Atrial Fibrillation (AFib) Treatment

When you come to us for treatment, our team will evaluate your individual situation to determine the best course of action to take. Treatment for atrial fibrillation will depend on your symptoms, severity, reversible cause and whether you have heart disease. Our team of physicians will work with you to determine exactly what method of treatment is best for you. And you can be sure that you will have the most options for advanced treatment.

Treatment for AFib - Medications

If you have atrial fibrillation (Afib) your doctor may prescribe medication. Since the most devastating complication of atrial fibrillation (Afib) is a stroke, your doctor may prescribe blood thinners to prevent clotting. This could be aspirin, warfarin or a novel oral anticoagulant like Pradaxa, Xarelto or Eliquis. Blood thinners may increase your risk of bleeding. In some cases, monthly tests may be required to monitor how the medication is affecting you. If you are not able to tolerate blood thinners, you may be a candidate for the WATCHMAN device.

Medications may also help control your heart rate. Both beta-blockers and calcium channel blockers are used to slow a racing heart rate. Most patients will feel and function better if their heart rates are controlled. Your doctor may also prescribe medication for maintaining normal rhythm if rate control medicine isn’t producing desired results. Medications to control your heart rhythm can reduce symptoms of fatigue, shortness of breath or dizziness. Medications like Solatol, Tikosyn, Multaq, Amiodarone Rythmol and Flecainide slow the electrical signals in the heart that promote AF. Your medication and dosage will be carefully monitored to ensure that it’s working to efficiently manage your condition. Your dosage may be changed or increased until your symptoms are controlled. Be sure that you take the medication as directed.

Treatment for AFib - Procedures

If your atrial fibrillation is not controlled with medication, your cardiologist and cardiovascular surgeon might suggest one of several procedures. A variety of procedures are available to treat AFib.

Electrical cardioversion, a non-surgical procedure, is a rhythm reset. You will receive an electric shock on the outside of the chest while under anesthesia. The shock can “reset” the heart to a normal rhythm.

Ablation is a common minimally-invasive procedure used when medications and electrical cardioversion haven’t been successful. Cardiac ablation destroys areas of the heart that create abnormal electronic impulses, which cause atrial fibrillation (Afib).

  • Catheter ablation is minimally invasive procedure used where cardiac electro physiologists (heart rhythm specialists) insert long, thin tubes into your groin and guide them through blood vessels to your heart. There are electrodes at the tips of the catheter that use radiofrequency energy to destroy the regions that cause atrial fibrillation (Afib).
  • Thorascopic ablation uses a camera and surgical instruments are inserted into the chest through several small incisions. We are the only center in Arkansas to offer this procedure. Patients with persistent, permanent AFib, with a larger left atria or with depressed left heart function are candidates for this ablation.
  • Surgical maze is for patients who need valve repair or replacement or coronary bypass surgery. With this procedure, your surgeon will make several incisions in the upper chambers of the heart to create a pattern of scar tissue to interfere with the electrical impulses that cause atrial fibrillation. 

WATCHMAN procedure is for patients who cannot tolerate blood thinners and are at risk of stroke.

The biggest advantage is that the catheter therapies are performed through multiple groin punctures, and TT requires small half-inch incisions on the chest. Therefore, the TT approach results in more pain and a longer hospital stay.

Also, endocardial based therapies have the advantage of performing more complex atrial mapping than epicardial techniques (which can more accurately test the effectiveness of the ablation) and can address other atrial arrhythmias that may be unmasked after the atrial fibrillation is terminated, most commonly right or left atrial flutter for which epicardial TT ablation isn’t well suited.

As with any procedure, there are a few risks. Two phrenic nerves are around the heart’s membrane that could be injured. However, if this happens, it’s usually temporary and returns to normal with time. As with any heart procedure, there is a risk of major bleeding and infection. A very low risk of stroke does exist if there is a clot in the left atrium that could be disrupted.

 
Both procedures usually require general anesthesia and usually take about the same time, but there are more advantages for the maze procedure. However, the epicardial surgical ablations have been shown to be significantly more effective for more difficult types of AFib. With catheter ablations, there is a risk of injury to the esophagus but not for the epicardial. Autonomic testing and ablation is difficult from a cathether ablation but fairly easy from an epicardial. Often in the setting of more complex AFib, catheter ablations have to be performed on multiple occasions. The epicardial TT AFib ablation is a one-time procedure.
In most cases patients who have had previous open chest procedures (heart or lungs) are not candidates. However, there are surgical options available for those patients.
Generally, maze procedures are recommended for patients who have symptomatic AFib and have failed at least one anti-arrhythmic drug therapy. It can also be suggested for those who have long standing persistent AFib, an enlarged left atrium (generally >4.0 cm on echocardiography), have a failed catheter ablation therapy, or prefer a surgical (epicardial) approach.
Hybrid ablation combines a surgical procedure and catheter ablation in the same procedure in the same setting. This therapy uses both the endocardial and epicardial approaches. Theoretically, this takes advantage of the best of these approaches and is often recommended for patients with complex AFib.
If you are on long-term warfarin therapy or have been recommended for medication therapy to reduce the risk of stroke but are unable to tolerate that therapy, you may be a candidate for the WATCHMAN device