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Site FeedbackAtrial Fibrillation
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Treatment Goals | Treatment Options | John Muir Health Capabilities
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Definition
Atrial fibrillation is a heart rhythm disturbance, or arrhythmia, that results in irregular, and often, rapid heart beats. It is the most common arrhythmia, affecting over two and a half million Americans. Common symptoms include palpitations, lightheadedness, dizziness, fatigue, and shortness of breath. Although usually not life-threatening, it can cause uncomfortable symptoms and may increase the risk for stroke.
Treatment Goals
The treatment of atrial fibrillation involves three goals:
- Controlling your heart rate while in atrial fibrillation. This often requires medications such as beta blockers, calcium channel blockers, or digoxin.
- Minimizing stroke risk. Stroke risk in patients with atrial fibrillation is highest in older patients, and in those with other medical conditions such as heart failure, high blood pressure, diabetes, or prior stroke. Depending on your risk factors, blood thinning agents such as warfarin (Coumadin) or aspirin may be prescribed.
- Preventing episodes of atrial fibrillation. In some patients, this may be achieved with antiarrhythmic medications. Selected patients may be candidates for invasive procedures such as catheter ablation or surgery.
Treatment Options
Deciding which treatment option is most appropriate for a given patient depends on many clinical and personal factors. Therefore, therapy for atrial fibrillation is highly individualized. However, maintaining normal rhythm is often desirable in highly symptomatic patients. Possible treatment options for the attempted maintenance of normal rhythm is briefly outlined below.
Medications
Specialized medications known as anti-arrhythmics are often the first-line treatments for atrial fibrillation. Frequently, several anti-arrhythmic drugs need to be tried before the most effective one is found for a particular patient. If effective, they can significantly reduce the frequency and duration of atrial fibrillation episodes.
Catheter Ablation
Catheter ablation of atrial fibrillation can be an effective method of minimizing or eliminating episodes of atrial fibrillation. This invasive procedure involves cardiac catheterization using catheters which can both map and ablate (a form of cauterization) areas felt to be responsible for atrial fibrillation. Careful screening is required to select appropriate candidates to optimize procedure success and minimize risks.
Surgical Ablation
Surgical treatment for atrial fibrillation is also available. Usually this procedure, also known as the "maze operation," is reserved for those undergoing a concomitant open heart surgery, such as coronary artery bypass grafting or valve replacement. More recently, less invasive (thoracoscopic) surgical procedures have been developed for patients who do not also require open heart surgery.
AV Node Ablation and Permanent Pacemaker
Occasionally, highly symptomatic patients with atrial fibrillation cannot be controlled with medications and/or are not candidates for ablation procedures. Such patients may potentially benefit from a palliative procedure which controls heart rate using a combination of a permanent pacemaker and a simple ablation which prevents rapid heart rates. These patients will require warfarin anticoagulation indefinitely, as they continue to remain in atrial fibrillation despite the improved rate control.
John Muir Health Capabilities
John Muir Rhythm Center provides a full array of diagnostic and therapeutic modalities for the management of atrial fibrillation utilizing state-of-the-art equipment . The Rhythm Center has several cardiac electrophysiologists (cardiologists with specialized training in the management of rhythm diseases such as atrial fibrillation) on staff who can work with your cardiologist and primary care physician to tailor the optimal treatment strategy for you.