Proper treatment is necessary to reduce your risk of stroke.
Not all irregular heartbeats are life-threatening, but atrial fibrillation is a common heart problem that can lead to stroke, heart failure, and other serious heart-related conditions. Atrial fibrillation (AFib) leads to a rapid, fluttering heartbeat that makes the heart muscle pump less effectively. (Learn more about what atrial fibrillation is here.)
Treatment for atrial fibrillation has two primary goals: preventing stroke and reducing AFib symptoms.
Treatment Options to Prevent Stroke with Atrial Fibrillation
AFib increases your chances of having a stroke by four to six times, so preventing a stroke is an important and life-saving aspect of treating AFib.
The primary method of preventing stroke involves taking anticoagulants, better known as blood thinners, which stop blood clots from forming. Common types of blood thinners include warfarin and the newer class of novel oral anticoagulants (NOACs).
Treatment Options to Reduce Atrial Fibrillation Symptoms
Not all AFib patients experience symptoms, but for those who do, doctors may try rhythm or rate control to reduce symptoms.
Rhythm control aims to get the heart out of the abnormal rhythm. Anti-arrhythmic medications may help even out irregular heartbeats, but current options are only about 50 percent effective.
Rate control lowers the heart rate to reduce AFib symptoms like palpitations. Current medications for rate control include beta blockers and calcium channel blockers. In addition to slowing heart rate, calcium channel blockers also reduce the strength of the heart’s contraction.
Two other AFib treatment methods doctors may use include cardioversion and ablation. A cardioversion, also known as a rhythm reset, is an electric shock delivered to the chest that “resets” the pattern of the heart,according to the American Heart Association. An ablation is a procedure that burns away the piece of electrical tissue in the heart that is causing AFib.
“We’re able to go into the heart with catheters, and then we burn away the area where we think the atrial fibrillation is coming from,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital in New York City.
Like other AFib treatment options, patients may choose ablation if medication or cardioversion is unwanted, or doctors may suggest it if other treatments have been ineffective.
“Each patient comes to the table with a different set of risk factors, and a different story behind their atrial fibrillation,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “We try to individualize based on their profile.”
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Nieca Goldberg
Dr. Goldberg is a cardiologist and medical director of the NYU Langone Health Joan H. Tisch Center for Women’s Health.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
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When we talk about treatment
of atrial fibrillation,
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really we separate out
two different things.
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We separate needing to treat to
decrease a patient risk of stroke.
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But we also sometimes,
treat the symptoms of atrial fibrillation.
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We treat the risk for
stroke with anticoagulants.
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Those are also known as blood thinner.
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The most common blood thinner that was
used for years was Warfarin or Coumadin.
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Now we have newer medicines
that we call the NOACs.
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And those medicines, compared to Coumadin,
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show no difference in blood thinning,
and there may be a lower risk for
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bleeding on some of those medicines.
So there are two main
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strategies that we use in patients that
have symptoms from atrial fibrillation.
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Rhythm control refers to the fact
that we want to get them out of
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the irregular rhythm of
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Rate control means that will accept
the fact that they stay in atrial
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Their heart will still be irregular,
but we will lower their heart rate.
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So that the heart rate isn't so
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fast that they have symptoms.
There are some medicines that we can
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use to control heart rhythm, but
those are only about 50% effective.
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Your doctor may decide,
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in conjunction with you,
that they would rather rate control you,
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meaning get your heart rate at
a particular level, and they can do that
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with medications called beta blockers or
calcium channel blockers for example.
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Or your doctor may decide I actually want
to get you out of this HO fibrillation.
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They may suggest you have
something called a cardioversion.
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Cardioversion is an electrical shock.
In most cases,
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before we do a cardioversion, we want to
make sure we're not missing any clots
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that are already sitting in
the top part of the heart.
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He use something called
a transesophageal echocardiogram.
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Which is a special kind of echocardiogram
where a patient swallows a camera,
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similar to an endoscopy.
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Where the camera goes behind the heart and
shows us all the places where those
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clots might be hiding.
If there's no clot,
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then we can safely perform the cardio
version, which is the shock.
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Our hope is that, with that shock there,
you go back into normal rhythm.
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If you have atrial fibrillation,
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It likely means that you're gonna
have it again in the future.
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And sometimes the suggestion may be,
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how about we try to get
rid of it all together.
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And that's something called an ablation.
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Or were able to ultimately go
into the heart with catheters and
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then we burn away the area
where we think atrial
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fibrillation is coming from.
How we treat a atrial fibrillation is
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a very individualized decision that needs
to be done directly with a patient and
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Because every patient comes to the table
with a different set of risk factors and
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a different story behind
their atrial fibrillation.
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And we try to individualize
based on their profile.
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