Medical Management
There are two primary goals of treating atrial fibrillation: returning the heart to a normal rhythm and rate and preventing the formation of blood clots, which may dislodge from the heart and cause a stroke. This page discusses less invasive options in the heirarchy of atrial fibrillation treatment, including common medications and procedures. Other pages on the site address catheter ablation and maze surgery.
Medications
Antiarrhythmia drugs. Initial treatment of AF may involve medications to maintain the heart in normal sinus rhythm. These drugs include sotalol, propafenone, and amiodarone. These medicines have various side effects which affect their suitability in any given individual. Some require the patient to be hospitalized while the initial dosing is begun. Over the long term, however, the majority of patients on antiarrhythmia therapy will eventually fail to remain in normal sinus rhythm on any drug.
Rate-control drugs. These medications, such as beta-blockers and calcium-channel blockers, are not designed to maintain normal sinus rhythm, but rather control the ventricular rate while the patient remains in AF. The goal is to keep a patient's heart rate between 60 to 100 beats per minute so that the heart does not become overtaxed.
Anticoagulants. Commonly known as warfarin or Coumadin, an anticogulant, or blood thinner, is used to reduce the risk of blood clot formation. If blood clots form in the heart, they can break loose and be pumped out of the heart, restricting blood flow to the brain and causing a stroke. Blood thinning medications have no effect on heart rhythm. Some patients may be treated with aspirin only.
Procedures
Electrical cardioversion. The patient is given an intravenous sedative. A timed electrical shock is administered to the chest to reset the heart's rhythm. Regardless of whether cardioversion restores normal rhythm, it does not change the conditions in the heart which originally resulted in atrial fibrillation. Therefore, unless some other lasting therapy is given, recurrence of atrial fibrillation is common.
Atrioventricular (AV) node ablation. This procedure is performed in the heart catheterization laboratory. An older therapy for atrial fibrillation, AV node ablation involves a catheter inserted into the heart to produce a permanent electrical disconnection of the atria from the ventricles. The atria are left in permanent fibrillation, and a permanent pacemaker is needed to drive the ventricular rhythm. The atrial contribution to the heart's output is lost, and the patient must typically remain on warfarin chronically to guard against stroke.
More Information
For more details about atrial fibrillation treatments, including the five-box thoracoscopic maze procedure, request a phone consultation with Dr. John Sirak or call his appointment phone at (614) 366-7414.