Atrial Fibrillation and Its Treatments

The object of treatment for Atrial Fibrillation is to prevent blood clots from forming by first restoring and then maintaining normal heart rhythm and function. To initially restore heart rhythm, anti-arrhythmic drugs are usually used first. If they fail to restore normal rhythm, a procedure known as cardioversion is often effective. Even if a steady rhythm is restored by drugs or cardioversion, however, it often cannot be sustained for prolonged periods, so long-term maintenance therapy using anti-arrhythmic drugs may be required.

Anti-Clotting Drugs. After a diagnosis of Atrial Fibrillation, patients usually need to take drugs to reduce blood clotting, usually warfarin (an anticoagulant) or aspirin.

• Warfarin (Coumadin, Panwarfin) is an anticoagulant and is especially effective in preventing strokes in this population. Anti-coagulant agents reduce the risk for stroke by 62%, and are the agents of choice in preventing first and second strokes in high-risk patients with Atrial Fibrillation. Warfarin carries a risk for bleeding, however, and requires careful monitoring. Those at particular risk for bleeding are patients with a history of alcohol abuse, chronic kidney disease, or previous gastrointestinal bleeding. In one study, elderly women were half as likely to receive warfarin than men were, most likely because they are at higher risk for bleeding than men are. Nevertheless, this agent is still the best choice for women as well as men in this patient group.
• Aspirin is less effective but also has a lower risk for bleeding. It is used by people who cannot tolerate anticoagulation therapy. It is currently the preferred treatment for younger patients and those with no other medical risk factors for stroke.

Electrical cardioversion. Electrical cardioversion is mild shock therapy and is the current standard treatment used to restore normal heart rhythm. It is conducted as follows:

• Anticoagulants (drugs used to prevent blood clotting) should be administered, if possible, at least three weeks before the procedure.
• During the procedure, the patient must be conscious and, although sedated, can experience some pain from the procedure.

Although the stabilizing effect is usually only temporary, some evidence suggests that a series of cardioversions may succeed in maintaining normal rhythm in young healthy patients without the need for antiarrhythmic medications.

Implanted cardioverters (eg, Atrioverter, Jewel AF) are being investigated for maintenance. Studies are very promising.