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Atrial Fibrillation (cont.)

Treatment Overview

Treating atrial fibrillation is important for several reasons. An irregular, rapidly beating heart can weaken the heart muscle and cause it to dilate or stretch out. This can increase your risk of having heart failure or having chest pain or even a heart attack. Also, atrial fibrillation can greatly increase your risk of having a stroke. Atrial fibrillation can also cause symptoms that are hard to deal with.

Many people are able to live full and active lives while being treated for atrial fibrillation. To stay healthy, you will probably need to take medicines, including an anticoagulant or aspirin, a medicine to slow heart rate, or possibly a rhythm-control medicine.

Initial treatment

If atrial fibrillation is causing your heart to pump dangerously fast or your blood pressure to drop dramatically, you will probably be taken to the hospital for treatment to restore your blood pressure and heart rate to normal. If atrial fibrillation is not causing severe symptoms, you may be treated on an outpatient basis. Treatment for people who have just started having episodes of atrial fibrillation usually includes trying to convert the heart to a normal rhythm. Sometimes anticoagulant medicines are used to prevent clots and stroke.

  • If you have had atrial fibrillation for less than 48 hours, your doctor may perform a procedure called cardioversion, using either medicine or a low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm).
  • If atrial fibrillation has lasted for more than 48 hours, attempting cardioversion could cause a stroke. In this case, you may need to take an anticoagulant medicine, such as warfarin, for several weeks before your doctor tries cardioversion. Taking anticoagulants reduces the chance that a clot might travel from the heart to the brain after cardioversion.
  • If you are not sure how long you have had atrial fibrillation, you are also at risk of having a clot in your heart. If you are not having severe symptoms, such as fainting, your doctor will probably also recommend that you take anticoagulants for several weeks before cardioversion to prevent a stroke.
  • If you have severe symptoms and you are not sure how long you have had atrial fibrillation, your doctor may try to restore your heart to a normal rhythm immediately. In this case, your doctor will use a transesophageal echocardiogram to determine whether you have a clot in your heart that could cause a stroke. The results of this test will determine what your doctor does next:
    • If the heart is clear of clots, cardioversion can be attempted. Anticoagulants are used after to prevent strokes.
    • If there is a clot in the heart, your doctor will prescribe anticoagulants before trying cardioversion.

Cardioversion usually works to restore a normal sinus rhythm. But in many cases the heart rhythm goes back to atrial fibrillation.

Click here to view a Decision Point.Atrial Fibrillation: Should I Try Electrical Cardioversion?

Ongoing treatment

When atrial fibrillation comes on suddenly, lasts a short time, and goes away on its own, it is called paroxysmal atrial fibrillation. Typically, over time, episodes of paroxysmal atrial fibrillation come on more often and last longer.

Over time, episodes of atrial fibrillation typically last longer and often do not go away on their own. This is called persistent atrial fibrillation. When you have had atrial fibrillation for a long time, it is more difficult to return your heart to a normal rhythm (also called a normal sinus rhythm). When cardioversion is not an option or does not work, medicines are usually given to control the heart rate and prevent stroke.

Prevent a stroke

Having atrial fibrillation can raise your risk of stroke.

If you are at an average to high risk of having a stroke, your doctor may prescribe long-term use of an anticoagulant medicine, such as warfarin, to lower this risk. Anticoagulants, also called blood thinners, can prevent blood clots that can lead to a stroke. You may be at average to high risk of stroke if you are older than 75 or have a history of heart disease, high blood pressure, diabetes, or stroke.

If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?Click here to see an interactive tool.

If you are at low risk of having a stroke or you cannot take an anticoagulant, you may choose to take aspirin daily.

Click here to view a Decision Point.Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
Click here to view a Decision Point.Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?

Control your heart rate or rhythm

You may also need to take rate-control medicines or rhythm-control medicines (antiarrhythmics). Both of these types of medicines are effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.

Rate-control medicines. Rate-control medicines are used if your heart rate is too fast. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. They usually do not return your heart to a normal rhythm—in other words, your heartbeat will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. You might not have symptoms from an irregular heart rhythm if your heart rate is lower than 110 beats per minute. Rate-control medicines may relieve symptoms caused by the fast heart rate. But these medicines may not be an option if you have severe symptoms with atrial fibrillation.

Rhythm-control medicines.Rhythm-control medicines (also known as antiarrhythmics) may be used for some people who have atrial fibrillation. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning. These medicines might help relieve symptoms caused by an irregular heart rate.

Treatment if the condition gets worse

For some people with atrial fibrillation, medicines to slow the heart rate or control its rhythm do not work. These people continue to have a rapid, irregular heart rate. In these cases, doctors sometimes recommend a nonsurgical procedure called catheter ablation or a surgical procedure called the maze procedure. Experts suggest that these procedures should be done in a medical center where the staff has experience with the procedures.

Catheter ablation

Catheter ablation for atrial fibrillation is a relatively new procedure. Catheter ablation destroys the heart tissue that causes atrial fibrillation and that keeps atrial fibrillation going after it starts. Ablation might be done if you have symptoms of atrial fibrillation that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with. To help decide whether catheter ablation is a good choice for you, see:

Click here to view a Decision Point.Heart Problems: Should I Have Catheter Ablation?

Maze procedure

A surgical procedure to cure atrial fibrillation is called the maze procedure. The maze procedure is usually done during open-heart surgery. The procedure creates scar tissue that blocks excess electrical impulses from traveling through your heart. Because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and are having heart surgery for other reasons. Doctors are developing less invasive surgical maze techniques. These may be less painful and easier to recover from.

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