Treatment of Atrial Fibrillation
Cardioversion
Some people can be controlled with medications to prevent atrial fibrillation. If atrial fibrillation is diagnosed within 24-48 hours of symptoms, the person can be electrically cardioverted to normal sinus rhythm.
This is a sameday procedure where a patient comes to a designated monitored area such as the emergency room, electrophysiology laboratory or same day procedure unit and receives an intravenous medication that will acutely convert the atrial fibrillation to sinus rhythm. Alternatively, some people would come to the same area, receive a sedating medication through an intravenous line and have electrical energy applied to the chest using paddles or specialized pads that connect to an external defibrillator. The whole procedure takes about 5-10 minutes. Generally, one has to remain at the hospital for approximately 2 hours after cardioversion to recover from the anesthesia.
If it cannot be determined how long a patient has been in atrial fibrillation or if it is greater than 48 hours, a person would need to be on warfarin (Coumadin)for anticoagulation for 3-4 weeks prior to conversion to sinus rhythm or undergo a transesophageal echocardiogram (TEE).
A TEE is done by a specially trained cardiologist with ultrasound imaging equipment. A special probe for visualizing the structures of the heart is placed into the esophagus after receiving IV sedation and spraying the back of the throat with a local anesthetic. The probe pictures the inside of the atria while the doctor studies and records it for further analysis.
Radiofrequency Atrial Ablation
If a person experiences frequent episodes of paroxysmal or persistent atrial fibrillation despite medication therapy, ablative therapy may be an option to prevent further episodes. Ablation therapy is when an energy source, currently radio frequency energy, is applied to an area in the heart that is a focus for an arrhythmia. In the case of atrial fibrillation, research shows that the source of electrical irritability is surrounding the os (opening) of each of the pulmonary veins. There are typically, four pulmonary veins that come off the left atria leading to the lungs.
Radiofrequency ablation is a catheter-based procedure in which radiofrequency energy is used to destroy (ablate) abnormal electrical pathways. Ablation is used to treat atrial fibrillation, atrial flutter, ventricular tachycardia, and paroxysmal supraventricular tachycardia.
Surgery
The most common arrhythmia surgery is the Modified Maze procedure. This minimally invasive procedure is typically reserved for patients whose atrial fibrillation has not been corrected with medication and for patients at high risk for blood clots or stroke, such as those who cannot take blood thinners. In this operation, a small incision is made in the left chest and the left atrial appendage is closed off so blood cannot stagnate inside of it and become clotted.
