Atrial fibrillation treatment

Atrial fibrillation is a common form of abnormal heart rhythm, or arrhythmia.

In atrial fibrillation, the atria, the upper chambers of the heart, pump too quickly, or flutter in an irregular and unpredictable way. As a result, blood can pool in the atria and form a blood clot that can break apart and travel to the brain, causing stroke. Atrial fibrillation also can lead to additional heart rhythm problems, as well as heart failure. Learn more about the causes and symptoms of atrial fibrillation.

Atrial fibrillation treatment seeks to repair this electrical pathway, control the heart rate, restore normal heart rhythm and prevent blood clots.

Treatment options for atrial fibrillation

At HonorHealth, you have a full range of atrial fibrillation treatment options, including medication and minimally invasive medical and surgical procedures, some of which use reduced radiation procedures. The goals of each include relieving symptoms, controlling and normalizing heart rate and rhythm, preventing blood clots and minimizing the risk of stroke.

Your cardiologist will determine which treatment option is best for you based on factors such as:

  • How long atrial fibrillation has been present.
  • The severity and type of symptoms.
  • The underlying health conditions or factors that may be causing atrial fibrillation.
  • Your heart’s size and function.

Atrial fibrillation treatments include:

1. Medication that can control heart rate and rhythm as well as blood thinners to help prevent blood clotting, which can lead to stroke. Anti-arrhythmic medications decrease and normalize the heart rate. They are possible first-stage treatment for atrial fibrillation, especially for patients who have just begun to experience symptoms.

2. Cardioversion: This involves resetting the heart rate to normal with medication and electrical therapy. Electrical cardioversion:

  • Interrupts and resets heart rhythm with an electrical charge transmitted to the heart through paddles placed on your chest.
  • Should not be confused with the emergency heart-shocking treatment you see on TV. Electrical cardioversion is planned in advance and performed in a carefully controlled setting, under general anesthesia.
  • May be accompanied by a transesophageal echocardiogram. A tube is guided down your throat so that detailed, up-close ultrasound images can be taken of the heart. A transesophageal echocardiogram also can measure blood flow and check for blood clots.

3. A heart implant: If you have atrial fibrillation, you may be a candidate for a tiny permanent implant. This less-invasive implant not only reduces stroke risk in afib patients, it enables them to stop using a blood thinner such as warfarin or coumadin.

Your cardiologist implants a device about the size of a quarter, and it fits completely over the left atrial appendage, or pouch. Over time, tissue grows over the implant, effectively blocking the release of blood clots.

Implanting the device is similar to a stent procedure. The cardiologist, backed by a team of specialists, inserts a small tube in the upper leg and threads it up to the heart, where it is placed in the left atrial appendage. Because it is a less-invasive procedure, most patients only stay in the hospital for one night.

The device has been approved by the U.S. Food and Drug Administration for reducing stroke risk in select afib patients.

4. Catheter ablation: An electrophysiologist, a specialist in heart rhythm disorders, repairs the pathway that conducts electrical impulses through the heart, negating the effects of abnormal tissue. This normalizes the heart's electrical signals and restores normal heart rhythm.

Prior to the catheter ablation, a diagnostic procedure called an electrophysiology study is performed. A thin, flexible tube (catheter) is guided along a blood vessel, starting at the groin or the neck, to the heart. At the end of the catheter, tiny electrodes gather data on the heart's electrical signals. These electrodes also can send electrical impulses to heart tissue, triggering or disabling abnormal heart rhythms, to pinpoint the tissues transmitting incorrect electrical signals.

Once the study has confirmed the source of the atrial fibrillation, a catheter ablation destroys, or blocks, abnormal tissue by creating lesions (scarring). The catheter can heat the tissue by releasing high-energy radiofrequency electrical signals (radiofrequency ablation) or freeze it with extremely cold vapors (cryoablation).

Most cases of atrial fibrillation are triggered by abnormal electrical firing in the pulmonary veins or areas where the pulmonary veins connect with the left atrium. A specialized catheter ablation procedure called pulmonary vein antrum isolation can target this area.

Two to three months after catheter ablation, small circular scars form at the source of the abnormal electrical signals, disconnecting or isolating them from the rest of the heart. The arrhythmia is corrected without need for medications or implantable devices.

5. Surgical ablation: A surgical treatment for atrial fibrillation is maze surgery, which includes open-heart and minimally invasive techniques (mini-maze surgery). In each technique, a maze-like pattern of small cuts, or burns, are made on the heart's atrium, isolating cells that produce abnormal electrical signals. Scar tissue eventually forms on the heart, repairing the heart's electrical pathway.

Classic open-heart maze surgery, which requires a large chest incision and cutting of the breastbone (sternum), usually is performed only when a patient requires open-heart surgery for other reasons, such as coronary artery bypass surgery or valve repair. HonorHealth uses newer, minimally invasive mini-maze approaches whenever possible, for several reasons:

  • The sternum does not need to be cut open. Only small incisions between the ribs are needed.
  • A heart-lung machine is not used. Maze surgery is performed on the beating heart.
  • The heart itself is not cut. In maze surgery, abnormalities in the heart tissue are corrected using high-frequency energy or extremely cold vapors (cryosurgery).
  • Maze surgery enables surgeons to remove the left atrium's appendage, a tiny, ear-shaped area of the heart where blood clots most commonly form. Removing the appendage can reduce the long-term risk of stroke.

As a result, compared with conventional surgery, mini-maze approaches offer less pain, shorter hospital stays and less scarring. What's more, mini-maze can be performed using the latest robotic surgery technologies.

Mini-maze surgery typically involves a keyhole approach. Keyholes are three small incisions made between the ribs and on the side of the chest, serving as entry points — or ports. They make way for a miniature camera and small instruments to access the heart.

The surgeon places a clamp-like tool on the left atrium near the pulmonary veins, isolating the heart tissue that causes the atrial fibrillation. Next, this tissue is rapidly heated with radiofrequency energy. The surgeon will ensure that the heart's abnormal tissue is properly deactivated, performing diagnostic tests as needed. The left atrial appendage, a fingerlike structure where clots form, also may be removed.