Treatments for Atrial Fibrillation (AF) can vary from patient to patient and depend on the severity of the condition.
While it is a common heart irregularity, there are different types of AF and it is this which will primarily influence and guide the physician on the designated treatment.
The four main types of AF are: paroxysmal, persistent, long-standing persistent, and permanent.
AF is a type of arrhythmia, or irregular heartbeat, which causes the upper and lower chambers of the heart to beat out of sync, fast, and erratically.
Additionally, one type of AF can become another classification as the condition progresses but the main aim of treatment is to restore the normal rhythm of the heart, slow down heart rate, and prevent blood clots that may lead to stroke.
Paroxysmal AF can last a matter of seconds, or up to a week, and treatment can include lifestyle changes, such as eliminating caffeine and reducing stress; medications to restore heart rhythm or heart rate such as beta-blockers, calcium channel blockers, or antiarrhythmics; and anticoagulants to prevent blood clots.
With persistent AF, which may last for more than seven days but less than a year, there again may be the option of lifestyle change as a treatment and medication to restore heart rhythm or prevent stroke, but physicians may also recommend electrical cardioversion, catheter ablation, or a pacemaker.
Long-standing persistent AF that lasts more than a year can also be helped by the above medications, as well as electrical cardioversion (electrical shock), which involves giving the heart a controlled electric shock to try to restore a normal rhythm.
It is usually carried out in hospital so the heart can be carefully monitored.
If cardioversion is not effective, surgical procedures to treat the condition include catheter ablation, which destroys the diseased area of the heart or tissue causing AF via high-frequency radio waves that generate heat transmitted through one of the catheters and interrupts abnormal electrical circuits.
Surgeons may also use a ‘maze procedure’, where cuts are made in strategic places to create a “maze” of scar tissue to prevent electrical signals from passing through, as scar tissue does not conduct electricity. The maze interferes with stray electrical heart signals that cause atrial fibrillation.
A pacemaker, a small battery-operated device usually implanted in the chest just below the collarbone, may be used in AF to help the heart beat regularly. Having a pacemaker fitted is usually a minor surgical procedure carried out under a local anaesthetic.
For permanent AF, there is no treatment to restore the normal rhythm of the heart but doctors may use beta-blockers and calcium channel blockers, as well as medications to prevent blood clots or improve heart function.
One of the key steps in managing AF is assessing the risk of stroke in a patient. For people with risk factors such as age or high blood pressure, anticoagulation medications are recommended to help prevent blood clots to lower the risk of stroke.
Warfarin is the oldest anticoagulant but more recently novel anticoagulants (NOACs) have been introduced, such as dabigatran, rivaroxaban, apixaban and edoxaban.
For those unable to tolerate anticoagulants, a LAAO (Left Atrial Appendage Occlusions) procedure is an option for closing the small pouch off the heart in which clots can form.
AF may be treated by a GP, who can prescribe various medicines, or a cardiologist, or an electrophysiologist specialising in the management of abnormalities of heart rhythm.
Factors that will be taken into consideration when treating AF include: age, overall health, the type of AF, symptoms, and whether a patient has an underlying cause that needs to be treated.
AF remains relatively difficult to diagnose as the symptoms can be intermittent but smart devices, such as the CART-I ring cardio tracker from Sky Labs, can help detection by measuring heart rate from screening the bloodstream 24/7 through the wearer’s finger to identify any irregularities.