Arrhythmia Atrial Fibrillation Treatment

Atrial fibrillation treatment options vary depending on a number of factors. Chronic arrhythmia may require medications such as beta blockers or calcium channel blockers to slow an irregular heartbeat. Patients may also be treated with anticoagulants, such as warfarin or aspirin, to prevent blood clots. In some cases, a pacemaker may be required to control the heart rate.

Beta Blockers and Calcium Channel Blockers for Irregular Heartbeat

Heart medication is available for both long-term and emergency treatment of atrial fibrillation. Medications such as beta blockers, calcium channel blockers, and digitalis slow an irregular heartbeat by affecting the heart’s AV node. These medications lengthen the time it takes an electric signal to enter the AV node from the atrial chambers and exit into the ventricles.

Beta blockers, calcium channel blockers, and other atrial fibrillation medications do not necessarily slow the atrial chambers’ irregular heartbeat. However, by slowing the electrical activity through the AV node to the ventricles, these heart medications slow the ventricular heart rate. This leads to more effective ventricular contractions. Since the ventricles are the pumping powerhouses of the heart, maintaining a regular ventricular rhythm is a key aspect of treatment for atrial fibrillation.

Defibrillation

In an emergency, severe atrial fibrillation may require treatment with a defibrillator. A defibrillator produces an electric charge that jolts the heart, “resetting” the irregular heartbeat to a normal rate.

Hyperthyroidism

Hyperthyroidism is sometimes the underlying cause of atrial fibrillation. If hyperthyroidism is a factor, treating hyperthyroidism will improve atrial fibrillation symptoms.

Antiarrhythmic Medication

While beta blockers and calcium channel blockers slow an irregular heartbeat, antiarrhythmic heart medication attempts to return the irregular heartbeat to a normal rhythm. Medications such as quinidine and amiodarone are available for this type of treatment. Antiarrhythmic medication varies in its effectiveness, and can produce unwanted side effects though.

Anticoagulant Treatment: Warfarin and Aspirin

Atrial fibrillation increases the risk of blood clots and stroke. To prevent such complications, anticoagulant medications such as warfarin and aspirin may be prescribed. Both aspirin and warfarin “thin” the blood, making coagulation (and therefore blood clot formation) less likely to occur.

Warfarin is a more effective anticoagulant than aspirin, and is usually prescribed for patients with an especially high risk of stroke, over the age of 65, or with a history of heart problems. Younger patients with a lower stroke risk usually receive aspirin. While it is a more effective medication, warfarin produces more side effects than aspirin. Warfarin use is also often associated with bleeding problems, especially in older people.

The Need for a Pacemaker

In rare cases, treatment of atrial fibrillation may require radiofrequency ablation (RFA) and a pacemaker. RFA treatment uses beams of radiofrequency energy to destroy areas of heart tissue that generate abnormal electric activity. The tissue selected is in either the atrial chambers or the AV node.

If RFA treatment affects the AV node, the treatment is called atrioventricular junction ablation. Ablation of the AV node requires subsequent placement of a pacemaker to generate the electrical signal for a regular heartbeat.

In less severe cases of atrial fibrillation, an ICD may be implanted. An ICD, or internal cardioverter defibrillator, is a special type of pacemaker. This pacemaker can sense electric activity consistent with an irregular heartbeat. If the pacemaker senses such activity, it releases an electric charge. If successful, the pacemaker’s electric charge “resets” the heartbeat before atrial fibrillation occurs.

Resources

American Heart Association. (updated 2005). Living with atrial fibrillation.

Beers, M.H.