Treatment of  Atrial Fibrillation

Atrial Fibrillation is a life long disease , without a cure but with multiple therapy options . A step up approach is usually used , starting with “minimal side effects ” medications and move to the next option, if symptoms are persistent; the next level therapy is more efficient but with more side effects .

Important facts

• Pacemaker or Defibrillator won’t treat or cure Atrial Fibrillation.

• After implanting a pacemaker you still need the same treatment for AFib , including anticoagulation

• Short episodes of AFib , up to 1-2 days are common and don’t require Emergency department visit or any adjustment in treatment as long as you don’t have chest pain, or fainting . These episodes are normal part of the disease .

Treatment consists of:

Controlling the heart rate to less than 60 at rest

• Converting AFib to normal rhythm- sinus or SR

• Preventing Strokes. Anticoagulation

First step :Heart Rate Control 

• Starts usually with Betablockers, Calcium Blockers, Digoxin, which slow down the heart rate, eliminating cardiac symptoms.

• While being on these medications, ” breakthrough ” episodes of palpitations may appear. As long as these symptoms are short lasting and don’t interfere with your activities and lifestyle, you don’t need to go to the next treatment level.

• These medications won’t cure fibrillation, but wont allow any heart damage; they have minimal side effects and toxicity.

An echocardiogram is done periodically, to assess the strength of the heart, or EF.

” Breakthrough episodes ” are acceptable, as long as the EF on echo remains normal and you can sustain your normal level of exertion.

Second Step : Cardioversion

• An electrical, painless shock applied to the heart, which restores normal rhythm.

• It’s not a permanent solution, since relapses are quite frequent.

• Even after cardioversion, anticoagulation is frequently not stopped. Read more about Cardioversion

Third Step : Anti-arrhythmic Drugs

• Amiodarone , Flecainide, Sotalol. These medications will keep your heart rate into normal rhythm, reducing the fibrillation episodes.

• They need close monitoring for side effects and toxicity, and some requires hospitalization to be started.

Fourth Step : Ablation

• For patients who remain symptomatic or show signs of ” failing heart” on echocardiogram, Ablation is indicated

• Ablation induces small burns or freezes to cause scarring on the heart to help break up the electrical signals that cause irregular heartbeats. 

• Generally, ablation is accomplished by applying radiofrequency energy (cauterization) or cryoenergy (freezing) through a catheter, to destroy a small area of cardiac muscle in order to disrupt the arrhythmia.

• Success rate is approximately 50 percent. This means that the recurrence AFib is very high, even after invasive treatments

Anticoagulation therapy protects from Strokes. Does not affect or control the heart beats or AFib .

Anticoagulation Therapy

More at Anticoagulation

Important facts

• Pacemaker or Defibrillator won’t treat or cure Atrial Fibrillation.

• After implanting a pacemaker you still need the same treatment for AFib , including anticoagulation

• Short episodes of AFib , up to 1-2 days are common and don’t require Emergency department visit or any adjustment in treatment as long as you don’t have chest pain, or fainting . These episodes are normal part of the disease .