The type of treatment depends on how long a patient has had AFib and its severity. But the goal is the same: reset the heart’s rhythm and ensure blood circulates properly.
Medication and lifestyle changes
A cardiologist may prescribe medications that control the heart’s beating and prevent blood clotting. They may also recommend lifestyle changes such as weight loss, stress reduction, avoidance of tobacco and alcohol, and treatment of sleep apnea.
Cardioversion therapy
If an AFib episode persists and causes intolerable symptoms or heart failure, cardioversion therapy might be recommended. Performed in a hospital, cardioversion therapy resets the heart’s rhythm — either with medicine or by an electric shock delivered through patches or paddles that are placed on the chest.
Anti-arrhythmic medications
Heart rhythm medications may be prescribed for patients with frequent AFib episodes. Some of these medications may simply slow down the heart rate to avoid rapid heart rates during AFib episodes. Stronger medications may alter the electrical properties of the heart muscle to prevent episodes from occurring at all. Some patients may experience side effects from these medications, and some medications require hospitalization for monitoring during their first few doses.
Catheter ablation
Catheter ablation is a procedure performed in a cardiac catheterization lab. There are several types of catheter ablation, though all have the same goal of eliminating the heart tissue responsible for the arrhythmia being treated. Traditionally, ablation is accomplished using either radiofrequency (heating) or cryothermal (freezing) energy. Although serious complications are rare, these types of ablation could damage the esophagus or phrenic nerve (which controls the actions of the diaphragm), or they may cause pulmonary vein stenosis.
Pulsed-field ablation
Boston Children’s specializes in a type of catheter ablation that is minimally invasive and has been shown to reduce risk: pulsed-field ablation (PFA). With a catheter, PFA delivers a targeted, high-voltage electric field to heart muscle cells causing arrhythmia. The electric field pulses eliminate the cells by creating pores in heart cell membranes without heating or freezing. This technology is widely used in the treatment of adults with AFib without CHD and drastically reduces the risks of damage to the esophagus, phrenic nerve, and pulmonary veins compared to traditional ablation energy procedures.
Electrophysiologists first try PFA on pulmonary veins that are causing AFib. Known as pulmonary vein isolation, this step creates scar tissue around pulmonary vein openings to block the faulty electrical signals. But many people with AFib need additional ablation, especially if there is dilation (stretching) or pre-existing scarring in the atria. PFA technology delivers larger and faster applications than traditional heating and freezing ablation, making the procedure shorter than others and requiring less time under anesthesia. Also, by causing less inflammation and pain than other types of cardiac ablation, PFA usually leads to quick recoveries; patients typically go home the same day or stay in the hospital one night for care and observation.
Pacemaker
A pacemaker is a small battery-powered device that is placed under the skin and monitors the heart’s rhythm. If the heart beats too slow, the pacemaker can send electrical signals to increase the heart rate to normal levels.
Implantable cardioverter defibrillator (ICD)
Like a pacemaker, an ICD is small and placed under the skin. It also senses if the heart is beating fast and will deliver an electrical shock to the heart to restore normal rhythm.
