Treatment and Management of AF

Anticoagulation

People with AF are 5 times more likely to have a stroke. The irregular beating of the atria and ventricles means the volume of blood pumped with each heartbeat varies causing pooling, stagnation and thickening of the blood. This thickening (coagulation) forms blood clots that can travel from the heart to the brain causing an embolic stroke.

Anticoagulants are a group of drugs used to treat and prevent abnormal blood clotting. By disrupting the blood clotting mechanism, these drugs prevent an abnormal blood clot from forming. When a blood clot already exists, these drugs stop it from enlarging and reduce the risk of it breaking off and traveling to the brain.

Patients are usually given heparin once admitted into hospital. But for long-term management, an anticoagulant drug called warfarin (Coumadin) is usually given. Aspirin is also an anticoagulant but it only has ½ the benefit of warfarin. Taking warfarin requires periodic monitoring of how well it is keeping the blood thin. This is done by taking a blood test to monitor clotting times. Based upon the results of the test, the dose of warfarin may be either increased or reduced.

However, for patients at very high risk for bleeding complications, such as an elderly person who is subject to falls or someone who has previously suffered a hemorrhagic (rupture of blood vessel) stroke, the dangers of warfarin or aspirin therapy probably exceed its potential benefit.


Rhythm Control
(explained by Divya)

Rate Control
(explained by Divya)


Catheter Ablation
This is the most common surgical method. In this procedure, a thin tube (catheter) is threaded into the heart to destroy targeted areas of tissue (AV node) using radiofrequency energy, and block irregular impulses that cause atrial fibrillation.

This prevents the fibrillating atria from sending excess electrical impulses to the ventricles. In almost all cases, this procedure causes a complete block of the heart's electrical impulses and a pacemaker must be installed to establish normal heart rhythm.

The risk of thromboembolism is unchanged, and patients still require anticoagulation; however, most patients are relieved of their symptoms.


Pulmonary Vein Isolation
This surgical procedure uses radiofrequency energy to create scars on the four pulmonary veins to prevent them from initiating electrical impulses to the atria, thus preventing AF. The procedure has shown promise, with success rates greater than 80% in some centers. There are some complications, however, related to the scarring.


Maze Procedure
This open-heart surgery, a maze of incisions made in the atria blocks the flow of excess electrical impulses within the chambers. This prevents the development of a chaotic atrial rhythm and allows the impulse from the sinoatrial node only to get to the atrioventricular node.

This procedure is reserved for patients whose symptoms are severe; the AF cannot be controlled by medications, and for patients with AF who are undergoing heart surgery for other reasons.