There is no one size fits all approach to treatment of A-fib. At KCHRI, we develop a personalized treatment plan to lessen or cure your symptoms and reduce your risk of stroke. Combined with experienced electrophysiologists and advanced technology, we are able to deliver the most cutting-edge care with the best possible results.
Your physician will decide the best approach for long-term management and treatment based on your:
- Unique type of A-fib
- Stroke Risk
- Heart function
- Medical history
- Risk factors
There are two general approaches to treatment and management:
- A rhythm control strategy is used to restore your heart’s regular beat. Therapies may include:
- Antiarrhythmic drugs
- Catheter ablation
- Surgical ablation
- A rate control strategy can include medications to slow the conduction of electrical impulses across the atrioventricular (AV) node to the lower heart chambers. (The AV node controls how quickly or slowly the heart beats) Examples of these medications include:
- Beta blockers
- Non-dihydropyridine calcium channel blockers
Most newly diagnosed symptomatic patients will need the rate of their ventricles (lower heart chambers) slowed. Atrial fibrillation can cause the lower chambers of the heart to beat too fast. This condition is called A-fib with RVR (rapid ventricular response). This can cause serious complications and requires treatment with either medication or cardioversion. Patients will usually see a substantial improvement in their symptoms when the ventricular rate is slowed.
Medication is generally the initial treatment for A-fib. Drugs don’t cure the condition and they may not be effective in all patients. In some, medications may lose their effectiveness over time.
Many patients also need to take blood thinners to prevent blood clots from forming and prevent stroke.
Cardioversion is not a cure for AF, but is used to bring your heart rate back into a normal rhythm using an electric shock or medication. It can be performed in an emergency situation or can be scheduled as an outpatient procedure.
Electrical cardioversion has a high success rate and a low rate of complications.
A pacemaker is not used to treat atrial fibrillation. Pacemakers are used to treat a slow heart rate. Sometimes, a person with A-fib will have tachybrady syndrome (slow and fast heart rates). If this is the case, a pacemaker may be implanted to stop the slow heart rate and prevent the patient from fainting. However, the fibrillation will still be present.
A pacemaker may also be used if a patient is on medication to slow their heart rate. Then a pacemaker may be needed to prevent the heart from beating too slowly.
Left Atrial Appendage Closure
LAA occlusion is used to reduce the stroke risk in patients who are at a high-risk for bleeding and cannot take blood thinners. During the procedure, the left atrial appendage is closed to prevent blood from pooling and forming clots. There are several LAA closure devices used:
- WATCHMAN – A minimally invasive, catheter based procedure using a cap like device to seal the appendage from inside the heart
- LARIAT – A minimally invasive, catheter based procedure using a lasso like device to close the appendage from outside the heart
- AtriClip – A minimally invasive surgical procedure using a clip to seal the appendage from outside the heart
- Other investigational treatments are available through a clinical trials
Results: Left atrial appendage occlusion has been shown to reduce the risk of stroke. Talk to your physician about your individual stroke risk and the results you can expect.
Learn more about left atrial appendage closure.
Ablation for A-fib
Atrial fibrillation is considered a complex arrhythmia. That means there is usually more than one site in the atria that is causing the irregular heartbeat. Complex ablation is considered one of the best solutions for this condition and may even be used as a first-line treatment.
Pulmonary Vein Isolation
Pulmonary vein isolation is a complex ablation procedure that is used to treat or cure AF. It is painless, minimally invasive and low-risk. It is performed using catheters that are inserted through a blood vessel in the groin and guided up to your heart and into the upper left chamber. Energy is then used to cauterize the tissue around where the four pulmonary veins connect. This is a relatively new procedure that can offer patients symptom relief within just a few months.
Results: The vast majority of patients, experience a significant improvement in their quality of life and substantial reduces their number of visits to the hospital. Many patients are able to stop taking their rhythm medications in about 2-3 months and their blood thinners in about 6 months. Talk to your physician about the results you can expect.
AV Node Ablation
For patients who have not responded to rate control medication, atrioventricular node ablation may be an option. This is a minimally invasive, catheter based procedure to control the ventricular rate of the heart. It is used to prevent the upper heart chambers from sending faulty signals to the lower heart chambers. However, the A-fib is still present. This procedure requires the placement of a pacemaker either at the same time as the ablation or before.
Results: Many patients, experience a significant improvement in their symptoms. The pacemaker will control the heart so there will not be a need for rate control medication. Blood thinners may still be needed to reduce the risk of stroke. Talk to your electrophysiologist about your expected results.
Learn more about cardiac ablation.
Maze – Surgery for Atrial Fibrillation
Maze is a surgical ablation procedure. It is for patients with AF who need open heart surgery for a coronary artery bypass, heart valve repair or replacement, or corrective surgery for congenital heart disease. This surgery is performed in collaboration with a cardiothoracic surgeon.
During the Cox-Maze IV, ablation is used to create several lines of scar tissue which forms a new “maze” for electrical impulses to travel through. The left atrial appendage is also removed.
Results: The maze surgery can potential cure atrial fibrillation. Patients report a significant improvement in quality of life following the procedure. Talk to your cardiologists about the results you can expect.
Mini maze is a minimally invasive version of the maze surgery. This surgery involves several smaller incisions and there is no needs to stop the heart.
For more persistent, longstanding forms of atrial fibrillation, two minimally invasive procedures may be necessary to achieve the best outcomes. The first part of the convergent procedure is done by a cardiothoracic surgeon using a minimally invasive laparoscopy. The surgeon uses ablation to eliminate the faulty electrical currents coming from the back wall of the heart (posterior heart) and performs a left atrial appendage closure. This part of the procedure usually requires a two night hospital stay.
About six to eight weeks later, after inflammation has gone down, a catheter ablation is performed by an electrophysiologist. They put the finishing touches on the ablation to achieve the most complete results. This part will usually require an overnight hospital stay for monitoring.
Results: This two part procedure results in a more complete ablation with better outcomes.