What Are the Treatments for AFib?

Atrial fibrillation is a problem with your heart's electrical activity. You and your doctor have treatment options if your symptoms become too severe.

With AFib, your heart quivers, beats too quickly, or skips beats. It can't pump blood through its chambers and out to your body as well as it should. Sometimes blood can pool in the heart and form clots, which could lead to a stroke.

Treatments such as medications, nonsurgical procedures, and surgery can slow your heartbeat and bring it back into a normal rhythm. AFib treatments also prevent clots and help keep your heart healthy.

Medications

These can prevent clots and strokes, slow your heart rate, and control your heart rhythm.

Blood thinners : These medications thin your blood to lower your chance of having those problems. But they can raise your risk of bleeding, so you might have to cut back on some activities that can lead to injuries. The most common are:

Blood thinners can make you more likely to bruise or bleed too much. You'll see your doctor for a blood test every month to make sure the medication is working and you're on the right dose.

Heart rate medicines: The most common way to treat atrial fibrillation is with drugs that control your heartbeat. These slow your rapid heart rate so your heart can pump better. Most people take a medication called digoxin (Lanoxin).

You may need other drugs. Some are called beta-blockers. They also slow your heart rate. Some examples are:

Others are known as calcium channel blockers. They slow your heart rate and tone down contractions. You might get:

Heart rhythm medicines: They slow the electrical signals to bring your heartbeat into what’s called a normal sinus rhythm. These treatments are sometimes called chemical cardioversion

Sodium channel blockers, which slow your heart's ability to conduct electricity:

Potassium channel blockers, which slow the electrical signals that cause AFib:

You might get them in your doctor's office or at a hospital. Your doctor will monitor you to make sure the medicine is working.

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Procedures to Treat AFib

If medicines don't work or they cause side effects, you can try one of two procedures called cardioversion or ablation. These treat AFib without surgery.

Electrical cardioversion : The doctor gives your heart a shock to regulate your heartbeat. She’ll use paddles or stick patches called electrodes onto your chest.

First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest, and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.

Most people only need one. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

Your skin may be irritated where the paddles touched it. Your doctor can point you toward a lotion to ease pain or itching.

Cardiac ablation: There are two major options:

Catheter ablation , also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s the least invasive option. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then she guides it to your heart. When it reaches the area that’s causing the arrhythmia, it sends out electrical signals that destroys those cells. The treated tissue helps get your heartbeat regular again.

There are two main types of catheter ablation:

  • Radiofrequency ablation: The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that creates circular scars around each vein or group of veins.
  • Cryoablation: A single catheter sends a balloon tipped with a substance that freezes the tissues to cause a scar.

Surgical ablation involves cutting into your chest:

Maze procedure: This is usually done while you’re having open-heart surgery for another problem, like a bypass or valve replacement. The surgeon makes small cuts in the upper part of your heart. They’re stitched together to form the scar tissue that stops abnormal signals.

Mini maze:  Most people with AFib don’t need open-heart surgery. That’s where this minimally invasive option comes in. The doctor makes several small cuts between your ribs and uses a camera to guide catheters for either cryoablation or radiofrequency ablation. Some hospitals offer robot-assisted surgery that uses smaller cuts and allows for greater precision. Your doctor will put a video camera or tiny robot into your chest. It’ll guide the creation of scar tissue that may help keep your heartbeat at the right pace.

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Convergent procedure: This pairs catheter ablation with a mini maze. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.

AV node ablation: You might get this procedure if:

  • You don’t respond to medications
  • You can’t take medications because of side effects
  • You aren’t a good candidate for a procedure that cures you.  

Your doctor will insert a catheter into a vein in your groin and slide it up to the AV node, a nerve that conducts electrical impulses between the top and bottom chambers of your heart. She’ll send radiofrequency energy through the catheter to destroy the AV node. This stops the signals from reaching your ventricle. Then the doctor will implant a pacemaker into your chest. This electronic device lies under the skin of your upper chest. It’s connected to one or two wires that are inserted through a vein and sit in your heart. It delivers painless electric pulses that make your heart beat.

Treating the Causes of AFib

If problems such as high blood pressure, cholesterol, or an overactive thyroid caused your AFib, you'll need to treat the root cause. Your doctor might prescribe medications to get those conditions under control.

Your doctor may also recommend screening and treatment for sleep apnea, a disorder in which breathing starts and stops throughout the night.

Lifestyle Changes

Your doctor also might recommend you take some simple steps to help keep your heart healthy:

  • Change your diet -- eat heart-healthy, low-salt food. Go for fruits, veggies, and whole grains.
  • Get more exercise -- more physical activity strengthens your heart

And she will probably suggest that you make other changes to lower your odds of heart disease:

  • Quit smoking
  • Stay at, or try to reach, a healthy weight
  • Control your blood pressure
  • Manage your cholesterol
  • Drink alcohol in moderation
  • Keep doctors’ appointments
WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on May 02, 2018

Sources

SOURCES:

Agency for Healthcare Research and Quality: "Treatment of Atrial Fibrillation."

American College of Cardiology: “Recommended Doses of Anticoagulant/Antithrombotic Therapies for Patients with Atrial Fibrillation.”

American Heart Association: “Ablation for Arrhythmias,” "Atrial Fibrillation Medications," "Non-surgical Procedures for Atrial Fibrillation (AFib or AF)," "Surgical Procedures for Atrial Fibrillation (AFib or AF)," "What is Atrial Fibrillation (AFib or AF)?"

Cleveland Clinic: "Atrial Fibrillation (AFib)."

National Heart, Lung, and Blood Institute: "How Is Atrial Fibrillation Treated?" "What is Cardioversion?"

The Society of Thoracic Surgeons: "Atrial Fibrillation Surgery -- Maze Procedure."

UAB Medicine: "Left Atrial Appendage Occlusion."

Mayo Clinic: “Atrial fibrillation,” “Cardioversion,” “Sleep Apnea.”

StopAfib.org: “Maze Procedure (Surgical Ablation),” “Using Electrical Cardioversion for Atrial Fibrillation.”

Heart Rhythm Society: “Types of Ablations.”

Keck School of Medicine of USC: “Robotic-Assisted Maze Surgery.”

Frankel Cardiovascular Center: “AV Node Ablation.”

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