Treatment options for atrial fibrillation (A-fib) are not one-size-fits-all. If one A-fib treatment doesn’t work, a combination of treatments might.

Story by: Norton Healthcare; Reviewed by Kent E. Morris, M.D., cardiac electrophysiologist with Norton Heart & Vascular Institute on June 28, 2024

Atrial fibrillation (A-fib) is the most common arrhythmia in adults and it increases with age. In A-fib, the heart’s upper chambers (atria) beat irregularly and chaotically and are out of sync with the lower chambers (ventricles). This chaotic electrical activity in the atria leads to irregular and sometimes rapid heartbeats. This irregular rhythm can lead to stagnant flow of blood through the top chamber of the heart which can lead to a blood clot forming that could cause a stroke. The irregular rhythm and rapid heart rates can also lead to heart failure. It is crucial to manage A-fib to help restore a more regular heart rhythm and reduce the risk of serious complications.

Treatment of atrial fibrillation focuses first on controlling the heart rate, and second on using blood thinners where appropriate to reduce the risk of stroke. There are times when restoring normal rhythm may improve outcomes including reducing symptoms. Managing atrial fibrillation requires careful monitoring and appropriate treatment to reduce the risk of serious health issues.

Symptoms of A-fib

In a patient with A-fib, the heart rate is irregular and often faster than normal. In comparison, a normal heart rhythm has a steady and regular heart rate, typically between 60 to 100 beats per minute at rest.

Symptoms of A-fib may include:

1. Irregular heartbeat
2. Heart palpitations
3. Fatigue
4. Dizziness or lightheadedness
5. Shortness of breath
6. Chest pain
7. Weakness
8. Confusion
9. Exercise intolerance
10. Fainting or near-fainting episodes

If you are experiencing any of these symptoms, you should consult a health care provider for proper diagnosis and management. Call 911 if you are experiencing sudden chest pain, weakness, confusion or shortness of breath.

Types of A-fib

1. Paroxysmal atrial fibrillation: This type of A-fib is intermittent and typically resolves on its own within seven days. Episodes may occur occasionally and stop spontaneously.

2. Persistent atrial fibrillation: Persistent A-fib lasts longer than seven days and requires treatment to restore a normal heart rhythm.

3. Long-standing persistent atrial fibrillation: When A-fib continues for over a year, it is classified as long-standing persistent A-fib.

4. Permanent atrial fibrillation: In permanent A-fib, the irregular heartbeat becomes constant, and efforts to restore a normal rhythm have been unsuccessful or deemed unnecessary.

By understanding the different types of A-fib, you and your health care providers can tailor treatment plans to manage your condition effectively.

A-fib blood clot risk

A-fib significantly increases the risk of blood clots forming inside the heart. The irregular and rapid heartbeat in A-fib can cause blood to pool in the atria, which can form blood clots. If a clot dislodges and travels to other parts of the body, it can cause serious health complications, such as stroke or heart attack. Managing your A-fib involves assessing your risk of blood clots and often involves strategies to reduce the risk of blood clots, such as blood-thinning medications, also called anticoagulants.

Living with A-fib

Not unlike an electrician who repairs wiring in your home, a doctor has options when it comes to treating the irregular electrical rhythm of your heart.

According to Kent E. Morris, M.D., electrophysiologist with Norton Heart & Vascular Institute, treatment options for A-fib are not one-size-fits-all and depends on severity of symptoms, associated health conditions, and the impact on quality of life.  A multi-faceted approach tends to work best.

“Risk factor modification is critical for successful treatment of A-fib,” Dr. Morris said. “Maintaining a healthy weight, treating sleep apnea, avoiding excess alcohol intake, and controlling high blood pressure and diabetes can increase the chances of staying in normal rhythm for longer periods of time.”

In addition to addressing risk factors, medications often are the initial treatment. If the medication isn’t effective or if side effects are impacting quality of life, there are other options. Catheter ablation is a minimally invasive technique where a catheter is placed in the heart and used to modify or ablate the abnormal signals that lead to A fib.

“By working together with patients, we can find a solution to living with A-fib,” Dr. Morris said.

A-fib treatment options

There are several common A-fib treatment options available to manage the condition. These include:

1. Medications: Antiarrhythmic drugs can help control the heart’s rate or rhythm, while anticoagulants often are prescribed to reduce the risk of blood clots and stroke.

2. Cardioversion: This procedure involves restoring the heart’s normal rhythm through electrical cardioversion (shock delivered to the chest) or pharmacological cardioversion using medications.

3. Catheter ablation: In cases where medications are ineffective, catheter ablation may be recommended. This minimally invasive procedure creates scarring in the heart to interrupt abnormal signals that trigger A-fib. It is performed using a catheter inserted into a blood vessel in the leg and guided to the heart. The electrophysiologist then carefully destroys malfunctioning tissue creating scar in the problematic areas so they can no longer transmit abnormal signals.

4. Lifestyle changes: Managing A-fib may involve lifestyle modifications such as reducing alcohol and caffeine intake, quitting smoking, maintaining a healthy weight and regular exercise.

5. Surgical Interventions: In certain cases, surgery like the hybrid ablation may be discussed. During hybrid ablation, the heart surgeon treats areas along the outside of the heart, and the electrophysiologist treats inside the heart. This approach can be more effective for patients with more persistent A-fib.

6. Left atrial appendage closure procedure: This procedure might be recommended in certain A fib patients who are not a good long term candidate for blood thinners to reduce the risk of stroke by closing off the left atrial appendage where blood clots commonly form.

If you have A-fib, it is crucial to work closely with your health care providers to determine the most suitable treatment plan, based on your specific condition and medical history.

A-fib vs. atrial flutter

Atrial flutter is a type of abnormal heart rhythm that is closely related to A-fib. Both conditions originate in the atria, the two upper chambers of the heart, and are characterized by irregular heartbeats. While A-fib involves chaotic electrical signals causing the atria to quiver, atrial flutter is characterized by a very rapid but regular beating of the atria.

Patients with atrial flutter are at an increased risk of developing A-fib, and vice versa. Both conditions share some similar risk factors, such as age, high blood pressure, heart disease and obesity. Some treatment options for atrial flutter and A-fib are similar, including some medications, electrical cardioversion, catheter ablation and lifestyle modifications.

Living a fulfilling life with A-fib is possible with the proper treatments and medical support. Making healthy lifestyle choices, following your treatment plan and keeping up with regular visits to your provider can help manage your condition effectively.