What are my treatment options?

There are three overall things to be considered.

  • One is a blood thinner to prevent a stroke.
  • Second is to control your heart rate.
  • Third is to control your heart rhythm.

First Step Treatment: Blood Thinner

We evaluate whether patients need a blood thinner or not based on different risks.

Points
Congestive Heart Failure 1
Hypertension 1
Age >75 2
Diabetes 1
Stroke or Prior TIA 2
Vascular (hx MI, PVD) 1
Age>65 1
Sex Female 1
Total Possible Points 9
Chance of Stroke Based on How Many Points
Points % Risk of Stroke per Year
0 0
1 0.7
2 1.3
3 2.2
4 3.2
5 4.0
6 6.7
7 9.8
8 9.6
9 15.2

Second Step Treatment: Rate Control

The goal of this is to decrease your resting heart rate to less than 110 bpm. If you continue to have symptoms then decreasing your heart rate further to less than 80 bpm may be beneficial.

Third Step Treatment: Rhythm Control

The goal of this treatment is to control the rhythm or restore you back into a regular rhythm if you continue to have symptoms. Sometimes feeling tired is a symptom that patients have and they are not sure if this is because of Atrial Fibrillation.

Cardioversion:

A cardioversion is a good test to figure out if you feel better in a regular rhythm. If you do feel better then further treatment is warranted, as a cardioversion is not a permanent solution to treating your atrial fibrillation.

Medications:

Antiarrhythmic Medications are medications that are used to prevent an abnormal rhythm. There are many medications but which medication that could potentially could be used will depend on factors including your EKG, echocardiogram, and underlying past medical history. The medications in general can be successful up to 40-50% of the time but generally have significant side effects that must be considered.

Amiodarone is considered to be the most effective medication with success rates of 60-70% however there are extreme side effects such as lung failure, liver failure, thyroid failure, vision changes and sin changes some of which may not be reversible. In most cases amiodarone should not be used until other options have been exhausted including an ablation.

Ablation:

An ablation is a procedure that delivers cooling or heating to the tissue of the heart to create scar tissue so electrical activity can not pass in the region that the scar is created. The area that we create scar is tiny and in an area that should not adversely affect the function of your heart.

The procedure in general is successful approximately 70% of the time with ranges depending on the duration that you have been in atrial fibrillation.

Pacemaker:

A pacemaker is a device that can be used to regulate the heart beat. In patients who have atrial fibrillation it may be necessary to place a pacemaker to control slow heart rates while medications are used to control fast heart rates. This condition is called Sick Sinus Syndrome or Tachy-Brady Syndrome. In most cases, a pacemaker is not needed if no other treatment has been performed for your atrial fibrillation. See more information on Pacemakers at heartdevices.org