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Electrical Cardioversion continued...

“This isn’t a permanent fix,” says Whang. “Sometimes a person could have a recurrence of their AFib by the time they get home from the procedure. But getting the person back into normal rhythm, even for a short time, can tell us whether or not that makes them feel better. That tells us what we should do about treatment.”

That’s particularly helpful in a young person who may not think that their AFib is causing them symptoms but notices a dramatic difference after cardioversion. “They’ll say, ‘Wow, I didn’t realize I was feeling so bad! I thought I was just getting lazy, but it was really the AFib that was sapping my energy,’” Wylie says.

Prior to performing a cardioversion, doctors must make sure that there are no clots lurking in the atria that could be dislodged by the procedure and cause a stroke. Usually a month on blood-thinning medications will dissolve any hidden clots. If symptoms are too severe to wait that long, cardiologists will perform a procedure called a transesophageal echocardiogram (TEE).

Traditional echocardiograms use ultrasound transducers placed on the outside of the chest. A TEE gives a more detailed picture of the heart’s left atrium, where clots associated with AFib usually hide. Doctors guide the ultrasound transducer, attached to a long flexible tube called an endoscope, through the mouth and down the patient’s esophagus, which runs right behind the left atrium. This outpatient procedure is usually performed under IV sedation. If the TEE does not identify any blood clots, the doctor usually proceeds with the cardioversion.

Medications

The next step in restoring the heart’s normal rhythm is medication. There are several medications used to treat atrial fibrillation. For a patient who is in AFib all of the time, doctors may combine medications with cardioversion. For someone who is in and out of atrial fibrillation, they usually use medication alone. 

There are two main categories of drugs used in people with atrial fibrillation: rate control drugs and anti-arrhythmic drugs.

Rate control drugs control your heart rate. In a lot of people with atrial fibrillation, the problem isn’t so much the off-kilter rhythm; it’s that it’s simply beating too fast. “When the heart rate is over 100 beats per minute for very long, over time the ventricles, the bottom pumping chambers, can become weak,” says Whang. “So it’s important to try to control the heart rate.

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