedures

  • Maze procedure

This is normally performed in conjunction with another open-heart procedure, such as a bypass or valve replacement. Tiny cuts are made in the upper part of your heart by the surgeon. They're stitched together to form scar tissue that prevents abnormal signals from reaching the brain.

  • Mini maze

The majority of people who have AF do not need open-heart surgery. This is where the less intrusive alternative comes in. The doctor makes some small incisions between the ribs and guides catheters for cryoablation or radiofrequency ablation with the aid of a camera. Robot-assisted surgery, which uses smaller cuts and allows for greater precision, is available at some hospitals. A video camera or a small robot will be implanted in your chest by your doctor. It will facilitate the formation of scar tissue, which may aid in keeping your heart rate in check.

  • Convergent procedure

Catheter ablation is combined with a mini maze in this procedure. A surgeon makes a tiny incision under your breastbone to use radiofrequency energy on the outside of your heart, and the doctor uses radiofrequency ablation throughout the pulmonary vein.

  • AV node ablation

If you meet the following criteria, you may be eligible for this procedure:

    • Medication for AF is not working optimally for you.
    • Medication for AF is causing intolerable side effects for you.
    • You aren't a suitable candidate for a cure-all treatment.

A catheter will be inserted into a vein in your groyne and slid up to the AV node, a nerve that conducts electrical impulses between your heart's top and bottom chambers. They'll use radiofrequency energy to kill the AV node via the catheter. The impulses would no longer be able to penetrate your ventricle as a result of this. A pacemaker will then be implanted in your chest by the doctor. This electronic system is hidden under your upper chest muscle. It's attached to one or two wires that pass through a vein and through your heart. It sends out non-painful electric pulses that cause the heart to pound.

Treating the Causes of AF

 

If your AF was affected by issues like high blood pressure, cholesterol, or an overactive thyroid, you'll need to address the underlying cause. Your doctor can prescribe medication to help you manage your symptoms.

Sleep apnea, a condition in which breathing begins and stops repeatedly during the night, may also be recommended by your doctor for screening and treatment.

 

Complementary Treatments

 

Alternative and complementary therapies for AF need further testing. However, a few have shown promise in preliminary research. They are as follows:

  • Yoga
  • Acupuncture
  • Biofeedback
  • Omega-3 fatty acids
  • Antioxidant vitamins, such as Vitamins C and E
  • Herbal supplements like berberine, cinchona bark, and shenshongyanxin (a traditional Chinese mixture)

Always check with your doctor before you try a complementary treatment.

 

Lifestyle Changes

 

Your doctor can also advise you to take the following easy measures to help keep your heart healthy:

  • Change your diet to include low-salt, heart-healthy foods. Fruits, vegetables, and whole grains are all healthy choices.
  • Increase your physical activity because it strengthens your heart.

They will advise you to make the following lifestyle improvements to reduce the risk of heart disease, as well as conditions like diabetes and lung disease, which may lead to AF:

  • Stop smoking.
  • Maintain or strive for a healthy weight.
  • Keep your blood pressure in check.
  • Maintain a healthy cholesterol level.
  • If you want to consume alcohol, do so in moderation.

Your doctor will probably tell you to avoid stimulants because they can trigger AF episodes. Over-the-counter cough medications containing pseudoephedrine (found in nasal decongestant sprays), as well as recreational drugs like cocaine and amphetamines, fall under this category.

Don't forget about your mental well-being. Look for ways to relieve stress, as it can exacerbate atrial fibrillation. You could try:

  • Yoga, tai chi, or other mind-body exercises can be beneficial.
  • Meditation
  • Journally
  • Spending time with loved ones

Ask your doctor to refer you to a mental health provider if you are experiencing signs of anxiety or depression, such as persistent low mood or difficulty concentrating.

Sources

Referenced on 20/4/2021

  1. Agency for Healthcare Research and Quality: “Treatment of Atrial Fibrillation."
  2. American College of Cardiology: “Recommended Doses of Anticoagulant/Antithrombotic Therapies for Patients with Atrial Fibrillation.”
  3. American Heart Association: “Ablation for Arrhythmias,” “Atrial Fibrillation Medications," “Non-surgical Procedures for Atrial Fibrillation (AFib or AF)," “Surgical Procedures for Atrial Fibrillation (AFib or AF)," “What is Atrial Fibrillation (AFib or AF)?" “Lifestyle Strategies for Atrial Fibrillation (AFib or AF)."
  4. Cleveland Clinic: “Atrial Fibrillation (AFib)."
  5. National Heart, Lung, and Blood Institute: “How Is Atrial Fibrillation Treated?" “What is Cardioversion?"
  6. The Society of Thoracic Surgeons: “Atrial Fibrillation Surgery — Maze Procedure."
  7. UAB Medicine: “Left Atrial Appendage Occlusion."
  8. Mayo Clinic: “Atrial fibrillation,” “Cardioversion,” “Sleep Apnea,” “Atrial fibrillation and managing stress."
  9. StopAfib.org: “Maze Procedure (Surgical Ablation),” “Using Electrical Cardioversion for Atrial Fibrillation.”
  10. Heart Rhythm Society: “Types of Ablations.”
  11. Keck School of Medicine of USC: “Robotic-Assisted Maze Surgery.”
  12. Frankel Cardiovascular Center: “AV Node Ablation.”
  13. Medscape: “How is drug and alcohol abuse related to atrial fibrillation (Afib) (AF)?"
  14. Journal of Thoracic Disease: “Alternative medicine in atrial fibrillation treatment—Yoga, acupuncture, biofeedback and more."
  15. https://www.webmd.com/heart-disease/atrial-fibrillation/atrial-fibrillation-treatment  

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