Treatments for atrial fibrillation

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, you may need a more invasive treatment, such as surgery or medical procedures using catheters.

In some people, a specific event or an underlying condition, such as a thyroid disorder, may trigger atrial fibrillation. Treating the condition causing atrial fibrillation may help relieve your heart rhythm problems. If your symptoms are bothersome or if this is your first episode of atrial fibrillation, your doctor may attempt to reset the rhythm.

Resetting your heart's rhythm

Ideally, to treat atrial fibrillation, the heart rate and rhythm are reset to normal. To correct your condition, doctors may be able to reset your heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you've had it. Cardioversion can be conducted in two ways:

  • Electrical cardioversion. In this brief procedure, an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart's electrical activity momentarily. When your heart begins again, the hope is that it resumes its normal rhythm. The procedure is performed during sedation, so you shouldn't feel the electric shock.
  • Cardioversion with drugs. This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Depending on your heart condition, your doctor may recommend trying intravenous or oral medications to return your heart to normal rhythm.

    This is often done in the hospital with continuous monitoring of your heart rate. If your heart rhythm returns to normal, your doctor often will prescribe the same anti-arrhythmic medication or a similar one to try to prevent more spells of atrial fibrillation.

Before cardioversion, you may be given a blood-thinning medication such as warfarin (Coumadin) for several weeks to reduce the risk of blood clots and stroke. Unless the episode of atrial fibrillation lasted less than 48 hours, you'll need to take warfarin for at least four weeks after cardioversion to prevent a blood clot from forming even after your heart is back in normal rhythm.

Or, instead of taking blood-thinning medications, you may have a test called transesophageal echocardiography — which can tell your doctor if you have any heart blood clots — just before cardioversion.

Maintaining a normal heart rhythm

After electrical cardioversion, your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include:

  • Dofetilide (Tikosyn)
  • Flecainide
  • Propafenone (Rythmol)
  • Amiodarone (Cordarone, Pacerone)

Although these drugs may help maintain a normal heart rhythm, they can cause side effects, including:

  • Nausea
  • Dizziness
  • Fatigue

Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart's lower chambers. These medications may be needed indefinitely. Even with medications, the chance of another episode of atrial fibrillation is high.

Jul. 18, 2014 See more In-depth