Atrial Fibrillation Treatment Procedures

Atrial fibrillation is a term used to describe a heart condition involving an abnormal heartbeat or arrhythmia. People with atrial fibrillation have a problem with their heart’s electrical activity. Atrial fibrillation is commonly referred to as A-fib. In people with this condition, the electrical signals between the two chambers of the heart that should be coordinated do not work together as they should, which causes the contraction of the heart to happen erratically. Due to this, the heart starts to beat either too fast, too slow, or irregularly.^{(1, 2, 3)}

There are many different types of treatments for atrial fibrillation, with the exact one depending on the severity of your condition. The focus of atrial fibrillation treatment is to control your heart rate, reduce the risk of stroke, and also restore normal heartbeat rhythm. The right atrial fibrillation procedure for you depends on your cardiologist’s recommendation. You will discuss your treatment plan with your cardiologist and healthcare team to decide what is the most suitable treatment for you. There are several factors taken into consideration to choose the right atrial fibrillation treatment. These include:^{(4, 5, 6)}

• Your age
• Your overall health
• What type of atrial fibrillation you have
• The severity of your symptoms

If you have any other underlying condition that needs to be treated

The first step to determining the right treatment procedure for your atrial fibrillation is to find the underlying cause of the A-fib. If there is an underlying cause, you might only need to be treated for this. For example, if your atrial fibrillation is caused by an overactive thyroid gland, a condition known as hyperthyroidism, medicine to treat this condition can also help cure the A-fib.^{(7, 8)}

The heart of people with atrial fibrillation is not able to pump blood properly through its chambers and out to the body. Sometimes, blood can begin to accumulate also in the heart, leading to clot formation, which could cause a heart attack or stroke.

There are many different treatments for A-fib, including medications, non-surgical procedures, and surgical procedures. These treatments slow down your heartbeat and help bring it back to a normal heart rhythm while also preventing the formation of clots and keeping your heart healthy.

Let us look at some procedures to treat atrial fibrillation.

1. Medications for Treating Atrial Fibrillation

   Medications are prescribed for the prevention of blood clots and strokes. They also help slow down your heart rate and control the heart rhythm to bring it back to normal. Here are some of the common types of medications prescribed for atrial fibrillation.

   Blood Thinners: Blood thinners are a class of drugs used to thin the blood to reduce the likelihood of developing clots or getting a stroke. However, these medicines increase the risk of bleeding, which is why when on these medicines, you might have to cut back on doing activities that may cause injuries, as blood thinners make you more susceptible to bruising and bleeding too much. The commonly prescribed blood thinners for atrial fibrillation are: ^{(9, 10)}

   • Aspirin
   • Heparin
   • Apixaban (brand name: Eliquis)
   • Enoxaparin (brand name: Lovenox)
   • Warfarin (brand names: Coumadin, Jantoven)

   Heart Rate Medications: The most common treatment for atrial fibrillation is with medications that help control the heartbeat. These drugs slow down your rapid heart rhythm and allow your heart to pump blood better. If you need drugs to slow down your heart rate, you might be prescribed beta-blockers like:^{(11, 12)}

   • Atenolol (brand name: Tenormin)
   • Bisoprolol (brand name: Zebeta)
   • Carvedilol (brand name: Coreg)
   • Timolol (brand name: Betimol)

   Calcium channel blockers may also be prescribed for slowing down your heart rate and toning down the contractions of the heart. In such cases, you may be prescribed drugs like verapamil or diltiazem.

   Heart Rhythm Drugs: These medicines help slow down the electrical signals of the heart, which brings the heart rhythm into a normal sinus rhythm. These treatments are also known as chemical cardioversion. Sodium channel blockers, like flecainide, quinidine, or propafenone, are usually prescribed. Potassium channel blockers, such as sotalol, dofetilide, and amiodarone, are also used for slowing down the electrical signals that are causing atrial fibrillation.^{(13, 14)}

   In cases where medications do not work, or they cause severe side effects, there are two major procedures that are used to treat atrial fibrillation without surgical intervention. These are known as electrical cardioversion and cardiac ablation. Let’s take a look at these procedures.

2. Electrical Cardioversion

   Cardioversion is usually recommended for those people with atrial fibrillation who did not get relief with medications. The process involves giving an electric shock to the heart under controlled circumstances to help- restore the normal heart rhythm. The procedure is generally done in the hospital so that the heart rhythm can be closely monitored.^{(15, 16)}

   If you suffer from atrial fibrillation for over two days in a row, cardioversion can, however, increase the risk of developing a blood clot. In such a case, your doctor will prescribe an anticoagulant medication for at least three to four weeks before the procedure of cardioversion is carried out. The medicines are to be continued for at least four weeks after the procedure to lower the risk of having a stroke.^{(17, 18)}

   In an emergency or in severe cases, pictures of the heart are taken to look for blood clots, and electrical cardioversion is carried out without having to take the medication first. Anticoagulation medications are stopped after your doctor deems that the cardioversion was successful. However, you may need to continue taking the medication even after cardioversion if your doctor determines that you are at a high risk of atrial fibrillation happening again or you have a high risk of having a heart attack or stroke.^{(19, 20, 21)}

   Most people only need to undergo one cardioversion, and since the procedure happens under sedation, you won’t have any memory of being shocked. It is possible to return back home on the same day as the procedure. A slight discomfort of cardioversion could be that your skin becomes irritated at the place where the paddles are attached. Your doctor will recommend a cream or lotion to ease any pain and itching.

3. Cardiac Ablation

   There are two major types of cardiac ablation – catheter ablation and surgical ablation.

   Catheter Ablation

   Also known as pulmonary vein ablation or radiofrequency ablation, catheter ablation is not surgery. It is also a less invasive option for ablation. During this type of ablation, the doctor inserts a thin, flexible tube into one of the blood vessels in your neck or leg. The line is guided to the heart, and once it reaches the area that is causing the irregular heartbeats, the tube sends out electrical signals to destroy the cells causing the arrhythmia. After the procedure, the treated heart tissue helps your heartbeat return to normal again.^{(22, 23)}

   There are two types of catheter ablation as well – radiofrequency ablation and cryoablation.

   In radiofrequency ablation, catheters are used to send radiofrequency energy to restore your regular heartbeat as it disrupts the abnormal electrical pathways in the heart that are causing the arrhythmia. Radiofrequency energy is similar to using microwave heat. The radiofrequency energy causes minor burns to cause some amount of scarring on the inside of the heart or around each vein or a group of veins. This restores the regular rhythm of the heart.⁽²⁴⁾

   Meanwhile, in cryoablation, a single catheter inserts a balloon that has a substance present on the tip to freeze the tissues of the heart, causing a scar and disrupting the abnormal electrical pathway that is causing the arrhythmia.⁽²⁵⁾

   Surgical Ablation

   Surgical ablation involves actually cutting open the chest to perform ablation. This is done through a maze procedure which is usually carried out while you are having open heart surgery for treating other heart-related problems like a valve replacement or even a bypass surgery. In this procedure, the surgeon makes some minor cuts in the upper part of the heart and stitches them together to cause scar tissue to form. This disrupts the abnormal electrical signals, thus stopping the irregular heartbeat.

   It is essential to keep in mind that most people with atrial fibrillation seldom need open heart surgery. The less invasive options are utilized most of the time.

4. Pacemaker

   Another procedure for atrial fibrillation is inserting a pacemaker. A pacemaker is a tiny device that keeps track of your heartbeat and sends a signal to stimulate or shock your heart if it starts beating too slowly or too fast. The pacemaker has very thin wires that connect it to the heart to allow it to constantly monitor your heart rate. While getting a pacemaker may sound scary, but it is actually just a minor procedure in which your doctor first puts a needle into a large vein near the shoulder to guide the wires of the pacemaker into the heart. The pacemaker is then inserted into the chest by making a small cut, and once it is in place, the device is tested to ensure that it is working correctly.⁽²⁶⁾

   There are some risks associated with putting in a pacemaker, including:

   • Infection
   • Collapsed lung
   • Damaged blood vessel
   • Bruising or bleeding from the site where the pacemaker has been placed.
   • You may need another surgery if any problems crop up with the device.
   • Discomfort may be caused by the signals sent from the pacemaker.
   • Dizziness
   • Throbbing in the neck every time the pacemaker sends an impulse

   Once you have a pacemaker, you have to follow certain precautions, including maintaining some distance from objects that give off strong magnetic energy, as this could disrupt your pacemaker’s electrical signals. Such devices may include metal detectors, electric generators, MRI machines or some other medical equipment, MP3 players and cells phones (rare cases), etc.⁽²⁷⁾

Your doctor will discuss with you the various options available for treating your atrial fibrillation and which procedure would be the best option for you. They will also recommend other lifestyle changes that you can take to keep your heart healthy. Changes like controlling your blood pressure, managing your cholesterol levels, quitting smoking, maintaining a healthy weight, and other such positive changes can help you achieve a better quality of life, even with atrial fibrillation.

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