As soon as a patient gets diagnosed with atrial fibrillation (AFib), their doctor sets three main goals they want to reach: restore the normal rhythm of the heart or control its rate, manage stroke risk factors, and prevent blood clots.
Choosing the best treatment for patients suffering from atrial fibrillation is not a simple task but rather a complex process of weighing the pros and cons of each option and deciding on the ideal treatment for every patient individually.
Depending on the selected treatment approach, your doctor may prescribe different medications including:
Before novel anticoagulant drugs appeared, the go-to anticoagulant medication was Coumadin (warfarin) which impedes vitamin K – the vitamin responsible for many of the blood’s clotting factors.
However, one of the main disadvantages of this drug is that it requires frequent blood testing and dose adjustment. In case of a low dose, the patient is still at risk of clots and stroke while when the dose is too high, there’s a risk of bleeding. Luckily, the main advantage of Coumadin is that the effects can be reversed by taking vitamin K.
On the other hand, there are now newer drugs – Novel anticoagulant (NOAC) drugs – that don’t impede Vitamin K to hamper clotting factors but inhibit certain factors directly. Some NOAC drugs include Eliquis (apixaban), Xarelto (rivaroxaban), Savaysa (edoxaban), and Pradaxa (dabigatran).
What’s more, they don’t require patients to test their blood frequently and make dosage adjustments. That’s why NOAC drugs have replaced Coumadin and became the golden standard anticoagulant medications, even though they are far more expensive.
Heart Rate Control Medications
To reduce high heart rate, Lanoxin (digoxin) or Digitalis were once the standard drugs prescribed but they were only effective when the patient rests and didn’t work when performing an activity. Plus, the risk of digoxin toxicity is quite high since there’s only a small difference between a toxic and a therapeutic dose which is why patients should be monitored regularly.
That said, doctors nowadays prefer the combination of calcium channel blockers or beta-blocking drugs as an effective alternative to Lanoxin or Digitalis. They reduce high heart rates by slowing electrical impulse conductivity through the atrioventricular node.
Finally, to reset normal heart rhythm and stop atrial fibrillation your doctor may recommend some antiarrhythmics medications which are taken intravenously and may include Tambocor (flecainide), Rhythmol (propafenone), Tikosyn (dofetilide), Pacerone, Nexterone (amiodarone), and Corvert (ibutilide).
Unfortunately, the success of these drugs in restoring a normal heart rhythm is only 50% to 60% of the cases and comes with many side effects.
Also, oral antiarrhythmic medications could also be prescribed after cardioversion which can be taken on either as-needed or an ongoing basis. Sotalol is also an option used in drug cardioversion. But, several side-effects may occur like nausea, fatigue, and dizziness.
Medical Procedures and Surgery
Similar to medications, depending on the selected treatment approach, several medical procedures and surgeries may be performed including:
In case of an emergency or if medications failed to restore the normal rhythm of the heart, AFib patients may undergo electrical cardioversion. This procedure involves chest electrical shock with a set of paddles and fortunately is almost 100% effective.
This procedure involves cauterization or freezing of the inside of the heart to eliminate the cells responsible for the abnormal rhythm. It is 50% to 80% effective but comes along with many risks like bleeding, stroke, and even death.
Maze procedure is actually an open-heart surgery using incisions, radiofrequency, or cryotherapy to scar the upper chambers and thus hamper the electrical signals that cause abnormal rhythm. And, since open-heart surgery is quite risky, it is only recommended to those who don’t respond to other treatment options.
Implanting a pacemaker to regulate heartbeat is usually performed on patients suffering from bradycardia, i.e. slow heart rate. But, since this can happen when taking antiarrhythmic medications, a pacemaker may be implanted as a temporary measure.
Left Atrial Appendage Closure
Last but not least, this is also a procedure involving a catheter but it is for reducing the risk of blood clots which usually develop in the left atrial appendage. Plus, if a patient has to undergo an open-heart surgery they could also have their left atrial appendage closed.