Download treating atrial fibrillation

TREATING ATRIAL FIBRILLATION
A range of treatments can help with atrial
fibrillation. In some cases, lifestyle changes
such as healthy eating and exercise can reduce
arrhythmic events as well as benefit overall
health. Medicine can be effective in correcting
irregular heartbeats, although sometimes it
is used in concert with another treatment
or simply to guard against complications. In
addition to medicine, several procedures and
surgical techniques exist to treat atrial fibrillation.
TREATMENT GOALS
Three main goals of treatment are:
To restore the heart’s normal rhythm and
in some cases cure the condition—If atrial
fibrillation is not treated, it can eventually
weaken the heart muscle and cause permanent
damage. Restoring the heart’s regular rhythm
can relieve the symptoms of atrial fibrillation
and prevent dangerous blood clots from forming.
To slow the heart rate and relieve some
symptoms without stopping the irregular
heart rhythm—Controlling rapid heart rates
allows the heart to pump oxygen-rich blood
efficiently, relieves some or all symptoms of atrial
fibrillation, and protects against a weakening of
the heart muscle. Controlling rapid heart rates,
however, does not address the underlying
arrhythmia.
To prevent clots from forming, thus avoiding
strokes—For many patients with atrial fibrillation,
anticoagulant medication is used in conjunction
with other treatments. This medication is an
important way of preventing
clots and reducing the risk
of stroke.
Treating atrial
fibrillation can prevent
chronic fatigue, stroke
and heart failure.
Atrial fibrillation is an irregular heartbeat resulting from rapid electrical activity in
the upper chambers of the heart (atria) with irregular and often rapid conduction to the lower
chambers of the heart (ventricles). It is the most common type of heart rhythm disturbance.
In atrial fibrillation, the heartbeat is irregular and rapid. Sometimes the upper chambers beat
as often as 300 times a minute, about four times faster than normal, and the lower chambers
may beat at 100 to 150 beats per minute. Blood does not move through the heart in a normal
way, which may increase the risk of clots and stroke. If treated appropriately, atrial fibrillation
seldom causes serious or life-threatening problems. Effective treatment for atrial fibrillation
may return the heart to a normal rhythm or control the heart rate in atrial fibrillation and
prevent blood clots and strokes.
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TREATMENT OPTIONS
Today a number of treatment options are available,
including:
Medication—Medication that controls the heart
rate includes beta blockers and calcium channel
blockers. Other medication focuses on returning
the pattern of heartbeats—the heart’s rhythm—
to normal. In some patients, atrial fibrillation
may continue even with medication. Different
medication may work better or have fewer side
effects. Medication may reduce the frequency of—
or even eliminate—episodes of atrial
fibrillation.
Electrical Cardioversion—
Cardioversion is a way of converting the
heart back to its normal rhythm.
It can sometimes be achieved
using intravenous or oral
medication. Alternately,
an electrical shock can be
delivered to the chest wall
to convert atrial fibrillation
back to a normal rhythm.
In an electrical cardioversion,
a patient is sedated. Then
electrical energy is applied
through the chest using paddles
or specialized pads, shocking the heart
back to its normal rhythm. The procedure is most
effective if atrial fibrillation has not been present
for long.
Some patients require anti-arrhythmic
medication after electrical cardioversion to prevent
a relapse. Some take anticoagulant medication to
prevent blood clots and reduce the risk of stroke.
Pacemaker Therapy—Sometimes
implanted pacemaker devices are
used to treat atrial fibrillation.
They monitor the heart rate and
send stimulating electrical impulses
to the heart if the rate slows too much.
Patients with paroxysmal atrial fibrillation (where
the arrhythmia comes and goes without treatment),
often see a reduction in atrial fibrillation after a
pacemaker is implanted.
Catheter Ablation—If medication is not successful in
treating atrial fibrillation, a procedure called catheter
ablation may be an option. In ablation, energy either
destroys the troublesome areas that trigger abnormal
electrical signals or creates a roadblock that stops
such signals from
traveling through
the heart.
TYPES OF ABLATION
Depending upon each patient’s specific case,
doctors may choose from a range of ablation
techniques.
Catheter Ablation of
Atrial Fibrillation—
Atrial fibrillation often
originates from the four
pulmonary veins that carry
blood from the lungs to
the left atrium. It can be
cured in some patients with
a technique called catheter
ablation of atrial fibrillation.
With this procedure, catheters
are placed in the heart and guided
to the left atrium, where energy is
delivered to destroy or isolate the areas
that trigger the atrial fibrillation. The procedure is
generally reserved for patients who have significant
symptoms from the atrial fibrillation and have failed
medication. In some patients, a second procedure
may be needed if the atrial fibrillation returns after
the intial ablation. There are some risks associated
with catheter ablation of atrial fibrillation.You should
discuss whether you are a candidate for catheter
ablation and the risks and benefits with your
cardiologist and heart rhythm specialist.
AV Node Ablation—The AV node is where the
atrial and ventricular electrical systems meet.
Catheters deliver energy to ablate the node. This
procedure slows and regularizes the heart rhythm
and requires placement of a permanent pacemaker.
While symptoms improve, atrial fibrillation remains
and blood-thinners are required to reduce the risk
of stroke.
AV Node Modification—This procedure is similar
to AV node ablation, except that the node
is damaged, not destroyed. This may slow
the heart rate somewhat. The major
advantage of this procedure
is that it can generally be
done without the need for a
pacemaker. This procedure
is not used very frequently.
The heart rate tends to
increase with time, reducing
the long-term benefit of the
procedure. Typically AV node
ablation and placement of
a permanent pacemaker is
preferred to AV node modification.
The Surgical Maze Procedure—The Maze
procedure is an effective surgical treatment of
atrial fibrillation. Because it involves incisions and
stitching —and a relatively long operation—it is only
appropriate for certain patients: those whose atrial
fibrillation cannot be treated effectively with
medication or ablation; or patients who need heart
surgery for another heart problem.
In the Maze procedure, surgeons make precise
incisions to the right and left atria. This separates the
electrical systems in each chamber, which interrupts
the flow of the abnormal electrical signals that cause
atrial fibrillation. A modified version of the Maze
technique focuses mainly on the left atrium.
IMPORTANCE OF TREATMENT
At one time, atrial fibrillation was considered
harmless. Although it isn't life threatening, it is
associated with blood clots and a five-to-sevenfold increase in stroke. It is also linked to chronic
fatigue and heart failure, a condition in which
the heart is unable to pump enough
blood to the other organs and
fluid accumulates in the body.
The good news is that these risks can
be reduced drastically if properly monitored
and treated. The key is for patients and doctors
to work closely together to determine and
implement the best course of care in each
patient’s situation.
To learn more about atrial fibrillation or other heart rhythm
disorders and treatments, visit the Heart Rhythm Society’s website at:
www.HRSpatients.org
This information is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice.
Those with questions or who need more information should consult their physician. Heart Rhythm Society is located at 1400 K Street NW, Suite 500, Washington DC 20005.
Phone: 202-464-3400 Fax: 202-464-3401 Copyright ©2005 Heart Rhythm Society. All rights reserved.
Supported by a grant from Biosense Webster, Inc.