Atrial fibrillation treatment has three main goals: preventing stroke, controlling symptoms, and if possible correcting heart rhythm. Treatment is personalized and planned according to your condition.
Preventing Stroke
The most important point in AFib treatment is preventing stroke. For most people, this means taking blood thinner medication.
Your stroke risk is evaluated according to the CHA₂DS₂-VASc score. This score takes into account your age, gender, and health conditions. If your score is 2 or higher, anticoagulant treatment is definitely needed. If the score is 1, your condition is evaluated and medication is usually still recommended.
Anticoagulant medications prevent blood clot formation. Today, newer generation blood thinners called DOACs are generally preferred. Apixaban, rivaroxaban, edoxaban, and dabigatran are the most commonly used. These medications are taken at a fixed dose, do not require regular blood tests, and have few food interactions.
Warfarin is an older medication but is still used in some cases. It is especially preferred for those with mechanical heart valves or patients with moderate-to-severe mitral stenosis. Warfarin requires regular INR monitoring and dosage is frequently adjusted.
Aspirin is no longer recommended for stroke prevention in AFib because it is not as effective as anticoagulants and still has bleeding risk.
Controlling Symptoms
If AFib symptoms are bothersome, they need to be treated. There are two main methods for this: rate control and rhythm control.
In the rate control approach, AFib continues but the heart rate is brought to normal. The heart starts beating between 60-100 per minute and this significantly reduces symptoms. For most people this is sufficient and is a simpler approach.
Beta blockers are generally used for rate control. Medications like bisoprolol, atenolol, or metoprolol slow the heart rate. Side effects may include fatigue, cold hands, and dizziness.
Calcium channel blockers are another option. Diltiazem and verapamil slow heart rate and lower blood pressure. They may have side effects such as ankle swelling and constipation.
Digoxin is especially used in people who are very sedentary or have heart failure. It is usually given in combination with other medications.
Restoring Normal Rhythm
In the rhythm control approach, the goal is to return the heart to normal sinus rhythm and maintain this rhythm. This is especially preferred in young, symptomatic patients.
Cardioversion quickly returns the rhythm to normal. Electrical cardioversion is the most effective method. A controlled electrical shock is applied to your body and this usually returns the heart to normal. The procedure is performed under light anesthesia, takes only a few minutes, and is painless.
Before cardioversion it must be ensured that there is no clot in the heart. For this reason, you use blood thinners for 3 weeks before the procedure or echocardiography is performed through the esophagus to check that there is no clot.
Pharmacological cardioversion attempts to correct the rhythm with medications. Medications such as flecainide or amiodarone can be given intravenously or orally. It is not as effective as electrical cardioversion but is preferred in some cases.
Maintaining Rhythm
After cardioversion or in a rhythm control strategy, antiarrhythmic medications are used to prevent AFib recurrence.
Flecainide and propafenone are used in people without structural heart disease. They are generally well tolerated but may have side effects such as dizziness and blurred vision.
Sotalol both slows heart rate and maintains rhythm. It requires ECG monitoring because it can cause QT prolongation.
Amiodarone is the most powerful antiarrhythmic and is used when other medications do not work. It is very effective but has significant side effects. It can cause thyroid problems, lung toxicity, liver problems, and skin sensitivity. Regular monitoring is required with long-term use.
Dronedarone was developed as an alternative to amiodarone. It has fewer side effects but cannot be used in patients with severe heart failure.
Catheter Ablation
If medication fails or side effects are too much, catheter ablation may be considered.
In AFib ablation, a thin catheter is advanced to the heart from the groin. Abnormal electrical areas causing AF are found and destroyed with radiofrequency energy (heat), cryoenergy (cold), or a new method called PFA. The procedure is usually performed under local anesthesia or light sedation and takes several hours.
Ablation is especially successful in paroxysmal AFib. AFib disappears or significantly decreases in 70-80 percent of patients. The success rate is somewhat lower in persistent AFib. In some patients the procedure may need to be repeated.
Ablation is generally safe but has risks like any procedure. Complications such as bleeding, infection, and damage to the heart sac may rarely occur.
Other Procedures
AV node ablation and pacemaker placement may be considered when all other treatments have failed. The AV node is destroyed by ablation and a permanent pacemaker is placed. This way heart rate is completely controlled but AFib does not disappear, only symptoms are controlled.
Closure of the left atrial appendage is used to reduce stroke risk. Most blood clots (90%) form in the left atrial appendage area. This area is closed with a special device and the risk of stroke due to atrial fibrillation is mostly eliminated. This procedure is considered in patients who cannot use blood thinners.
Treatment Selection
When determining your treatment plan, your doctor takes many factors into account. Your atrial fibrillation type is important. Whether it is paroxysmal, persistent, or permanent affects treatment. The severity of your symptoms is important. If there are very bothersome symptoms, more aggressive treatment is needed.
Your age and general health condition affect treatment decisions. In young and healthy people, rhythm control strategy is more often preferred. In elderly people or those with many health problems, rate control may be more appropriate.
If your stroke risk is high, anticoagulant treatment is definitely needed. Your other health problems, such as kidney or liver disease, affect medication choice.
Your personal preferences are also important. Discuss treatment options, their risks and benefits with your doctor. Determine the most appropriate approach for you together.
Treating Underlying Causes
If your AFib results from another health problem, treating that problem is very important. If there is a thyroid problem, treating it can improve AFib. Control of high blood pressure, treatment of sleep apnea, correction of heart valve problems contribute to AFib management.
Follow-up and Monitoring
Regular follow-up is very important after atrial fibrillation treatment is started. More frequent visits may be needed in the first weeks and months. How your symptoms are, whether medications are working, whether there are side effects are evaluated.
Regular ECG checks are done. Blood tests may be needed to monitor medication effects. Heart functions are evaluated with echocardiography periodically.
Your treatment plan may change over time. Adjustments are made according to your condition. What is important is that you live a symptom-free, complication-free, quality life.
Preparing for Your Appointment
What you can do:
- When did heart palpitations start and how often do they occur?
- Are palpitations constant or intermittent?
- What symptoms are you experiencing?
- Did you notice any triggering factors?
- List all medications and supplements you are taking.
- Mention if there is a family history of heart disease or AFib.
- Write your questions down in advance.
Questions you can ask your doctor:
- Is the diagnosis of atrial fibrillation certain?
- What type of AFib do I have?
- What is my stroke risk?
- Do I need blood thinners? For how long?
- What is the most appropriate treatment for me?
- Can ablation be done?
- What are the side effects of medications?
- Can I exercise?
Your doctor may ask you:
- When did heart palpitations start?
- Are palpitations constant or come and go?
- What symptoms are you experiencing?
- Have you fainted?
- Have you had heart disease before?
- Do you have high blood pressure?
- Do you have sleep apnea?
- What medications are you taking?
- Do you consume alcohol? How much?