Atrial Fibrillation

Treatment

Atrial fibrillation treatment goals include restoring the heart to normal rhythm, slowing the heart rate and preventing blood clots. Treatment options for atrial fibrillation include nonsurgical procedures, surgical procedures and medications.

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 with drugs or electrically.

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 percent 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 more than 95 percent of patients, but more than half of patients 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. 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 percent to 80 percent of patients who are treated. In addition, medications that did not help patients prior to ablation are now effective.
• AV node ablation with pacemakers — In AV ablation, a catheter is placed near the atrioventricular (AV) node (the electrical connection between the atria and ventricles). Radiofrequency energy is applied through the catheter to destroy a small area of tissue. The radiofrequency energy prevents the atria from sending too many electrical impulses to the ventricles. In 98 percent of patients, this procedure completely blocks the heart's electrical impulses and eliminates atrial fibrillation. Once the AV node is destroyed, doctors then implant a pacemaker to establish normal rhythm. Anticoagulation medication (blood-thinning medication) is required after the procedure to reduce the chance of developing blood clots.

Surgical Procedures

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 if medications to prevent atrial fibrillation or control the heart rate result in excessively slow heartbeats, and after AV node ablation.

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.

Minimally Invasive Surgery

Surgeons at Mayo Clinic offer minimally invasive heart surgery for atrial fibrillation. Mayo Clinic cardiac surgeons access the heart through small incisions in the right and left chest walls. By accessing the heart from the side of the chest, surgeons avoid having to split the breastbone (sternotomy). Avoiding sternotomy reduces pain and recovery time for most patients, enabling them to resume normal daily activities sooner. Minimally invasive surgery also leaves smaller, less-noticeable scars than open heart surgery, has a lower risk of infection, and may involve less blood loss.

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.

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.
• Drugs to try to prevent atrial fibrillation
• Drugs to prevent blood clots — Patients with atrial fibrillation and heart disease are at especially high risk of stroke.
• Blood-thinning medications (anticoagulants) such as aspirin may be prescribed.