Treatment of atrial fibrillation
What sort of treatment is there available for me now that I have been diagnosed with atrial fibrillation? Can I just be treated with medication?
Following your tests and depending on the severity of atrial fibrillation, you will usually be prescribed medication. People whose atrial fibrillation has only just started may benefit from electric shock treatment.
If you have heart problems and the fibrillation is considered part of your illness, you will be treated with medication to keep your heart rate as steady as possible. To some extent the medication used will depend on the cause.
• If you have heart failure, you may be prescribed digoxin.
• If you have high blood pressure but no muscle pump damage, you may be prescribed a beta-blocker, verapamil or diltiazam.
• Once heart failure is controlled a beta-blocker may be added to digoxin or replace it.
Most people are on a beta-blocker or verapamil (but not if they have heart failure), but some are on more than one medication to get more benefit. It is vital that you know what each type is for (write it down when you are discussing it with your doctor) because, if you stop taking one medication, your heart may race away again You will help yourself by reducing caffeine, alcohol, stopping smoking and reducing weight.
What medication will I be offered to treat my atrial fibrillation?
Digoxin, beta-blockers (such as atenolol, bisoprolol, propranolol, metoprolol), calcium antagonists (such as verapamil, diltiazem), amiodarone, flecainide, propafenone, disopyramide, quinidine, and combinations of the above. Warfarin is used to thin your blood.
I have been told that I am going to have shock treatment for atrial fibrillation. What will this involve and is it dangerous?
If the heart is all right and it appears to have been a temporary upset, you may undergo shock treatment to get the heart back to its regular rhythm. Electric shock treatment involves passing a high voltage electric current through your heart and is known as cardioversion or a DC shock. It is used to correct rhythm disturbance, such as atrial fibrillation or rapid rates from an abnormal origin, and will usually be performed if the fibrillation has been picked up early enough. The machine used is a defibrillator.
Under a brief general anaesthetic, an electric current is passed via a paddle on the top of your chest to a paddle on the left side or back. It takes less than five minutes. The abnormal palpitation is halted at its source, and this allows the normal electrics to take over. It is successful 9 out of 10 times. Usually the patient receives warfarin for at least 4 weeks beforehand and a month afterwards to prevent the formation and dislodging of clots. If cardioversion is performed at short notice, your blood is thinned with heparin given through a vein. Cardioversion is usually done as a daycase procedure (in and out the same day) and you will notice how much better your heart behaves almost immediately.
There is no need to worry about electric shock treatment; it is safe and effective provided that all the precautions are taken – making sure of the diagnosis and use of warfarin.
A new technique involving a shock inside the heart is being used more frequently, as it appears to be more successful. A special tube is passed to the heart via the vein at the top of the leg under local anaesthetic. Once it is in place under heavy sedation or a brief general anaesthetic, a shock is delivered almost directly to the atrium, where the problem arises. The results are very encouraging, and you may be offered this as an alternative to the external shock treatment.
My cardiologist has mentioned cardiac ablation. What will this involve? Is it safe?
First, an electrophysiology study (EPS) is performed by a cardiologist in hospital (see the section Tests above). Once the source of the palpitation has been identified, and if the cardiologist considers you to be a suitable case, a special electrical pacemaker catheter can be placed at the source of the palpitations and radio frequency waves used to ablate them (doctors often say ‘zap’!). When the cardiologist is satisfied that all is well, all catheters are removed; pressure is applied to the vein at the top of the leg for 15 minutes or so, and after two to four hours’ bed rest, you will be allowed up and about; you will usually go home the next day. An ECG will be taken to check the rhythm and a 24-hour ECG may be organised to judge the effectiveness of the procedure when you are out of hospital.
Cardiac ablation can be a lengthy procedure as the catheter has to be placed very accurately. It is usually successful and abolishes the palpitations, removing or reducing the need for medication. Very rarely, the normal electrics are damaged because the abnormal electrics are very close by and they can get caught by the ablation and a pacemaker is then needed.
The procedure can remove young people from a lifetime of dependence on medication; women can become pregnant without fear of any medication damaging the baby. Also, if medication is successful but gives side effects, cardiac ablation is an effective alternative. Because ablation is a very individual procedure, it is important to discuss fully with your cardiologist the potential risks and the chances of benefit for you – not someone in general, but you specifically.
