Treatments for Atrial Fibrillation
There are three primary goals in the treatment:
- SLOWING THE HEART RATE (RATE CONTROL)
- RESTORING A NORMAL RHYTHM (RHYTHM CONTROL)
- PREVENTING CLOTS AND STROKES
The first step in treating AF is to visit your doctor. Together you will determine the best option for you. If needed, you may be treated in one or more of the following ways.
Your doctor may use medications called “anti-arrhythmics” to help stop atrial fibrillation (AF) and restore a normal rhythm to your heart. Examples of anti-arrhythmic drugs are amiodarone, procainamide and quinidine. When AF cannot be converted to sinus rhythm your doctor may prescribe rate-controlling medications to slow the heart rate. Rate-slowing drugs include the beta-blockers, calcium channel blockers and digoxin. Blood thinning medications may also be prescribed to reduce the risk of stroke by preventing the formation of blood clots. Examples of these are coumadin, aspirin and Plavix.
To reset your heart to its regular rhythm quickly, your doctor may perform an electrical cardioversion. Sometimes this must be done in a hurry but most times it is a scheduled procedure. For a cardioversion, after you have received medication to help you relax, an electrical shock is delivered to your heart through external patches placed on your chest. After cardioversion, medications may be prescribed to help prevent future episodes of AF. Although it is highly successful in converting most patients to a normal rhythm, it is unfortunately not very good at maintaining it, particularly in patients who have had AF for a long time or who also have other forms of heart disease.
An electrophysiologist (a heart rhythm cardiologist) can sometimes treat AF by catheter ablation. During this procedure you are given medications to relax or you may be asleep under anesthesia. A special catheter (a long, tube-like device) is inserted into the heart to heat the abnormal tissue causing the problem. The heat scars certain areas of the heart muscle that give rise to AF. Catheter ablation usually requires an overnight stay in the hospital and is most useful to patients who have had AF for only a short time and have no other heart disease. Maimonides Medical Center has a state of the art electrophysiology (EP) lab staffed by experienced electrophysiologists who have successfully performed numerous catheter ablations.
A surgical procedure called the Maze Procedure has had excellent results in curing AF. This procedure requires that the cardiac surgeon open the chest, use a heart-lung machine and make numerous small incisions on the atria to block the flow of excess electrical signals that cause AF. Although this is an extremely successful procedure, it is limited in its acceptance due to the invasive technique used.
Recent advances, pioneered by the doctors at Maimonides, have greatly simplified surgery to stop AF. They have developed a technique known as Endoscopic Microwave Ablation (or a modified Maze), which is much faster and safer than the Maze. In this procedure, surgeons use radio frequency or microwave energy probes to create the same scars as traditional surgery, but does not require the use of a heart-lung machine. It does not require stopping the heart or making incisions on it. It can be performed through tiny key-hole incisions in the chest and usually can be completed within two hours. Patients often go home the day after surgery.
Thanks to advances in medicine and surgery, several treatment options are available to you. At Maimonides, we are prepared to consult with you to determine the best option to treat your AF.