Treatment for atrial fibrillation, a common heart rhythm disorder, depends on how long you've had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the treatment goals for atrial fibrillation are to:
- Reset the rhythm or control the rate
- Prevent blood clots
The strategy you and your doctor choose depends on many factors, including whether you have other problems with your heart and if you're able to take medications that can control your heart rhythm.
In some cases, your doctor may recommend a procedure to destroy the area of heart tissue that's causing the erratic electrical signals and restore your heart to a normal rhythm. These options can include:
May. 01, 2014
Catheter ablation. In many people who have atrial fibrillation and an otherwise normal heart, atrial fibrillation is caused by rapidly discharging triggers, or "hot spots." These hot spots are like abnormal pacemaker cells that fire so rapidly that the upper chambers of the heart quiver instead of beat efficiently.
In catheter ablation, a doctor inserts long thin tubes (catheters) into your groin and guides them through blood vessels to your heart. Electrodes at the catheter tips can use radiofrequency energy, extreme cold (cryotherapy) or heat to destroy these hot spots, scarring the tissue so the erratic signals are normalized. This corrects the arrhythmia without the need for medications or implantable devices.
Surgical maze procedure. The maze procedure is conducted during an open-heart surgery. Using a scalpel, doctors create several precise incisions in the upper chambers of your heart to create a pattern of scar tissue. Because scar tissue doesn't carry electricity, it interferes with stray electrical impulses that cause atrial fibrillation. Radiofrequency or cryotherapy also can be used to create the scars, and there are several variations of the surgical maze technique.
The procedure has a high success rate, but atrial fibrillation may recur. Some people may need catheter ablation or other treatment if atrial fibrillation recurs.
Also, because it usually requires open-heart surgery, it's generally reserved for people who don't respond to other treatments or when it can be done during other necessary heart surgery, such as coronary artery bypass surgery or heart valve repair.
Atrioventricular (AV) node ablation. If medications or other forms of catheter ablation don't work, or if you have side effects or are not a good candidate for other procedures, AV node ablation may be another option. The procedure involves applying radiofrequency energy to the pathway connecting the upper chambers (atria) and lower chambers (ventricles) of your heart (AV node) through a catheter to destroy this small area of tissue.
The procedure prevents the atria from sending electrical impulses to the ventricles. The atria continue to fibrillate, though. A pacemaker is then implanted to keep the ventricles beating properly. After AV node ablation, you'll need to continue to take blood-thinning medications to reduce the risk of stroke because your heart rhythm is still in atrial fibrillation.
See more In-depth
- What is atrial fibrillation? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/af/. Accessed Feb. 17, 2014.
- Cheng A, et al. Overview of atrial fibrillation. http://www.uptodate.com/home. Accessed Feb. 17, 2014.
- Verdecchia P, et al. Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE intolerant subjects with cardiovascular disease studies. Journal of Hypertension. 2012;30:1004.
- Furie KL, et al. Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: A science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:3442.
- Wann LS, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2011;57:223.
- Passman R. Radiofrequency catheter ablation to prevent recurrent atrial fibrillation. http://www.uptodate.com/home. Accessed Feb. 13, 2014.
- Cheng A. Surgical approaches to prevent recurrent atrial fibrillation. http://www.uptodate.com/home. Accessed Feb. 13, 2014.