Physicians at Ohio State design a specific, personalized plan for each of our patients. This plan will consider your medical problems, the health of your heart and your goals. In general, the AF plan will consider three major components: prevention of blood clots and stroke; controlling your heart rate; and controlling your heart rhythm.
Prevention of Blood Clots and Stroke
During AF, there is no organized vigorous contraction of the top chambers of the heart (the atria) and so blood clots may form within the heart chamber. This increases the chances that the blood clot may travel from the heart to the brain resulting in a stroke, which is permanent damage to part of the brain.
Even though a patient may have a diagnosis of AF, the risk of stroke varies greatly from one patient to another. Your physician will discuss with you whether your risk of stroke is high enough to warrant the use of an anticoagulant (blood thinner) such as warfarin (Coumadin) or if a different therapy, such as aspirin, is more appropriate.
Controlling Heart Rate During Atrial Fibrillation
For many patients, symptoms related to AF are due to a rapid heart rate. Controlling your heart rate may help to minimize your AF symptoms and can be done through the use of medications such as beta blockers, calcium channel blockers and digoxin. These medications slow your heart rate when you are in AF. Patients often use a monitoring device, such as a Holter monitor or cardiac event monitor, to ensure that their heart rate is being controlled.
It is important to note that medications used to control heart rate are unlikely to reduce or eliminate the episodes of AF. In other words, these medications are designed to reduce the heart rate but not to control the heart rhythm, so these medications are unlikely to reduce the occurrence of AF.
For some patients, treating the heart rate but not eliminating the AF heart rhythm will be the proper therapy. This approach is called rate control.
Controlling The Heart Rhythm: Restore Normal Rhythm and Prevent Recurrences of Atrial Fibrillation
There are many treatment options (medications, cardiac catheterization or surgery) that treat AF by preventing recurrences of the AF and restoring normal rhythm. These therapies are called rhythm control and treatment options include:
Antiarrhythmic medications – These are medications specifically designed to help restore and to maintain normal rhythm by preventing recurrences of AF. The majority of patients will require daily medications, but rarely, some can be managed with "Pill-in-the-Pocket." This treatment is based on the concept that because the episodes of AF are so infrequent and because there are no other significant heart problems, the patient can take an antiarrhythmic medication soon after the AF begins. In this manner, the hope is that the medication will help stop the episode of AF quickly. If this is a successful method, then the patient will not need to take medicine on a daily basis, but only at the time of their infrequent episodes of AF. This approach is not suitable for most patients.
Electrical cardioversion – An electrical shock is delivered to the heart to convert the heart rhythm to normal. The electrical shock is quite successful in restoring normal rhythm, but the shock does not have any lasting effect to prevent recurrences of the AF. Patients will often require an antiarrhythmic medication or catheter ablation procedure.
Catheter ablation – An ablation therapy to permanently eliminate AF by burning away the electrical short circuits that are the root cause of the AF. This procedure is performed through a small hole in the leg vein that involves inserting catheters – thin, flexible wires – into a blood vessel, and winding the catheter into the heart. By use of a technique called radiofrequency ablation, energy in the radio wave frequency is delivered through the tip of the catheter to eliminate (or ablate) the site of the AF. Another ablation technique is the use of cryoablation, an ultra-cold substance that freezes the site of the AF.
Thorocoscopic maze procedure – A minimally invasive surgical ablation therapy for AF performed through small incisions in the chest wall.