Treatment and Prevention
There are three main strategies to manage AF:
- rate control (preventing the heart rate from going too fast)
- rhythm control (trying to change the rhythm from AF back to normal sinus rhythm)
- anticoagulation (prevent clot formation and strokes with the use of blood thinners)
For rate control, several medications exist to help slow down a rapid heartbeat. With this strategy, the goal is to reduce the amount of impulses passing through the AV node and to slow the heart rate down. It should be noted that AF is still present when using this strategy.
Beta-blockers (e.g., atenolol*, metoprolol) and specific calcium channel blockers (e.g., diltiazem and verapamil) are medications used for rate control for people with a variety of heart conditions. These medications can be used for more than one purpose (e.g., they are also used to treat high blood pressure). Another medication, digoxin, has been used to treat arrhythmias for over 200 years. It is derived from a substance called digitalis.
The rate is too difficult to control with medications in certain people, in which case a specialized cardiologist (an electrophysiologist) will put in a cardiac pacemaker and arrange to do a procedure called AV node ablation (burn) a few weeks later. With special tubes inserted into a vein in your leg, heat is applied around the AV node of the heart to block all passage of electrical signals. The pacemaker then controls your heart rate, making it beat regularly.
Rhythm control can be achieved in different ways. The process of bringing the rhythm back to normal is called cardioversion; if medications are used in this process, it is called chemical cardioversion. Medications called antiarrhythmics can convert an abnormal rhythm back to normal and prevent the abnormal rhythm from recurring. Alternatively, electrical cardioversion uses a machine called a defibrillator that gives a controlled electrical shock to the heart, converting the AF to a normal rhythm. Patients are given an anesthetic so they do not feel anything during the procedure.
A technique developed by electrophysiologists called pulmonary vein ablation (or pulmonary vein isolation) is also used. Using special catheters placed in the heart, doctors either ablate (burn) areas that cause AF or isolate the area so that it does not affect the other parts of the atrium. This option may offer a "cure" to AF that the other options cannot offer.
Anticoagulation helps prevent the formation of blood clots and is critical for people with AF because of the increased risk for stroke. In order to prevent blood clots, doctors often recommend medications that thin the blood. These may include anticoagulants (such as warfarin) or antiplatelet medications (such as aspirin). Depending on your risk of developing a clot, your doctor may recommend either an antiplatelet or anticoagulant medication. Though the risk of bleeding increases with the use of these types of medication, the protection they offer to prevent from stroke and other blood clot-related conditions outweighs the risk.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.