Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms Evaluation Treatment anticoagulation cardioversion catheter ablation drugs questions for doctor specialist Home Care diet pulse check taking control warning signs Complications Underlying Cause Anatomy

Fibrillation Atrial Treatment

Treatment for atrial fibrillation focuses on reducing the rapid heart rate, or converting the atrial fibrillation to a normal sinus rhythm. During treatment, blood thinners may be given, in order to reduce the risk for a stroke by preventing blood clots from forming in the heart. Medications or electrical cardioversion reset atrial fibrillation to a normal sinus rhythm. During electrical cardioversion, the heart is subjected to a small electrical shock, delivered through paddles, or patches, placed on the skin over the chest. The electrical current interrupts the atrial fibrillation rhythm, allowing the normal heartbeat to take over. After cardioversion, medications maintain the normal rhythm. Although the conversion to a normal rhythm may occur quickly, ongoing treatment with medication may be required for months or years.

If medication or cardioversion do not convert the heart o a normal rhythm, then the doctor may recommend radiofrequency catheter ablation or the Maze procedure. During radiofrequency ablation, a special catheter is threaded through the bloodstream and to the heart. The catheter is used to deliver radio waves, which destroy the tiny region of heart cells that are responsible for the abnormal rhythm. The maze procedure requires open heart surgery to destroy the cells that are responsible for atrial fibrillation.

Treatment options for atrial fibrillation may include:

Fibrillation Atrial Anticoagulation

Most people who have atrial fibrillation require treatment with blood thinners, called anticoagulants. Atrial fibrillation can cause blood clots to form in the chambers of the heart. The clot can break off of the wall of the heart chamber, where it is carried through arteries by the bloodstream. As the artery becomes smaller and smaller, eventually the clot becomes stuck in the artery. This completely stops blood from flowing to the tissues supplied by the artery. The most common place that this occurs is in the brain, where the clot causes a stroke. The anticoagulant medications reduce the risk of clot formation.

Initial anticoagulant medications use to treat atrial fibrillation include:

The anticoagulant effects of warfarin are delayed. Heparin or low molecular weight heparin are started at the same time as warfarin, in order to provide anticoagulation until warfarin becomes active. The heparin or low molecular weight heparin are discontinued once warfarin becomes active.

Warfarin should be avoided in those with:

Alternatives to long-term treatment with warfarin include:

Regular monitoring of prothrombin times is essential for any patient taking warfarin. Most experts recommend a target INR value between 2 and 3. Initial therapy requires daily prothrombin times until stabilized, then 2-3 times per week for 1-2 weeks. Regular prothrombin times should be obtained every 4-8 weeks thereafter.

Fibrillation Atrial Cardioversion

Paddle Cardioversion
Electrical cardioversion may be used to treat atrial fibrillation. Cardioversion introduces a brief electrical current to the heart, through the chest wall. The electric current is delivered through metal electrodes that are attached to the surface of the chest. The procedure resets the heart's own pacemaker, which converts the atrial fibrillation to a normal rhythm.

Internal Cardioversion
An internal automatic cardiac defibrillator may also be used to perform cardioversion in those who have recurrent atrial fibrillation. This is a small device that is placed inside the chest, like a pacemaker. The defibrillator can deliver a brief electric current when it senses atrial fibrillation.

Pacemaker Cardioversion
Some cardiac pacemakers also have built-in defibrillator capability, allowing for cardioversion when the heart rate or rhythm becomes abnormal. Pacemakers are electronic devices that regulate the heart rate within a normal range.

Fibrillation Atrial Catheter Ablation

Radiofrequency catheter ablation may be used to treat atrial fibrillation in those who do not respond to treatment with medication or electrical cardioversion. During this procedure, a thin catheter is inserted in a blood vessel and the end is threaded into the heart. The catheter tip can generate electrical current and heat. The cardiologist performing the procedure uses the catheter to make pinpoint burns in the tissue on the inside surface of the heart. The pinpoint burns interrupt the electric signals from the tissue that cause atrial fibrillation.

The same procedure is used to perform pulmonary vein ablation, which also treats atrial fibrillation. In this case, the atrial fibrillation originates from tissues inside the pulmonary vein.

Fibrillation Atrial Drugs

Atrial fibrillation can cause the lower chambers of the heart to beat too fast. Medications are used to slow the heart rate.

Medications for atrial fibrillation include:

Fibrillation Atrial Questions For Doctor

The following are some important questions to ask before and after the treatment of atrial fibrillation.

Questions to ask before treatment:

  • What are my treatment options?
    • Is surgery an option for me?
  • What are the risks associated with treatment?
  • Do I need to stay in the hospital?
    • How long will I be in the hospital?
  • What are the complications I should watch for?
  • How long will I be on medication?
  • What are the potential side effects of my medication?
  • Does my medication interact with nonprescription medicines or supplements?
  • Should I take my medication with food?

Questions to ask after treatment:
  • Do I need to change my diet?
  • Are there any medications or supplements I should avoid?
  • When can I resume my normal activities?
  • When can I return to work?
  • Do I need a special exercise program?
  • What else can I do to reduce my risk for cardiac arrhythmias?
  • How often will I need to see my doctor for checkups?
  • What local support and other resources are available?

Fibrillation Atrial Specialist

Physicians from the following specialties evaluate and treat atrial fibrillation:

Continue to Fibrillation Atrial Home Care

Last Updated: Jun 2, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Fibrillation Atrial References
  1. Alchaghouri S. Atrial fibrillation. 2: Management. Hosp Med. 2004 Sep;65(9):546-52. [15449492]
  2. Freestone B, Kamath S, Lip G. Atrial fibrillation (acute). Clin Evid. 2003 Jun;(9):61-71. [15366136]
  3. Johnson J, Napier KT. Atrial fibrillation: new theories, emerging treatments. JAAPA. 2005 Jun;18(6):36-41. [15977854]
  4. Leonardi M, Bissett J. Prevention of atrial fibrillation. Curr Opin Cardiol. 2005 Sep;20(5):417-23. [16093761]
  5. Mead GE, Flapan AD, Elder AT. Electrical cardioversion for atrial fibrillation and flutter. Cochrane Database Syst Rev. 2002;(1):CD002903. [11869642]
  6. Veenhuyzen GD, Simpson CS, Abdollah H. Atrial fibrillation. CMAJ. 2004 Sep 28;171(7):755-60. [15451840]
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