Atrial Fibrillation

Treatment

Treatment goals for atrial fibrillation include restoring the heart to normal rhythm, slowing the heart rate and preventing blood clots. Treatment options may include:

• Nonsurgical procedures
• Medications
• Medical devices – pacemakers
• Surgical procedures
• Follow-up care

Nonsurgical procedures

Cardioversion

To correct atrial fibrillation — reset the heart to its regular rhythm (sinus rhythm) — the physician will often perform cardioversion. This can be done in two ways:

Cardioversion with drugs

Medications (anti-arrhythmics) are used to stop the atria's quivering and restore normal sinus rhythm. The medications effectively maintain sinus rhythm for at least one year in 50 to 65 percent of people. However, they can cause side effects such as nausea and fatigue, as well as some long-term risks. In rare cases, the medications may actually increase the heart rate.

Electrical cardioversion

A patient under light anesthesia receives an electrical shock through paddles or patches on the chest. The shock stops the heart's electrical activity for a split second. When the heart's electrical activity resumes, the rhythm may be normal.

Cardioversion is not always effective. It may successfully restore regular heart rhythm in over 95 percent of patients, but more than half eventually go back into atrial fibrillation. In many instances, anti-arrhythmic medications are needed indefinitely.

Catheter Radiofrequency Ablation

For atrial fibrillations caused by abnormal heart tissue, catheter radiofrequency ablation can be used to destroy the abnormal tissue. The procedure is performed without open chest surgery. In the procedure, catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then uses a small cutter or radiofrequency energy to remove the abnormal tissue.

Types of ablation for atrial fibrillation include:

Pulmonary vein isolation ablation (PVI Ablation or PVA)

This procedure electrically isolates "hot spots" in the pulmonary veins that trigger atrial fibrillations. Pulmonary vein isolation eliminates atrial fibrillation in 60 to 80 percent of patients who are treated. In addition, medications that did not help patients prior to ablation are now effective.

Minimal Access Catheter Maze Procedure

With new technology, surgeons are now able to create electrical barriers in the walls of the heart by using cyroablation (freezing.) This is faster, safer and less invasive than open-heart maze surgery. Read more about maze heart surgery.

AV node ablation with pacemakers

This procedure involves applying radiofrequency energy to the atrioventricular (AV) node through a catheter to destroy a small area of tissue. This prevents the atria from sending too many electrical impulses to the ventricles. The atria continue to fibrillate and anticoagulation medication is still required. In 98 percent of patients, this procedure completely blocks the heart's electrical impulses. A pacemaker is then implanted to establish normal rhythm.

In a study, 85 percent of people who had this procedure reported an improved quality of life and increased ability to exercise.

Medications

Medications may be prescribed in combination with other treatments for atrial fibrillation. Treatment options may include:

Drugs to slow the heart rate

When atrial fibrillation cannot be stopped using cardioversion, the goal is to slow the heart rate.

Digoxin

Doctors have traditionally prescribed this medication. It controls the heart rate at rest, but not as well during activity.

Calcium channel blockers or beta-blockers

A newer approach is calcium channel blockers or beta-blockers, drugs to control heart rate more consistently at rest and during activity.

Drugs to prevent blood clots

Patients with atrial fibrillations and heart disease are at especially high risk of stroke. Blood-thinning medications (anticoagulants) such as warfarin (Coumadin) or aspirin may be prescribed.

Medical devices – Pacemakers

A pacemaker is a medical device that helps regulate the heartbeat. The device, smaller than a matchbox, is placed under the skin near the collarbone. A wire extends from the device to the heart. If a pacemaker detects an abnormally slow heart rate or no heartbeat, it emits electrical impulses that stimulate the heart to speed up or start beating again.

A pacemaker is used most often for patients with atrial fibrillation in either of these situations:

• If medications used to prevent atrial fibrillation or control the heart rate result in excessively slow heartbeats
• After AV node ablation

For people with occasional fibrillation, new types of pacemakers may help prevent recurrences.

Surgical procedures

Open-heart maze procedure
For surgical maze procedures, surgeons create multiple cuts into the muscle of the atria and then stitch them together. These incision lines interfere with stray electrical pathways and circuits. The lines reduce the size of atrial tissue sections needed to maintain atrial fibrillation.

Due to its complexity, only a few medical centers in the United States perform the surgical maze procedure. See more information about maze procedures.

Surgeons at Mayo Clinic's campus in Rochester offer minimally invasive heart surgery for atrial fibrillation. They access the heart from the side of the chest (between the ribs) rather than through the sternum, leading to shorter recovery times.

Follow-up care

Many patients have benefited from Mayo Clinic's cardiac rehabilitation program while recovering from heart surgery. The program starts with a walking schedule for the first six to eight weeks after surgery and progresses to more vigorous, supervised physical training.

Mayo Clinic also provides long-term monitoring of patients following heart surgery, including monitoring and adjusting medical devices.