AFib Treatment: From medication to surgery

4-minute read

If you have atrial fibrillation (AFib), your heart's upper chambers don't work in sync with the lower ones, causing an abnormal heartbeat. Just because your heart is out of rhythm doesn't mean your life has to follow suit. AFib treatment can help your heart get in a safe beat so you can focus on the people and activities you love. Best of all, with a variety of treatment options to choose from, your clinician can find one that works for you.

Why is treating AFib important? Symptoms for this condition, such as chest pain, shortness of breath, and fatigue, can affect your ability to work, do household chores, and spend time with loved ones. In addition, AFib increases your risk for stroke. In fact, 15% of strokes in the U.S. are due to AFib, according to the American Heart Association. You also have a higher risk for heart failure if you have AFib.

Let's explore the main AFib treatment options heart specialists use to control symptoms and help prevent stroke and other complications.

Medications: a common first-line AFib treatment

The most common treatment for AFib — and usually the first type of therapy clinicians recommend — is medication. In many cases, your provider may prescribe medications alongside recommendations for healthy lifestyle changes, such as exercising, maintaining a healthy weight, and quitting smoking. These changes can also help treat high blood pressure and other conditions affecting cardiovascular health and stroke risk.

Medications frequently prescribed as part of AFib treatment include:

Beta blockers. These medications slow the pumping rate of the heart's ventricles (lower chambers), giving them more time to fill with the blood your heart sends out to the rest of the body.
Blood thinners. Warfarin, heparin, apixaban, and other types of blood thinners help reduce the risk of blood clots forming. AFib increases your risk for strokes, which occur when a blood clot blocks blood flow to the brain. Be sure to follow your clinician's dosing and safety instructions carefully. Blood thinners increase your risk of bleeding, and other medications may interact with them. Certain blood thinners may require monthly blood tests to check the dosing levels.
Calcium channel blockers. Like beta blockers, calcium channel blockers slow the ventricles' pumping rate. Calcium channel blockers may be a good option for some people who can't take beta blockers.

Always take medications as prescribed, don't stop them without your clinician's permission, and notify your clinician of any side effects.

Restoring a normal rhythm with electrical cardioversion

Some patients may need a type of AFib treatment that restores a normal heart rhythm quickly using low-intensity electricity. Known as electrical cardioversion, this treatment may be necessary in an emergency, but clinicians also use it in nonemergency situations.

If you're a candidate for electrical cardioversion, you may first need a procedure called a transesophageal echocardiogram so clinicians can check for blood clots in the heart. If they find clots, you may need to take blood thinners before having an electrical cardioversion. During the procedure, a clinician will use a machine to deliver mild electric shocks to the chest. This energy sends the heart into a normal rhythm.

Catheter ablation to treat AFib

Many people think of medical-related scarring as an unwanted byproduct of certain treatments. However, for one type of minimally invasive AFib treatment, scarring is the goal.

During catheter ablation, clinicians scar the areas of heart tissue that produce the abnormal electricity driving AFib. How do they know which tissues to target? They use a special catheter, or small tube, to map the heart's electrical activity. After pinpointing the abnormal signals' origins, the clinicians send a different catheter through the blood vessels to the target areas and use heat energy or extreme cold to destroy the tissue, which creates scars.

Some people need an implantable device called a pacemaker after catheter ablation. If AFib occurs again, the device sends electrical impulses to the heart. These signals prompt it to return to a normal rhythm.

On guard against stroke: WATCHMAN treatment for AFib

If you have AFib unrelated to a heart valve problem and want an alternative to taking blood thinners to reduce stroke risk, a newer form of treatment may be appropriate for you. Known as the WATCHMAN device, the Food and Drug Administration approved this treatment in 2015. For eligible patients, WATCHMAN can eliminate the need for long-term warfarin therapy.

How does the treatment work? A clinician makes a small cut in the top of your leg near the groin and inserts a catheter. Then they guide the quarter-sized WATCHMAN device through the catheter to a sac in your heart's left atrium called the left atrial appendage (LAA). With AFib, blood can pool in the LAA and, potentially, form clots. A clot could leave the LAA, lodge in a blood vessel carrying blood to the brain, and cause a stroke.

When your clinician implants the WATCHMAN device in your LAA, it closes the structure to stop blood from entering and prevents blood clots from forming or getting out. Most people who have the WATCHMAN procedure can stop taking blood thinners within a few months.

Enter the maze: another surgical AFib treatment

While many people are able to have their AFib treated nonsurgically, that's not possible for everyone. In some cases, a surgical procedure called maze may be appropriate.

As with catheter ablation, the goal of the maze procedure is to create scar tissue. However, instead of making a small cut and using a catheter to reach the heart, the surgeon operates on the organ through an incision in the chest and makes a series of small cuts or other means to create scar tissue. Because electrical activity can't move through scar tissue, abnormal electrical signals can't reach the heart.

Wondering which treatment for atrial fibrillation would make the most sense for you? The specialists at the Reid Health Heart & Vascular Center can help you make a treatment plan.