Treating Atrial Fibrillation

By itself, atrial fibrillation is usually not a life threatening condition, but it still must be treated because:

  1. Atrial fibrillation can impact your quality of life and prevent you from doing the things that you normally do.
  2. Atrial fibrillation slows down the regular flow of blood through the heart, increasing the chances that the blood will pool and form clots. If a clot is pumped out of the heart, it can lead to a stroke.

Your plan for managing atrial fibrillation will include:

  • First, treatment to reduce your symptoms and improve how you feel
  • Second, treatment to reduce your risk of having a stroke or other complications

If my atrial fibrillation is under control, am I still at risk for having a stroke?

As of yet, there is no proof that rate or rhythm control treatment will reduce your risk of having a stroke — that remains the job of anticoagulant medications.

Reducing Symptoms with Medications

There are two main approaches to treating your symptoms: rate control to slow your heart to a more normal rate and rhythm control to restore a more regular heart rhythm.

The choice of treatment plan will depend on a number of factors, including:

  • The type of atrial fibrillation you have
  • Your other heart conditions or health issues
  • Your symptoms
  • Your preferences

Many patients start with one treatment but may need to change it as their condition progresses.

Rate Control Medications

The goal of rate control medications is to slow your heart to a more normal rate by reducing the number of abnormal electrical impulses. The majority of patients with AF are managed with rate control medications. Some examples of rate control medications include:

  • Beta blockers such as Metoprolol (Lopressor®) or Bisoprolol (Monocor®)
  • Calcium channel blockers such as Diltiazem (Cardizem®)
  • Cardiac glycosides such as Digitalis (Toloxin®)

Rhythm Control Medications

The goal of rhythm control medications is to restore a more regular heart rhythm. The most common rhythm control medications are:

  • Amiodarone (Cordarone®)
  • Dronedarone (Multaq®)
  • Flecainide (Tambocor®)
  • Propafenone (Rythmol®)
  • Sotalol (Sotacor®) 

Procedures for Rhythm Control

The most common procedures for treating atrial fibrillation are electrical cardioversion and catheter ablation.

Electrical Cardioversion

This procedure involves delivering a shock to your heart much like a defibrillator would only with a smaller amount of electricity. If you are scheduled to have a cardioversion, you will come in to the Heart Institute for the day. You will be given a medication to help you sleep and relax. Once this medication has taken effect, the defibrillator pads will be placed on your chest and a small shock will be delivered. You will not remember the shock and you will not feel any pain. After the procedure, your doctor may start you on a rhythm control medication to help your heart maintain a normal rhythm.

Cardioversion is only a short-term solution. In most patients, the atrial fibrillation comes back.

Catheter Ablation

This procedure involves inserting thin wires through the veins in your groin or neck. The tip of the wire is directed towards the areas in your heart that are firing off the irregular impulses. Once properly positioned, it delivers a small jolt of radiofrequency electrical current to burn out the tiny areas.

Before you are scheduled for any of these procedures, your doctor will provide you with more detailed information and the opportunity to ask questions.

Other Treatments to Manage Symptoms

In some situations, your doctor may recommend that you have a pacemaker implant or surgery called a maze procedure to treat your atrial fibrillation. If this is the case, your doctor will provide you with more detailed information.