Non-Surgical AFib Treatment

Medications

Medicines used to treat atrial fibrillation work in different ways.

Slow the Heart Rate
Medications, such as beta-blockers and calcium-channel blockers are used to control the ventricular rate while the patient is in atrial fibrillation. The goal is to keep the heart from becoming overtaxed. Medications are effective 30 - 60% of the time, but over time may lose effectiveness. You may need to try several medications before your physician finds the best one.

Restore Normal Heart Rhythm
To restore normal heart rhythm, a drug called an antiarrhythmic may be prescribed. Because of the side effects of antiarrhythmic medications, they are not suitable for all patients. Over the long term, the majority of patients on antiarrhythmia therapy will eventually fail to remain in normal sinus rhythm on any drug.

Prevent Blood Clots
“Blood thinners” or anticoagulants are used to reduce the risk of blood clot formation. If clots form in the heart, they can break loose and cause a stroke. Blood thinning medications have no effect on heart rhythm. The main blood thinning medication used is Coumadin (warfarin), but a group of ‘novel’ agents are also available - Xarelto, Pradaxa, or Eliquis. The novel agents are convenient, generally easier to take and don’t require regulation, however, there is limited insurance and Medicare coverage at this time. Coumadin remains the main stay of therapy for several reasons. Generally, it is more economical; practitioners can regulate and reverse its effects, and it’s widely covered by insurances and Medicare. 


Procedures

Electrical Cardioversion
This procedure uses a synchronized (perfectly timed) electrical shock delivered through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back. The goal of cardioversion is to interrupt the abnormal electrical path in the heart and to reset the heart's rhythm. The heart is not damaged and most people are able to go home an hour or two after their cardioversion.

If the A-Fib is resolved, medication may be prescribed to help prevent it from recurring. For some patients, this treatment is short-lasting or unsuccessful. The success of electrical cardioversion often depends on the duration of atrial fibrillation and if there is an underlying cause of heart disease. Cardioversion is not appropriate for every patient with atrial fibrillation.

If you’re out of rhythm > 48 hrs and not on a blood thinner, a transesphogeal echocardiogram (TEE) may be done to make the procedure safer.  At minimum, three full weeks of anticoagulation will be required following the cardioversion.

Catheter Treatment - Ablation

Catheter ablation is a non-surgical procedure done by an Electrophysiologist (EP doctor) to ablate (scar) part of an abnormal electrical pathway of the heart that is causing the heart rhythm problem. During these procedures, performed in a Cath Lab, the physician will insert several long, thin, flexible tubes with wires (called catheters) into your heart through blood vessels in your arm, upper thigh, or neck. In the heart, electrodes at the end of the catheter can help the doctor detect the faulty electrical sites.

Hot or cold energy is then used to scar (ablate) these sites. Often, more than one ablation must be done to permanently cure atrial fibrillation. This treatment is generally used to treat paroxysmal AFib.

Types of Ablation
Atrial Fibrillation Ablation or Pulmonary Vein Isolation
The pulmonary veins are isolated with radiofrequency energy, creating a scar to help control AF more effectively than drugs alone.

Cryoablation
This newer, minimally invasive technology uses a catheter balloon inserted through the groin and guided to the heart. Once in place, the balloon is inflated, cooled, thus freezing tissue causing the irregular heartbeat and restores normal sinus rhythm.
Video: How Arctic Front Cryoblation Works

AV Nodal Ablation
The AV (atrio -ventricular) node of the heart is permanently scarred to stop electrical signals from being transmitted from the upper chambers to the lower chambers of the heart. A permanent pacemaker is then implanted to control the heart's electrical system. This procedure is reserved for patients with difficult to control AFib.


WATCHMAN
Left Atrial Appendage Closure Device
 

People with AFib often face lifelong use of blood thinners to reduce their risk of stroke. The one-time WATCHMAN™ procedure offers an effective alternative for those that are at high risk of bleeding complications or have had difficulties tolerating blood thinners.

The WATCHMAN™ device permanently seals off the left atrial appendage, a section of the heart that is the site of almost all stroke-causing blood clots in people who have A-fib. This permanent implant can reduce your risk of stroke as effectively as warfarin. And, unlike warfarin, WATCHMAN™ can also reduce your long-term risk of bleeding and eliminate the regular blood tests and food-and-drink restrictions that come with warfarin. Most people can stop taking warfarin 45 days after the WATCHMAN™ procedure.

WATCHMAN may be right for people who:

Learn more about WATCHMAN here.

How Artic Front Advance Cryoballoon Works