Atrial Fibrillation - Treatments

ATRIAL FIBRILLATION | CAUSES & SYMPTOMS | DIAGNOSIS & HEALTH RISKS | TREATMENTS

OPEN HEART MAZE | TOTALLY THORACOSCOPIC MINI-MAZE | TT MINI-MAZE PATIENT CENTER

There are 3 goals in the treatment of atrial fibrillation:

• Control Heart Rate
• Reduce the Risk of Stroke
• Restore and Maintain Normal Sinus Rhythm

Non Invasive Management of Atrial Fibrillation:

The first strategy addresses only the first 2 goals of treatment.  It consists of the administration of medications to control the heart rate and to “thin” the blood.  Heart rate control is usually achieved by prescribing beta-blockers or calcium channel blockers to keep the heart rate between 60 – 80 beats per minute.  The risk of blood clot formation leading to stroke is reduced by prescribing Coumadin (warfarin) to lessen the blood’s ability to clot.  Patients at a very low risk of stroke may be prescribed aspirin instead of warfarin.

The second strategy consists of attempting to achieve all 3 goals of treatment.  The same medications are prescribed for controlling the heart rate and “thinning” the blood.  In addition, the heart rhythm is chemically or electrically changed from atrial fibrillation to normal sinus rhythm, if possible.  AFib may be chemically changed by prescribing Ibutilide (given IV) or oral medications such as amiodarone, flecainide, sotalol, or propafenone.  AFib may be electrically changed into a normal sinus rhythm with cardioversion, a timed shock in a sedated patient.  Chemical and electrical treatments are often temporarily effective, but most patients revert to atrial fibrillation over time.
 

Catheter Ablation:

Catheter ablation consists of placing a small plastic catheter through the groin vein and threading into the patient’s heart.  Using x-ray and computer generated guidance, radiofrequency energy is used to create scars around the pulmonary veins.  For patients with paroxysmal atrial fibrillation, the origin of AFib is usually within the pulmonary veins.  By electrically isolating the pulmonary veins, AFib may be cured.   Catheter ablation is performed by an electrophysiologist in the cardiac catheterization lab.

The benefits of catheter ablation are the minor groin puncture and reasonable success with paroxysmal atrial fibrillation.  Conversely, catheter ablation is significantly less effective than surgical therapy in providing a cure for atrial fibrillation, especially for persistent and longstanding persistent AFib.  In addition, catheter ablation involves significant radiation exposure.