Treatment of Atrial Fibrillation

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What Is Atrial Fibrillation?

Atrial fibrillation, a heart disorder where the upper chambers of the heart quiver and fail to effectively pump the blood out of the chambers, occurs in about 2.2 million Americans, reports the American Heart Association. Blood may pool and clot, which increases your chances of a stroke. Symptoms may include chest pain, palpitations, irregular heartbeat, low blood pressure and lightheadedness.


Medications may be used as treatment of atrial fibrillation alone or in conjunction with other modalities. Drugs used to slow the heart rate include:

  • Digoxin
  • Beta blockers, such as propranolol and atenolol
  • Calcium antagonists, such as diltiazem and verapamil
  • Procainamide
  • Quinidine
  • Anticoagulants, like warfarin, to thin your blood

Controlling atrial fibrillation with medications reduces the need for invasive procedures, but each medication has its own side effects and risks. Some possible side effects of drugs to treat AF include nausea, unusual tiredness, weakness, bruising or bleeding, diarrhea, lightheadedness, fainting, swelling of the ankles, insomnia and dizziness. Tell your doctor if you have asthma, kidney or liver disease, diabetes, an overactive thyroid or if you are pregnant or plan to become pregnant as these can increase the risks of side effects with some AF medications.

Nonsurgical Procedures

Electrical cardioversion is a nonsurgical procedure using an electric current to reset the heart’s rhythm to a normal pattern. In atrial fibrillation uncontrolled with medications alone, an electrical cardioversion may be necessary. It becomes an emergency, if the heart rhythm is fast and causing symptoms, such as chest pain or heart failure.

Risks associated with an electrical cardioversion include dislodging a blood clot from the heart, irregular heartbeat, skin burn from the paddles and a reaction to the medication to help you relax.

Catheter ablation is a nonsurgical procedure in which thin, flexible wires with an electrode at the tip are threaded through the vein into the heart. The electrodes create heat that destroys the heart tissue causing the abnormal beat. The three types of ablation used to try to cure the AF are focal, circumferential and pulmonary vein ablation. Nodal ablation may be used as an effort to control your symptoms.

Potential risks for a catheter ablation include heart attack, stroke, heart puncture, pulmonary vein damage, irregular heart rhythms and sudden death. Following AV node ablation, anticoagulant medications will be necessary to reduce your chance for a stroke.

Surgical Procedures

A surgical procedure, such as pacemaker placement, may be necessary in the treatment of atrial fibrillation in conjunction with medication or an ablation procedure. Pacemakers are available as single-chamber and dual-chamber pacemakers. Following AV node ablation, a permanent pacemaker is necessary to maintain the lower chamber heartbeat.

Risks associated with pacemaker implantation include bleeding, infection, heart puncture, blood clot and difficulty breathing. Sensations of neck throbbing or lightheadedness may be experienced when the pacemaker is active.

A maze procedure may be performed in conjunction with heart surgeries, such as coronary artery bypass or mitral valve repair, or it may be a stand-alone mini-maze procedure for the treatment of AF. For a full maze procedure, the chest is opened through an incision. A mini maze procedure is performed through small incisions, through which the surgical instruments are inserted. According to the Mayo Clinic, maze heart surgery may include making incisions in the upper part of your heart to create scar tissue, using a freezing technique or radiofrequency ablation to interrupt the atrial fibrillation.

Risks associated with the maze procedure include stroke, bleeding, pneumonia, fluid retention and wound infection.


American Heart Association: Atrial Fibrillation

Mayo Clinic: Maze Heart Surgery