Which AFib treatment is right for you?

A diagnosis of atrial fibrillation (AFib)  can be scary. But it’s a condition that affects millions of Americans and—thanks to advances in the field of electrophysiology—is manageable in the vast majority of cases.

In fact, the question typically now is no longer, “Can anything be done to manage it?” But rather, “What is the best treatment approach?”

AFib treatment: What to know

Any treatment strategy for AFib must address two factors. First, the abnormal heart rhythm and symptoms it causes (like dizziness, chest pain and fainting), and second, the increased risk of stroke. People living with AFib, plus other risk factors such as high blood pressure or diabetes, are at a 450 to 500% higher risk of stroke.

The right treatment plan to address both factors is based on many variables:

• Age
• Gender
• Your risk factors
• Medical history
• Presence of other cardiovascular conditions, like heart failure

The most important consideration when determining a treatment is the type of AFib you are experiencing:

• Paroxysmal – lasts a week or less and stops on its own
• Short-lasting persistent – lasts longer than a week and less than a year
• Longstanding persistent – lasts longer than a year

Medications

There are several medications that treat rhythm-related issues associated with AFib, with even more medications available to help manage your stroke risk.

If you have short and infrequent AFib episodes (paroxysmal), you may be prescribed medication to take only on an as-needed basis—similar to a rescue inhaler for those with mild asthma. However, most people are prescribed medication to take on an ongoing basis at regular intervals to prevent an episode of AFib from occurring.

Some medications must initially be given in a hospital setting before transitioning home, while others can be prescribed in the doctor’s office. Sometimes even with an electrocardiogram or other blood tests and visits with a specialist, it can be difficult to predict which medicine will be effective, but they’re usually prescribed considering which will be the safest and most effective for you.

Here are some tips for working with your physician on choosing and using the best medication for your AFib:

• Discuss the risks and benefits of each medication with your physician
• Share both personal and family medical history, and any other potential risk factors
• Adhere to all dosage and dose timing recommendations closely
• Follow up with your physician’s office if you experience any side effects and for routine care

Because of the progressive nature of AFib, medications are often a starting point or used in conjunction with another therapy.

It is not uncommon to try different anti-arrhythmic medications or use them in combination with the ablation procedure and lifestyle changes for a more effective, long-term suppression of the arrhythmia.

Catheter ablation

Catheter ablation is a minimally invasive procedure that uses wires and balloons threaded through tubes to isolate the tissue—usually in or around the pulmonary veins—causing AFib and cut the pathways that impact heart rhythm. An ablation procedure uses heat or extreme cold to neutralize the problematic area.

Catheter ablation is a safe procedure with a high rate of success (although success rates can vary based on the type of AFib). Because of this, unlike many medical procedures, it is not considered a “last resort” and is often a preferred method of treatment even in younger, healthier people with the goal of sparing them a lifetime of medication.

However, ablation is not always used to attempt to cure AFib. For people with persistent or longstanding AFib, the goal of the procedure may simply be to better control it. This is referred to as a rate-control strategy rather than a rhythm-control strategy and is often used together with medication.

Surgical ablation

Rather than using access through the blood vessels in the leg, the surgeon makes small incisions between the ribs to perform the ablation from the outside of the heart. This creates scar tissue that, over time, will help normalize electrical flow in the heart and the heart’s rhythm.

While it can be used as a stand-alone procedure, it is more frequently performed in concert with another cardiovascular procedure such as bypass surgery, valve surgery or aneurysm repair.

Left Atrial Appendage Occlusion (LAAO) procedure

A Left Atrial Appendage Occlusion (LAAO) procedure is a minimally invasive procedure that may be considered as an alternative to blood thinners if your AFib is not caused by a heart valve problem. An LAAO implant is a cardiac device that is roughly the size of a quarter. The procedure is performed in a catheterization lab, and your cardiologist inserts a parachute-shaped implant into the left atrium (LAA), located at the top of the heart to help prevent the forming and circulation of blood clots.

Cardioversion

People who develop persistent AFib could also have their heart rhythm reset to a normal sinus rhythm through a procedure known as cardioversion.

Cardioversion is a highly effective way of restoring normal rhythm. It consists of delivering a controlled electrical shock to the heart to reset the electrical activity in the heart muscle. This procedure is very safe for people who have been on uninterrupted anticoagulation, which is the continuous use of blood thinners for three weeks or more.

Device therapy and beyond

People with persistent AFib that has led to a slower heart rate—or who are on medications that have slowed their heart rate—may need a pacemaker, a commonly used implant for people with AFib. Pacemakers help regulate the pace of the heart rhythm and are more likely to be used in those with congestive heart failure in addition to AFib. There are other therapies such as cardioversion, which uses electric shocks to restore a normal rhythm in certain people with AFib.

There are also exciting new therapies currently in clinical trials that will further expand treatment options in the coming years.

3 main treatment goals for people living with AFib

There are three main treatment goals for people living with AFib.

1. Avoid a stroke

It’s important to control your heart rhythm so you can do all you can to prevent a stroke or stroke recurrence when living with AFib. Several medications, such as blood thinners, can be used to help control the risk of stroke. Other things you can do to help lower this risk includes:

• Maintaining a healthy weight
• Eat foods that positively impact your health
• Exercise
• Getting quality sleep
• Avoiding alcohol or smoking.

2. Prevent damage to the heart muscle

It is important to prevent damage to the heart muscle from beating too fast for too long, a condition known as tachycardia-induced cardiomyopathy or heart failure. Living a healthy lifestyle and managing risk factors can help to minimize the strain on your heart and reduce the likelihood of AFib episodes causing further damage.

3. Restore your well-being

The overall goal is to eliminate any ongoing symptoms you may be experiencing from AFib, including:

• Chest discomfort
• Difficulty breathing
• Dizziness
• Fatigue
• Heart palpitations

While ideally, we would like to correct the arrythmia, AFib is often recurrent and difficult to completely eliminate. Ongoing treatments and monitoring are commonly necessary. However, treating other conditions and adopting lifestyle changes may help prevent the recurrence or progression of AFib.

Between what is already available and what is sure to come, you have more ways than ever before to keep your heart healthy—so you don’t have to skip a beat.

Living with AFib? Find heart care near you.