Treating atrial fibrillation
The treatment of atrial fibrillation varies from person to person and depends on:
- the type of atrial fibrillation
- symptoms
- treatment of any underlying cause
- age
- overall health
Some people may be treated by their GP, whereas others may be referred to a heart specialist, known as a cardiologist.
The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, you may just need treatment for this.
For example, medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation.
If no underlying cause can be found, the treatment options are:
- medicines to control atrial fibrillation
- medicines to reduce the risk of a stroke
- cardioversion (electric shock treatment)
- catheter ablation
- having a pacemaker fitted
Medicines to control atrial fibrillation
Medicines called anti-arrhythmics can control atrial fibrillation by:
- restoring a normal heart rhythm
- controlling the rate at which the heart beats
The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen and how well the atrial fibrillation responds.
Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.
Restoring a normal heart rhythm
A variety of drugs are available to restore normal heart rhythm. These include:
- flecainide
- beta-blockers, particularly sotalol
- amiodarone
- dronedarone (only for certain people)
New drugs are in development that may restore normal heart rhythm, but they are not widely available yet. If a particular drug does not work or the side effects are troublesome, another may be tried.
Controlling the rate of the heartbeat
The aim is to reduce the resting heart rate to under 90 beats a minute, although in some people the target is under 110 beats a minute.
A beta-blocker (such as bisoprolol or atenolol) or a calcium channel blocker (such as verapamil or diltiazem) will be prescribed.
A medicine called digoxin may be added to help further control the heart rate. In some cases, amiodarone may be tried.
Side effects
As with any medicine, anti-arrhythmics can cause side effects. Read the patient information leaflet that comes with the medicine for more details.
The most common side effects of anti-arrhythmics are:
- beta-blockers: tiredness, coldness of hands and feet, low blood pressure, nightmares and impotence
- flecainide: nausea, vomiting and heart rhythm disorders
- amiodarone: sensitivity to sunlight (high-protection sunscreen must be worn or skin covered up), lung problems, changes to liver function or thyroid function (regular blood tests can check for this) and deposits in the eye (these go away when treatment is stopped)
- verapamil: constipation, low blood pressure, ankle swelling and heart failure
Medicines to reduce the risk of a stroke
The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (see complications of atrial fibrillation for more information).
Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:
- stroke or blood clots
- heart valve problems
- heart failure
- high blood pressure
- diabetes
- heart disease
You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk.
Depending on your level of risk, you may be prescribed warfarin or aspirin.
Warfarin
People with atrial fibrillation who have a high or moderate risk of a stroke are usually prescribed warfarin, unless there is a reason they cannot take it.
Warfarin is an anticoagulant, which means it stops the blood from clotting. There is an increased risk of bleeding in people who take warfarin, but this small risk is usually outweighed by the benefits of preventing a stroke.
It is very important to take warfarin as directed by the doctor. People on warfarin need to have regular blood tests and, following these, their dose may be changed.
Many medicines can interact with warfarin and cause serious problems, so check that any new medicines are safe to take with warfarin.
Drinking more than moderate amounts of alcohol or drinking cranberry juice can also affect your warfarin and is not recommended.
Aspirin
People with atrial fibrillation who have a low risk of a stroke are likely to be given a low dose of aspirin to take every day instead of warfarin.
People who are unable to take warfarin may also be given aspirin instead.
Cardioversion
Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm.
The procedure normally takes place in hospital, where the heart is carefully monitored.
In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke.
If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin after cardioversion if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke (see above).
Catheter ablation
Catheter ablation is a procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated.
Catheters (thin, soft wires) are guided through one of your veins into your heart, where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue.
This procedure commonly takes two to three hours, so it may be done under general anaesthetic, where you are put to sleep.
For more detailed information on catheter ablation for atrial fibrillation, go to the Arrhythmia Alliance website.
Having a pacemaker fitted
A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone. It is usually used to prevent your heart rate going too slowly, but in atrial fibrillation it may help your heart beat regularly.
Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed).
This treatment may be used when medicines are not effective or are unsuitable.
Find out more about pacemaker implantation.
hgffgjjjgu