How can atrial fibrillation be treated

As well as reducing your risk of stroke, AF treatment may needed to help manage your symptoms. This may be done by:. Slowing your heart rate can relieve symptoms even if you still have an irregular heart rhythm.

In the first instance doctors will usually try medication to slow your heart rate down. Common types include:. Beta blockers are the most common type of rate control medication. Beta blockers prevent adrenaline speeding up your heart and lower your blood pressure.

If you have heart failure , beta blockers can stop it from getting worse. Usually your doctor will start you on a low dose of beta blocker and increase it slowly. You should only change the dose if your doctor tells you to. Often these side effects will reduce as your body gets used to the medication. But if you're experiencing erectile dysfunction or other side effects lasting longer than a few weeks, talk to your doctor about changing the medication.

Do not stop taking a beta blocker without first consulting your doctor. It is also important you don't run out of medication, or forget to take your pills on holiday. Stopping beta blockers suddenly can cause:. Calcium channel blockers are commonly used to treat high blood pressure.

Two of these medications, diltiazem and verapamil, are also used to help slow down the heart rate in patients with atrial fibrillation. They do this by reducing the number of electrical impulses that pass through the atrioventricular AV node into the lower heart chambers ventricles.

You should avoid grapefruit or grapefruit juice while taking diltiazem, because a chemical in the fruit prevents the absorption of the drug which can cause side effects. You should have your blood pressure and heart rate monitored regularly at your GP practice. Verapamil should not be used with a beta blocker as this combination may make the heart go too slowly.

Digoxin is used to slow the heart rate and increase the pumping force contraction of the heart. It can help to reduce symptoms of atrial fibrillation, such as breathlessness and palpitations.

If you have severe AF symptoms, or if it's your first episode of AF, your doctor may attempt to restore your heart rate to its normal rhythm sinus rhythm. To do this, doctors use a procedure called cardioversion. Electrical cardioversion also called direct current DC cardioversion, is a short procedure which uses a defibrillator to provide an electrical shock to the heart. It is performed in a hospital under sedation or anaesthetic.

The defibrillator sends an electrical impulse through your chest wall, via pads or electrodes which are placed on your chest. This impulse disrupts the abnormal rhythm for a split second, allowing your heart to resume a normal rhythm. The procedure takes a few minutes and because of the sedation you shouldn't feel any discomfort. Most people are able to go home from hospital the same day.

Pharmacological cardioversion, also known as chemical cardioversion, uses medicines called anti-arrhythmics to restore a normal heart rhythm. Your healthcare professional may give you these anti-arrhythmics in an oral form tablet or intravenously through a vein.

This procedure will also be carried out in hospital and your heart rhythm will be monitored closely throughout. It is also important to remember that cardioversion doesn't always work. For some people, their heart won't return to a normal rhythm. Others may slip back into atrial fibrillation at a later date. Even if your heart does return to a normal rhythm, you will still need to take medication to prevent blood clots because you are still at a higher risk of having a stroke.

After cardioversion, you may be prescribed antiarrhythmic medication to keep you heart rate in a normal rhythm. Common anti-arrhythmics include:. If cardioversions and medications fail to control your AF symptoms, your doctor may recommend a procedure, designed to interrupt the abnormal electrical circuit. Atrial fibrillation ablation, also known as AF ablation or AF catheter ablation, is a type of procedure that uses a catheter to destroy ablate the area inside the heart that is causing the abnormal rhythm.

Electrophysiologic radiofrequency ablation is a nonoperative, catheter-based procedure used to isolate and possibly destroy abnormal foci responsible for atrial fibrillation. Specific foci that cause atrial fibrillation have been found at or near the pulmonary vein ostia in the left atrium; locating these sites allows targeted ablation. Some trials have shown that radiofrequency ablation is superior to antiarrhythmics in selected patients, including patients with paroxysmal atrial fibrillation who are symptomatic but without structural heart disease, patients who are intolerant of antiarrhythmics, and patients with inadequate pharmacologic rhythm control.

Ablation of the accessory pathway is the optimal treatment for patients with Wolff-Parkinson-White syndrome and atrial fibrillation. Atrioventricular nodal ablation with pacemaker implantation may be beneficial for older patients with tachycardia-induced cardiomyopathy and persons with refractory ventricular rate control despite maximal medical therapy.

Surgical treatments for atrial fibrillation are invasive, high risk, and should be considered only in patients undergoing cardiac surgery for other reasons. The maze procedure aims to eliminate atrial fibrillation through the use of incisions in the atrial wall to interrupt arrhythmogenic wavelet pathways and reentry circuits. Two percutaneously inserted devices, the Watchman and the Amplatzer Cardiac Plug, can be used to achieve occlusion of the LAA, although the latter is not available in the United States.

Both are non-inferior to warfarin Coumadin in stroke risk reduction. Anticoagulation is an essential part of atrial fibrillation management. It significantly reduces the risk of embolic stroke, but increases the risk of bleeding. Although the benefit of anticoagulation exceeds the risk of bleeding for most patients, discussions about stroke prevention vs. Tools to aid in the assessment of the risks of stroke and bleeding are available and are useful in making decisions with patients about therapeutic options.

For many years, the CHADS 2 congestive heart failure; hypertension; age 75 years or older; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled] scoring system has been used to estimate risk of stroke in patients with atrial fibrillation. Anticoagulation is recommended for patients with a CHADS 2 score of 2 or more, unless a contraindication is present. Vascular disease prior myocardial infarction, peripheral artery disease, aortic plaque.

Similar clinical tools are available to assess anticoagulation bleeding risk. Warfarin lowers the risk of thromboembolic events, 36 — 39 but it has a narrow therapeutic range, multiple drug and food interactions, and requires frequent blood monitoring of the international normalized ratio. Direct oral anticoagulants, including a direct thrombin and several factor Xa inhibitors, are available.

Their major drawbacks are higher costs, difficulty reversing their effect in emergency situations, and the lack of simple blood tests to check drug levels.

A specific antidote for dabigatran is available, and factor Xa inhibitor antidotes are in the late stages of development. The oral direct thrombin inhibitor dabigatran is as effective as warfarin in preventing stroke and systemic emboli.

Major bleeding events were similar to those of warfarin, with fewer intracranial bleeds 0. These oral anticoagulants also have a slightly lower risk of intracranial hemorrhage compared with warfarin 0. Table 3 outlines the pharmacologic properties of direct oral anticoagulants and warfarin 16 ; none are recommended for patients on hemodialysis, nor are they approved for use during pregnancy or in patients with valvular atrial fibrillation or advanced kidney disease.

Table 4 compares some of the risks and benefits of direct oral anticoagulants vs. Variable dose adjusted to international normalized ratio. Generic prices not available; brand price listed in parentheses. Educate patients and check for interactions. Anticoagulation in atrial fibrillation.

Information from references 40 , 41 , 43 , 45 , and Although current practice has been to use heparin or low-molecular-weight heparin to bridge anticoagulation when patients taking warfarin need surgery or invasive procedures, a recent randomized trial in patients with atrial fibrillation who were undergoing surgery and who were at low or moderate bleeding risk found that these patients had worse outcomes if bridged than those who had their anticoagulation stopped during the perioperative period.

Patients with a very high risk of stroke or thromboembolism and those undergoing cardiac, spinal, or intracranial surgery were excluded from the study. The treatment of nonvalvular atrial fibrillation must be individualized to each patient's condition, which can change over time. Referral to a cardiologist is warranted for patients with complex cardiac disease; those who cannot tolerate atrial fibrillation despite rate control; those who need rhythm control, require ablation therapy, or may benefit from surgical treatment; and those who need a pacemaker or defibrillator because of another rhythm abnormality.

Data Sources: A PubMed search was completed in Clinical Queries using the terms atrial fibrillation, rate control, rhythm control, ablation therapy on nonvalvular atrial fibrillation, and anticoagulation therapy for nonvalvular atrial fibrillation. The search focused on randomized controlled clinical trials, systematic reviews, meta-analyses, and reviews published since Search dates: January to June Already a member or subscriber?

Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors. Eur Heart J. Stroke severity in atrial fibrillation. The Framingham Study. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. Heart disease and stroke statistics— update: a report from the American Heart Association.

Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med. Are cost benefits of anticoagulation for stroke prevention in atrial fibrillation underestimated? The intrinsic autonomic nervous system in atrial fibrillation: a review. ISRN Cardiol. Atrial remodeling and atrial fibrillation: mechanisms and implications.

Circ Arrhythm Electrophysiol. Is pulse palpation helpful in detecting atrial fibrillation? A systematic review. J Fam Pract. New oral anticoagulants and the risk of intracranial hemorrhage: traditional and Bayesian meta-analysis and mixed treatment comparison of randomized trials of new oral anticoagulants in atrial fibrillation.

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Strategies to incorporate left atrial appendage occlusion into clinical practice. Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.

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In an emergency, pictures of the heart can be taken to check for blood clots, and cardioversion can be carried out without going on medicine first. But you may need to continue taking anticoagulation after cardioversion if the risk of atrial fibrillation returning is high and you have an increased risk of having a stroke.

Catheter ablation is a procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits. Catheters thin, soft wires are guided through one of your veins into your heart, where they record electrical activity. When the source of the abnormality is found, an energy source, such as high-frequency radio waves that generate heat, is transmitted through one of the catheters to destroy the tissue.

The procedure can be very quick or it may take up to 3 or 4 hours, and may be carried out under general anaesthetic , which means you're unconscious during the procedure. You should make a quick recovery after having catheter ablation and be able to carry out most of your normal activities the next day.

But you should not lift anything heavy for 2 weeks, and driving should be avoided for the first 2 days. A pacemaker is a small battery-operated device that's usually implanted in your chest, just below your collarbone. It's usually used to stop your heart beating too slowly, but in atrial fibrillation it may be used to help your heart beat regularly. Having a pacemaker fitted is usually a minor surgical procedure carried out under a local anaesthetic the area being operated on is numbed and you're conscious during the procedure.

This treatment may be used when medicines are not effective or are unsuitable. This tends to be in people aged 80 or over. Find out more about pacemaker implantation.

Page last reviewed: 17 May Next review due: 17 May Factors that will be taken into consideration include: your age your overall health the type of atrial fibrillation you have your symptoms whether you have an underlying cause that needs to be treated The first step is to try to find the cause of the atrial fibrillation. If no underlying cause can be found, the treatment options are: medicines to reduce the risk of a stroke medicines to control atrial fibrillation cardioversion electric shock treatment catheter ablation having a pacemaker fitted You'll be quickly referred to your specialist treatment team if one type of treatment fails to control your symptoms of atrial fibrillation and more specialised management is needed.

Medicines to control atrial fibrillation Medicines called anti-arrhythmics can control atrial fibrillation by: restoring a normal heart rhythm controlling the rate at which the heart beats The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen, and how well the atrial fibrillation responds. Restoring a normal heart rhythm A variety of medicines are available to restore normal heart rhythm, including: flecainide beta blockers, particularly sotalol An alternative medicine may be recommended if a particular medicine does not work or the side effects are troublesome.

Controlling the rate of the heartbeat The aim is to reduce your heart rate to less than 90 beats per minute when you are resting. Side effects As with any medicine, anti-arrhythmics can cause side effects. The most common side effects of anti-arrhythmics are: beta blockers — tiredness, cold hands and feet, low blood pressure, nightmares and impotence flecainide — feeling sick, being sick and heart rhythm disorders verapamil — constipation , low blood pressure, ankle swelling and heart failure Read the patient information leaflet that comes with the medicine for more details.

Medicines to reduce the risk of a stroke The way the heart beats in atrial fibrillation means there's a risk of blood clots forming in the heart chambers. If these enter the bloodstream, they can cause a stroke. Find out more about complications of atrial fibrillation Your doctor will assess your risk and try to minimise your chance of having a stroke.