Atrial Fibrillation Treatment
The goals of treatment for atrial fibrillation are to reset your heart rhythm, prevent blood clots and prevent recurrence of atrial fibrillation. Treatment methods include medications, pacemakers, surgery, other medical procedures and lifestyle changes
Your WellStar Cardiac Network Physician may treat underlying health conditions predisposing a patient to atrial fibrillation.
Taking Care of Atrial Fibrillation
If you are diagnosed with atrial fibrillation, your WellStar Cardiac Network Physician will determine the best treatment or combination of treatments, taking into account any underlying health problems and the condition of your heart. You may be referred to a WellStar cardiologist.
If your cardiologist is concerned about blood clots, he or she may order a transesophageal echocardiogram to more closely evaluate for clots in the upper heart chambers. Your cardiologist may prescribe an anticoagulant (blood thinner) to prevent clots from forming. Some people require blood thinners for life to protect against blood clots and stroke. The most common anticoagulant is warfarin (Coumadin®), but newer anticoagulants will become available by the end of 2010 and are appropriate for certain patient subsets.
Your cardiologist will weight the risks and benefits of each drug on an individual basis.
In some cases, your cardiologist may be able to return your heart beat to a normal rhythm. If appropriate to your condition, your physician may choose electrical cardioversion or drug cardioversion:
- Electrical cardioversion: This procedure, performed while you are under anesthesia, can sometimes shock the heart back to normal rhythm. Your WellStar Cardiac Network Physician may prescribe warfarin (Coumadin®) or other blood thinners before and after this procedure to prevent blood clots from forming.
- Drug cardioversion: Medication may be used to restore and maintain normal rhythm. Among these anti-arrhythmics: amiodarone (Cordarone®, Pacerone®); propafenone (Rythmol®); sotalol (Betapace®); dofetilide (Tikosyn®). The differences between these drugs and potential side effects will be discussed with your doctor.
Sometimes, your heart rhythm cannot be returned to normal. In such a case, your cardiologist may use other medications, pacemakers or even surgery to control your heart rate.
- Medications: Your WellStar Cardiac Network Physician may prescribe digoxin (Lanoxin®) to control your heart rate at rest. This medication, also known as digitalis, increases the strength of your heart muscle contractions but tends to slow the heartbeat. Calcium channel blockers or beta blockers may also be used to slow your heart rate during activity.
- Atrioventricular (AV) node ablation: In this procedure, small catheters are routed through the blood vessels to the AV node, which is between the atria and the ventricles. Radio frequency energy is then used to destroy the AV node tissue, and a pacemaker is implanted to create a normal rhythm. Though the ablation will interrupt the atrial impulse to the ventricles, the atria will still fibrillate. Your cardiologist may prescribe blood thinners to prevent blood clots.
- Radiofrequency catheter ablation and Cryo-Ballon catheter ablation: This procedure is focused on the heart’s electrical tissue’s “hot spots,” the origins of the atrial erratic activity, by burning or freezing the tissue. Radiofrequency energy may scar the tissue, normalizing the electrical signals. Successful procedures, often achieved by WellStar Cardiac Network Physicians, correct the atrial fibrillation, without the need for a pacemaker or medications.
- Surgical maze procedure: If appropriate, a cardiologist may refer a patient for this procedure during open-heart surgery for another necessary repair, such as coronary artery bypass surgery. The procedure involves making several precise incisions in the upper chambers of the heart, creating a pattern of scar tissue that disrupts abnormal electrical impulses. A pacemaker is usually required after this procedure.
- Convergent ablation: A combined ablation approach using standard radiofrequency and minimal invasive surgery intended for more complex patients with refractory AFib. Kennestone is one of only a few hospitals in Georgia to perform the procedure. The goal is to improve success of the procedure for those more complex patients.