Treatment

Treatment for atrial fibrillation depends on how long you've had A-fib, your symptoms and the underlying cause of the heartbeat problem. The goals of treatment are to:

• Reset the heart rhythm
• Control the heart rate
• Prevent blood clots that can lead to stroke

Atrial fibrillation treatment may involve:

• Medications
• Therapy to reset the heart rhythm (cardioversion)
• Surgery or catheter procedures

Together, you and your doctors will discuss the best treatment option for you. It's important to follow your atrial fibrillation treatment plan. If A-fib isn't well controlled, it may lead to other complications, including strokes and heart failure.

Medications

You may be prescribed medications to control how fast your heart beats and restore it to a normal rate. Medications are also prescribed to prevent blood clots, a dangerous complication of A-fib.

Medications used to treat atrial fibrillation include:

• Beta blockers. These medications can help slow the heart rate at rest and during activity.
• Calcium channel blockers. These medicines control the heart rate but may need to be avoided by those who have heart failure or low blood pressure.
• Digoxin. This medication may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medications, such as calcium channel blockers or beta blockers.
• Anti-arrhythmic medications. These drugs are used to maintain a normal heart rhythm, not just to control the heart rate. Because they tend to have more side effects than drugs that control the heart rate, anti-arrhythmics tend to be used more sparingly.
• Blood thinners. To reduce the risk of stroke or damage to other organs caused by blood clots, a doctor may prescribe a blood-thinning medication (anticoagulant). Blood thinners include warfarin (Jantoven), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto). If you take warfarin, you'll need to have regular blood tests to monitor the drug's effects.

Cardioversion therapy

If A-fib symptoms are bothersome or if this is the first episode of atrial fibrillation, a doctor may attempt to reset the heart rhythm (sinus rhythm) using a procedure called cardioversion.

Cardioversion can be done in two ways:

• Electrical cardioversion. This method to reset the heart rhythm is done by sending electric shocks to the heart through paddles or patches (electrodes) placed on the chest.
• Drug cardioversion. Medications given through an IV or by mouth are used to reset the heart rhythm.

Cardioversion is usually done in a hospital as a scheduled procedure, but it may be done in emergency situations. If it's scheduled, warfarin (Jantoven) or another blood thinner may be given a few weeks before it's done to reduce the risk of blood clots and strokes.

After electrical cardioversion, anti-arrhythmic medications may be prescribed indefinitely to help prevent future episodes of atrial fibrillation. Even with medications, there is a chance of another episode of atrial fibrillation.

Surgery or catheter procedures

If A-fib doesn't get better with medications or other therapies, a doctor might recommend a procedure called cardiac ablation. Sometimes ablation is the first treatment for certain patients.

Cardiac ablation uses heat (radiofrequency energy) or extreme cold (cryoablation) to create scars in your heart to block abnormal electrical signals and restore a normal heartbeat. A doctor inserts a flexible tube (catheter) through a blood vessel, usually in your groin, and into your heart. More than one catheter may be used. Sensors on the tip of the catheter apply the cold or heat energy.

Less commonly, ablation is performed using a scalpel during open-heart surgery.

There are different types of cardiac ablation. The type used to treat atrial fibrillation depends on your specific symptoms, overall health and whether you're having another heart surgery.

For example, some of the types of cardiac ablation that may be used to treat atrial fibrillation are:

• Atrioventricular (AV) node ablation. Heat or cold energy is applied to the heart tissue at the AV node to destroy the electrical signaling connection. After AV node ablation, a pacemaker is needed for life.

• Maze procedure. A doctor uses heat or cold energy or a scalpel to create a pattern of scar tissue (the maze) in the upper chambers of the heart. Because scar tissue doesn't send electrical signals, the maze interferes with the stray heart signals that cause atrial fibrillation.

  If a scalpel is used to create the maze pattern, open-heart surgery is necessary. This is called the surgical maze procedure. It's the preferred method of atrial fibrillation treatment in those who need another heart surgery, such as coronary artery bypass surgery or heart valve repair.

Atrial fibrillation may return after cardiac ablation. If this happens, another cardiac ablation or other heart treatment may be recommended. After cardiac ablation, lifelong blood thinners may be needed to prevent strokes.

If a person with A-fib can't take blood-thinning medications, a doctor may recommend a catheter procedure to seal a small sac (appendage) in the left upper heart chamber, where most A-fib related clots form. This procedure is called left atrial appendage closure. A closure device is gently guided through a catheter to the sac. Once the device is in place, the catheter is removed. The device is left permanently in place. Surgery to close the left atrial appendage is an option for some people already having heart surgery.