The goals of treatment for atrial fibrillation include:

• Return the heartrate to a normal rhythm, if possible
• Control the heart rate
• Prevent blood clots from forming
• Treat the cause(s) of the abnormal rhythm and any AF complications
• Reduce the risk factors that may lead to the AF getting worse

Medications

If you have atrial fibrillation, you may need to take one or more medicines for the rest of your life, such as:

• Rhythm control medications (anti-arrhythmic drugs) – medications that help keep a normal heart rhythm
• Rate control medications – medications that slow down a fast heart rate and prevent weakening of the heart muscle
• Blood thinners – medications that help prevent blood clots and reduce the risk of stroke

Everyone reacts differently to medication. You may need to try more than one medicine before you find what works best for you and has the fewest side effects.

Cardioversion

Even though you are taking medication, you may still go into AF from time to time. Your doctor may offer cardioversion as one treatment option. Cardioversion is a procedure in which an electrical current, or shock, is given to the heart muscle to restore the normal rhythm. It sounds scary, but it is a simple, same-day procedure. You will be given a small amount of sedation through an IV line. Large pads (electrodes) will be placed on your chest. The electrical current will pass through these electrodes to return your heart rhythm to normal.

Catheter Ablation

Catheter ablation is a non-surgical procedure that can be used when medication is not working to control the heart rhythm. Catheter ablation is done in an electrophysiology lab in the hospital by a team of highly skilled nurses and technicians who work alongside the electrophysiologist (doctor who specializes in treating heart rhythm conditions). The goal of the procedure is to cure the AF or to lessen the episodes of AF by controlling your symptoms. Click to view a interactive demonstration of catheter ablation.

In this procedure thin, flexible wires called catheters are inserted into a vein in your neck and/or groin. These wires are threaded up through the vein and into the heart using X-rays to guide the way. There are electrodes at the tip of the wires. The electrodes are able to detect electrical signals from different parts of the heart. The doctor will be able to tell where the bad electrical signals are coming from. A special catheter called an ablation catheter sends out radio waves that create heat. This heat destroys the tissue in the heart that causes the AF and blocks the abnormal electrical signals. Special equipment creates a 3D picture of your heart. This helps the doctor know exactly where to apply the heat. Another option is to use freezing cold to destroy the heart tissue. The basic process would be the same.

You will be given sedation through an IV line to keep you comfortable during the procedure. You may have general anesthesia, which will put you to sleep or what is known as conscious sedation. Conscious sedation means that you are still awake. You will have enough medication that you will not be aware of what is happening or feel any pain. The type of sedation will depend upon your doctor, the hospital and your overall health. During the ablation, you will be given a blood thinner to prevent clots from forming in your heart during the procedure.

Catheter ablation usually takes between two and six hours. Your medical team will closely monitor your heart beat, blood pressure and breathing during this time. After the procedure, pressure will be placed on the area where the catheters were inserted to prevent bleeding. You may need to stay in the hospital for one or two days, so that these areas heal. The amount of time you will need to lay still and the amount of time you will stay in the hospital will depend upon your doctor and the medical center. Your doctor will tell you how to take care of yourself when you leave the hospital.

Atrial fibrillation ablation is a safe procedure, but there are some risks. Less than five out of every 100 people who have the procedure develop one of these related problems. Some of these risks include stroke, pericardial tamponade (collection of blood around the heart), damage to the blood vessels in your groin area, pulmonary vein stenosis (narrowing of the veins coming from the left atrium to the lungs) and a serious but extremely rare risk of atrioesophageal fistula (an opening that forms between the atria and the esophagus).

After the procedure you should watch for bleeding or oozing from the catheter sites, discomfort at the catheter sites, aches or discomfort in your chest, fatigue or lightheadedness. Contact your doctor if you have any questions or concerns about any symptoms.

Surgical Ablation

Surgical ablation is an approach that some physicians use to destroy the cells causing abnormal heart rhythms. Usually this treatment is used for AF patients who are not helped by medication or catheter ablation. Surgical ablation may also be used if there is another heart condition that requires surgery, at which time physicians will try to treat both issues at once.

Surgical ablation is a treatment that requires a more invasive approach then a catheter ablation procedure. During the surgical ablation, a surgeon burns the surface of the heart directly by making cuts that allow them to see the surface of the heart, rather then relying on catheters and X-rays to reach the heart. New techniques have allowed surgeons to use smaller cuts to perform surgical ablations and other open heart surgeries. There are many risks associated with surgical ablation. Some of these risks include atrioesophageal fistula (an opening that forms between the atria and the esophagus), injuries to the coronary artery (possible heart attack) and phrenic nerve paralysis (severe damage to your diaphragm). As with any surgery, complications and risks vary for each patient, so you should discuss all risks with your surgeon.

What to Ask your Doctor

If you have been diagnosed with atrial fibrillation, or suspect that you may have the condition, here are some questions that you may want to ask your physician.

• What is the cause of my AF?
• How can I be sure I have AF and not a more serious heart rhythm problem?
• Will my condition go away on its own?
• What are the risks that it will become worse (more symptomatic)?
• Am I at increased risk of having a stroke?
• What are my treatment options?
• What are the risks and side effects of medications to control my condition, or to reduce the risk of stroke?
• What are the risks and benefits of other treatment options?
• Should I see an electrophysiologist (a specialist in heart rhythm disorders)?