Treatment options to improve life with atrial fibrillation.
Multiple treatment options are making atrial fibrillation less deadly.
Atrial fibrillation (AFib) itself isn’t always the main problem for the four million Americans who have the condition—some also have a high risk of stroke. In AFib, the heart quivers when it should be beating, and blood pools inside the heart when it should be pumping though the body. Strokes occur when the stagnant blood thickens and forms clots that travel to the brain.
That’s why it’s important for AFib to be diagnosed and treated, says Dr. Moussa Mansour, associate professor of cardiology at Harvard-affiliated Massachusetts General Hospital.
“The first thing we do when we find that a person has AFib is to assess the risk of stroke,” he says. “Some risk factors or conditions increase stroke risk, such as heart failure, high blood pressure, diabetes, and older age.”
“The first thing we do when we find that a person has AFib is to assess the risk of stroke.”
— Dr. Moussa Mansour, Massachusetts General Hospital
AFib warning signs
Some people with AFib don’t know it, as they don’t experience any of the symptoms. Most people, however, feel one or more of the American Heart Association’s warning signs:
rapid, irregular heartbeat
fluttering or thumping in the chest
shortness of breath and anxiety
faintness or confusion
fatigue when exercising
chest pain or pressure (which is an emergency, as it could mean a heart attack).
After an episode of AFib, the heart may return to its normal rhythm all by itself. This is called paroxysmal fibrillation. Episodes are unpredictable and may occur every day, or only a few times a year. Whatever the frequency, this kind of AFib often turns into one of the more severe forms, in which a person has episodes of fluttering that last for two or more days (persistent AFib) or last indefinitely (permanent AFib).
Sometimes AFib has an underlying cause such as thyroid disease or excessive alcohol consumption. Successful treatment of these conditions may cure a person’s AFib. Other underlying conditions that may trigger AFib are high blood pressure, sleep apnea, and other forms of heart disease. Treatment of these conditions is unlikely to fully reverse AFib, Dr. Mansour says.
Some people diagnosed with AFib will be prescribed a blood thinner (anticoagulant) to lower stroke risk. Those at low risk of stroke may not need one.
That may be all a person without bothersome AFib symptoms needs. But those with AFib symptoms need help restoring a more normal heart rhythm.
“We do this in one of two ways: medication or catheter ablation,” Dr. Mansour says. “Usually we try medications first.” The first step is usually an effort to lower the heart rate with a beta blocker or calcium-channel blocker. The drug your doctor prescribes will depend on the underlying reason for your AFib and the type of side effects the drug may cause.
If that fails to curb the frequency of AFib episodes or symptoms, a drug to make the heart rhythm more regular (an antiarrhythmic drug) may be needed. These drugs tend to have more side effects than rate-control medications and cannot be used in certain people. That’s why many doctors try rate-control drugs first.
When drugs cannot be tolerated or fail to produce the desired results, a procedure to halt AFib—called pulmonary vein antrum isolation or pulmonary vein ablation—may be an option. This approach is based on the finding that during episodes of AFib, the electrical pulse that initiates the heartbeat comes from the wrong place: the pulmonary veins. During the procedure, a device carried on a catheter is used to scar the base of the pulmonary veins. This keeps them from emitting the disruptive electrical pulses and allows the heart to resume normal rhythm.
Another catheter procedure, called left atrial appendage closure, is gaining in popularity, particularly among people who develop bleeding issues that make it hard or impossible for them to tolerate anticoagulant drugs. The left atrial appendage is a pocket in the upper left quadrant of the heart where blood tends to pool and clot in people with AFib. Closing this area off prevents this from happening.
Dr. Mansour says people with AFib are lucky to be living at a time when so many different treatments are available.
“I think the field of AFib is rapidly growing,” he says.”?