Treating atrial fibrillation

A number of treatments are available for atrial fibrillation. Your doctor will decide what's best for you based on your individual needs. Goals of treatment plans for atrial fibrillation are to restore a normal heart rhythm, slow the ventricular heart rate and prevent blood clots. Some treatments for atrial fibrillation include:

• medication
• cardioversion
• catheter ablation
• pacemaker
• surgery

Medication

Several medications are used to treat atrial fibrillation, including the following.

• Heart drugs, such as procainamide, disopyramide, flecainide, propafenone, sotalol, dofetilide and amiodarone, are used to prevent atrial fibrillation from returning.
• Different types of digitalis, beta blockers and calcium channel blockers may be used to slow the ventricular heart rate. They each work a little differently, but all slow the passage of electrical impulses from the atria into the ventricles. This helps slow the beating of the ventricles, even if the atria continue to fibrillate (contract irregularly).
• Anticoagulants, such as aspirin and the prescription drug Coumadin® (Warfarin), help prevent blood clots from forming.

Cardioversion

Cardioversion may be used to restore your heart to a normal rhythm. In this procedure, doctors use devices called defibrillators to shock your heart. Defibrillator paddles are applied to your chest, delivering an electrical current to your heart. The shock stops your heart's electrical activity briefly, and when your heart immediately starts beating again, its rhythm is normal.

• Cardioversion fact sheet (pdf)

Catheter ablation

When other methods aren't effective, atrial fibrillation may be treated with a procedure called catheter ablation. Two types of ablation can be performed. Both are performed by a cardiac electrophysiologist.

• Ablation of the AV node with pacemaker implantation
  Soft wires known as a catheter (a long, thin tube) are inserted through the vein in your arm or leg and guided to your heart. High-frequency electrical energy at the tip of the catheter destroys a specific area of tissue to prevent the passage of electrical impulses from the atria to the ventricles. Since ablation causes the heart rate to become very slow, a permanent pacemaker must be implanted to maintain an adequate heart rate and to create a regular rhythm. Blood-thinning medications are usually still needed to help reduce the risk of stroke.
• Pulmonary vein isolation ablation
  Patients who have frequent atrial premature beats and paroxysm or a burst of atrial fibrillation, may be helped by isolating one or more of the pulmonary veins. Catheter ablation to electrically isolate the vein can stop them from starting atrial fibrillation. In this procedure, special catheters are inserted through the veins to the heart. A needle is used to guide the catheters to the left atrium. The catheter delivers energy (ablation) and maps or looks for the electrical impulses that fire abnormally. Energy is delivered into the area of the atria that connects to the pulmonary vein, producing a circular scar. The scar will block any impulses from firing within the pulmonary vein, thus preventing atrial fibrillation. This procedure can take three hours to six hours.

Pacemaker

A pacemaker is a small device that can regulate the heart's electrical signals when the heart's natural pacemaker is not working properly. It is implanted under the skin near the collarbone and connected to the heart by a wire. If a pacemaker detects a heart rate that is too slow or no heartbeat all, it emits an electrical impulse to stimulate your heart.

Surgery

A treatment called maze surgery can be used to eliminate atrial fibrillation in some people. In this procedure, a surgeon operates on the heart through the chest wall, making several incisions in the atria and stitches them together. The maze of incisions interrupts stray electrical impulses and restores normal rhythm to the heart.

Atrial fibrillation fact sheet (pdf)