Atrial fibrillation (or AFib) is characterized as an abnormally rapid and irregular heart rate that can cause extreme fatigue, heart palpitations, and shortness of breath. AFib occurs due to several medical issues (i.e., heart surgery, high blood pressure, heart defect, thyroid imbalance, stimulants, lung disease, stress, sleep apnea, and abnormal heart valves) that cause the upper chambers of the heart (or atria) to beat at different rates than the lower heart chambers (or ventricles).
AFib tends to be classified in 4 stages, as occasional, persistent, long standing persistent, or permanent:
- Occasional or paroxysmal AFib comes and goes and lasts for durations between a few minutes to a few hours only.
- Persistent atrial fibrillation requires electrical shock or drug treatment to restore a healthy heart rate when the heart’s rhythm doesn’t return to normal naturally.
- Long-standing persistent AFib is continual for 12 months or longer.
- Permanent atrial fibrillation results in a permanent and abnormal heart rhythm that requires the assistance of medication to control a healthy heart rate.
While atrial fibrillation isn’t considered a threat to health at the occasional stage, AFib may demand treatment if it leads to a higher risk of other health complications, such as heart failure, stroke, or the development of a blood clot that causes ischemia (blocked blood flow). These common treatments for AFib aim to help the electrical system of the heart return to a normal, healthy rate while lowering the risk of a blood clot or stroke:
1. Anti-arrhythmic drugs
Medications marketed under names like Sotalol, Propafenone, Flecainide, and Dofetilide act to restore normal heart rhythms and prevent atrial fibrillation from recurring. However, they need to be taken with close monitoring by a doctor and often cause unpleasant side effects (i.e., fatigue, nausea, lightheadedness).
2. Beta blocker and calcium channel blocker therapy
Research from the Journal of the American College of Cardiology indicates that a combination of these medications are considered primary therapy for AFib in order to reset a healthy heart rate both at rest and during activity.
Cardioversion helps restore normal heart rhythm via one of 2 ways—either through electrical cardioversion, which employs paddles or patches on the chest to deliver an electrical stock that ceases electrical activity in the heart for a brief moment and then resumes normal beat; or with drug induced cardioversion, which administers anti-arrhythmic drugs intravenously to restore normal heart rate.
4. Catheter ablation
In cases where cardioversion and medications aren’t effective, catheter ablation may be recommended to eradicate the precise area of heart tissue that’s rapidly triggering abnormal electrical signals, or “hot spots”, and causing the heart to quiver vs. beat normally. Catheter ablation inserts thin catheters up through the groin, blood vessels, and into the heart where it at blasts these hot spots with extreme heat or cold to permanently scar the tissue and normalize electrical signals to the heart.
5. Left atrial appendage closure
This procedure guides a catheter through a vein in the leg and through the right atrium in order to insert a left atrial appendage closure device, which closes a small sac in the left atrium. The aim is to lower the risk of blood clots in patients with atrial fibrillation in the left atrial appendage.
6. Surgical maze procedure
This form of open heart surgery is only used on patients who don’t respond to less invasive treatments. It aims to interfere with rogue electrical impulses that trigger Afib by creating a “maze” of incisions in the upper chambers of the heart.
7. Atrioventricular node ablation
For patients that are not candidates for drug therapy, cardioversion, or less invasive procedures, atrioventricular (or AV) node ablation administers radiofrequency energy via a catheter to destroy the pathway of tissue connecting the upper chambers (atria) and lower chambers (ventricles) of your heart and block electrical impulses that lead to AFib. During the procedure, a pacemaker is inserted to maintain a healthy ventricle heart beat.