The traditional treatments for atrial fibrillation consists of drug therapy and/or procedures and surgeries. The treatment that is right for you will depend largely on the type of atrial fibrillation you have and the severity of your symptoms.
It may also depend on other factors such as your age, lifestyle, overall health, other medications you may taking, and so on. The point is, there is not a “one-size-fits-all” treatment for afib. Everyone is different and everyone will respond differently to various treatments.
The treatment that is best for you may be awful for the next person. You’ll want to work closely with a doctor you trust to determine the best course of treatment for you.
For most patients with atrial fibrillation, doctors will start with drug therapies but it’s important to note that none of the traditional drugs prescribed cure atrial fibrillation! They only help to manage it. And your doctor may only prescribe one drug at a time or you may be prescribed more than one at a time.
Let’s take a look at the various drug therapies that are commonly prescribed.
Rate Control Medicines
Rate control medications try to control your heart rate. However, these medicines only target the lower half of your heart, the ventricular chambers. They leave the atrial chambers alone, which means you may continue to experience atrial fibrillation.
Rate control medicines are usually prescribed to people with aysmptomatic afib, which means they don’t have many (if any) symptoms. They’re also commonly prescribed to elderly patients.
There are three types of rate control medicines: beta-blockers, cardiac glycosides, and calcium-channel blockers.
Beta-blockers target your adrenaline. This makes your AV node less likely to accept the electrical impulses from your atria, which means your heart beat evens out. Younger patients are typically prescribed these.
These aren’t without risk, however. They have side effects such as lethargy, slow heart beat, and loss of sex drive.
Cardiac Glycosides block the electrical conduction between the atria and the ventricles so they slow down and control the heart rate – but only the ventricles. Because of this, you will likely still have afib if you take these medications so you’ll likely have to continue to take blood thinners.
Calcium channel blockers prevent or slow the flow of calcium into your heart. These are usually preferred over other rate control medicines for patients with heart or lung disease.
Rhythm control medications control your heart rhythm instead of your heart rate. This drug is meant to try to stop atrial fibrillation all together.
These are usually prescribed to patients that are young, active, and/or symptomatic from afib. They are also usually prescribed before a catheter ablation is considered.
The drawbacks to these drugs are patients typically develop a resistance to them and some have potential serious side effects. Amiodarone, in particular, has the potential for impaired liver function. And many of them require you to be hospitalized for a few days when you first start taking them just so you can be monitored for their potential side effects.
Some patients take these pills on a regular basis but some take them only when an afib episode occurs in the hopes of stopping it. This approach is called the, “pill in the pocket” approach. Flecainide and propafenone are commonly prescribed drugs for the “pill in the pocket” treatment.
The main risks facing patient with atrial fibrillation is blood clots and strokes. Because of this, blood thinners are a very common treatment for afib because they help reduce these risks (but don’t totally eliminate them). The term “blood thinner” is a little bit misleading. It might conjure up images of thin, watery blood. But that’s not what’s happening.
Instead, these medications inhibit your ability to form blood clots. The technical term of these drugs are “antithrombotic” or “anticlotting medications.”
Blood clots are made of two components: fibrin and platelets. Fibrin is a sticky protein, and platelets are cell particles. Together they make the stuff that makes scabs.
Drugs will either target one substance or the other. If they target fibrin they’re called anticoagulant drugs, and if they target platelets they’re called antiplatelet drugs.
Procedures and Surgeries
When drug therapies don’t work, doctors will usually recommend various procedures and surgeries. However, it’s not uncommon to have a procedure and have drug therapy. The goal is always to free the patient of drugs, but sometimes they can’t be avoided – even after these procedures.
A common procedure is the chemical or electrical carioversion. This isn’t a long-term solution but mainly a short-term fix. The primary goal of a cardioversion is to get your heart into a normal rhythm immediately.
Cardioversions are done chemically or electrically. When a chemical cardioversion is done, you are given a combination of drugs via an IV. If you respond, your heart will convert to a normal rhythm. When a chemical cardioversion doesn’t work, you may have an electrical cardioversion. This is where you are sedated while a defibrillator is used to shock your heart back to normal. Sometimes a combination of a chemical and electrical cardioversion is done.
A more long-term fix, is the catheter ablation, or also known as the pulmonary vein isolation (PVI) procedure. This is a minimally invasive procedure where the doctor inserts a catheter in your groin, arm, or neck area and threads it through to your heart.
The catheter is then slipped between your left and right atria. The doctor then uses laser energy, intense cold, or radio waves to create scar tissue that blocks the transmission of erratic electrical signals.
The maze procedure is another long-term fix. When the doctor performs a maze procedure he’ll make incisions in a maze-like pattern on both the left and the right atria. Again, the idea is to create scar tissue that blocks the transmission of erratic electrical signals.
Ninety-six percent of patients who have this procedure are cured up to 10 years after the surgery, and stroke is no longer a risk. However, the procedure is very difficult and many surgeons don’t like taking the risks.
Another long-term fix is having a pacemaker implanted to control your heart’s electrical system. A pacemaker doesn’t really stop the afib, however. It just controls your heart beat. So you may still have to take medication, even after you have this procedure.
The Bottom Line
There are a lot of traditional options for treating atrial fibrillation. Most of them help you manage your condition but do not cure it entirely. Your treatment plan may need to change over time as your condition evolves. It’s important to keep working with your doctor to make sure that you are always working with the treatment plan that is right for you.