What's the treatment for atrial fibrillation?
A highly effective, safe treatment for atrial fibrillation is still an unmet medical need. Nonetheless, current atrial fibrillation treatments, which are somewhat effective, include medication or invasive procedures, or some combination of the two. Because atrial fibrillation is a complex heart condition, the treatment program is typically managed by a physician who specializes in heart disease. Treatment has traditionally had 3 goals: to slow down the heart rate, to restore and maintain
normal sinus rhythm, and to prevent stroke. Findings have recently come to light indicating that maintaining sinus rhythm saves no more lives than simply slowing down the heart rate, a much simpler goal.
Treatment depends on the underlying cause. If the cause is coronary artery disease, treatment may consist of lifestyle changes, medications that treat high blood cholesterol and high blood pressure and/or procedures such as angioplasty and coronary artery bypass surgery. Atrial fibrillation resulting from thyrotoxicosis can be treated with medication or surgery, while fibrillation resulting from rheumatic heart disease may be treated by replacing damaged heart valves.
The arrhythmia of atrial fibrillation can be treated with medications, such as diltiazem hydrochloride (Cardizem), digoxin (Lanoxin) or verapamil (Tarka), which work to slow the heart rate. Another treatment option is electrical cardioversion, a procedure that delivers an electrical shock to the heart to restore normal heart rhythm. Although this procedure is effective in most cases, between 50 percent and 75 percent of patients eventually develop atrial fibrillation again. Drugs such as amiodarone (Cordarone), procainamide (Procan SR, Promine, Pronestyl) or quinidine (Cardioquin, Quinaglute Dura-tabs, Quinidex Extentabs, Quin-Release) may be given to try to prevent relapses of atrial fibrillation.
When medications are ineffective, catheter radiofrequency ablation sometimes can be performed. In this procedure, an area of tissue in the atrioventricular node is destroyed to prevent the passage of excess electrical impulses from the atria to the ventricles. The result is often complete blockage of all electrical impulses. A pacemaker is then implanted to control the heart rate and rhythm. The catheter delivers radiofrequency energy that burns ("ablates") a portion of the abnormal electrical conduction pathways in the left atrium, frequently around the openings of the pulmonary veins. This inactivates the abnormal pathway to provide more consistent flow of electrical impulses. This technique is very safe; however, the procedure is new, some say still experimental, with unknown long-term success. It should only be performed in tertiary care centers with significant experience with this technique. When it does work, atrial fibrillation is cured. It has few complications and, unlike surgery, requires little recovery time.
In addition to the treatments described above, people with atrial fibrillation often are given medications to prevent blood clots that can lead to stroke, pulmonary embolism and other complications. Treatment usually consists of anticoagulant medications (blood thinners), such as aspirin and warfarin (Coumadin). These patients usually receive heparin when admitted to the hospital. The older form of heparin, unfractionated heparin, is usually administered via continuous intravenous infusion, and frequent blood tests (PPT, prothrombin-proconvertin test) are performed to monitor how "thin" the heparin is making the blood. Some doctors use one of the newer heparin preparations, low-molecular-weight heparin, to thin the blood. These preparations are injected in the skin (usually in the abdomen) twice a day, and repeated monitoring is not required. Some doctors may use these medications after discharge from the hospital.