Focused Treatment for Atrial Fibrillation

September 25, 2024

Atrial fibrillation, or AFib, is a heart rhythm issue affecting more than 2 million American adults, according to the National Heart, Lung, and Blood Institute. Left untreated, AFib can cause your heart to race, and you may experience shortness of breath, dizziness, lightheadedness or fatigue. Additionally, AFib increases your stroke risk.

While this abnormal heart rhythm can go away on its own, it often causes symptoms for years or a lifetime. Fortunately, there are a growing number of ways to manage the condition. What treatment for atrial fibrillation is right for you? That depends.

“Treatment of atrial fibrillation requires a personalized, tailored approach,” says Jim Cheung, M.D., FACC, FHRS, professor of Medicine and cardiac electrophysiologist at Weill Cornell Medicine. “Proper treatment entails three things: reduction of stroke risk, symptom control and lifestyle modifications.”

Reducing Your Stroke Risk

With atrial fibrillation, your heart rate may exceed 180-200 beats per minute. At the same time, the upper heart chambers fall out of sync with the lower chambers. This fast, out-of-sync heart rhythm creates three problems.

Weak heartbeat. When the heart works too fast, each heartbeat may generate a weaker pulse due to worsened filling and contractility of the heart.
Blood pooling. Weakened upper chamber contractions during AFib can lead to pooling of blood.
Clot formation. Over time, this pooled blood can clot. If that clot escapes the heart, it can travel to the brain vessels and interrupt blood flow, which can cause a stroke.

Your risk for stroke increases with age, high blood pressure, diabetes or heart failure. Treating atrial fibrillation can reduce the risk of stroke. Treatment options include:

Blood thinners. Medication that helps keep your blood thin can reduce the likelihood of clots forming. If your stroke risk is low, you may reduce your risk with aspirin. Otherwise, your provider may prescribe warfarin or another blood-thinning medication.
Left atrial appendage occlusion. The left atrial appendage is a pouch of the left upper chamber of the heart, a common location of blood clots that form due to AFib. With a minimally invasive approach, a device can be deployed to block the opening of the left atrial appendage to prevent the formation of clots. This device can reduce the risk of stroke in patients with AFib and be an appropriate alternative to blood thinners in select patients with AFib.

AFib Treatment for Symptomatic Control

In addition to managing stroke risk, treating atrial fibrillation can help reduce symptoms and the probability of developing heart failure. Your treatment choices depend on the root source of your AFib symptoms.

Slow It Down

When your AFib symptoms are linked to your racing heart, you need to slow your heart down. Otherwise, your heart is at risk.

“If patients are at rapid heart rates for long periods of time,” Dr. Cheung says, “it can actually weaken the heart muscle.”

To control your racing heart, Dr. Cheung recommends medication. Options include:

Beta blockers. This common medication slows your heart rate, which reduces AFib symptoms.
Calcium channel blockers. Like beta blockers, calcium channel blockers can slow your heart rate. They also relax blood vessels, causing them to widen. This lowers blood pressure and increases blood flow.

Restoring Normal Rhythm by Stopping AFib

In a healthy heart, all parts work together to push blood into the body. Atrial fibrillation disrupts the rhythm between the lower and upper chambers, decreasing the heart’s efficiency. When top and bottom parts aren’t in sync, restoring normal rhythm can lead to significant improvements in cardiac function.

A common way to restore heart rhythm is electric cardioversion. This procedure includes:

Anesthesia. An anesthesiologist delivers anesthesia using an intravenous (IV) line. This medication helps you relax and remain unconscious during the procedure.
Electrodes. Electrodes placed on your chest (and possibly your back) monitor your heart’s electrical activity. A cardioversion machine records this information, which a cardiologist reviews in real-time.
Shocks. The cardiologist sends a low-energy shock to your heart muscle to get the top and bottom back in sync. If necessary, you receive multiple shocks.
Recovery. Your care team monitors you at the hospital for a few hours to ensure your heart rate and blood pressure remain stable.

Maintaining Normal Rhythm With Treatment

“Oftentimes, the hard part isn’t getting the patient back in normal rhythm,” Dr. Cheung says. “Rather, it’s getting them to stay in normal rhythm.”

For some patients, AFib can be paroxysmal, where it goes in and out of rhythm again and again. In others, AFib can return even after successful cardioversion. Therefore, treatment to keep patients in normal rhythm include:

Catheter ablation. An electrophysiologist guides a thin, flexible tube (catheter) to your heart through a vein in your groin. The electrophysiologist identifies the areas causing the abnormal heart rhythm and delivers energy to stop AFib at its source. This energy destroys the tissue, helping the heart regain regular rhythm. Recent innovations in catheter ablation therapy have made this procedure more effective, shorter in duration and safer for patients.
Antiarrhythmic drugs. Different medications that affect cardiac rhythm can keep patients in normal rhythm. The selection of the proper medication involves consideration of each patient’s disease profile and risks for side effects.

Fighting AFib on the Daily

No matter what other treatment for atrial fibrillation your provider prescribes, a healthy life helps control your symptoms. Lifestyle tips for AFib management include:

Maintain a healthy diet and exercise regularly. Dr. Cheung considers this a great way to reduce atrial fibrillation flares, especially for individuals who are obese. Alcohol has been well-established as a trigger of AFib, so reducing alcohol intake can significantly reduce AFib events.
Manage your other health issues. High blood pressure, diabetes, sleep apnea and chronic lung disease can all play a role in AFib. Treating atrial fibrillation properly requires you to manage these other chronic conditions as well.
Stop the stress. Stress does many things, including bringing on and worsening AFib. Practicing stress management can reduce your risk for worsening symptoms. The American Heart Association recommends meditation, yoga, spending time outside and positive self-talk.

“There’s no one-size-fits-all approach for atrial fibrillation,” Dr. Cheung says. “You need to educate yourself and speak to your doctor to figure out the best treatment for you.”

Could your heart use a helping hand? Weill Cornell Medicine is home to a comprehensive team of heart specialists who are eager to get your heart back in rhythm. Schedule an appointment with an arrhythmia and electrophysiology specialist.

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Clinical Service

Cardiology

Practice

Cardiology - Starr Pavilion

Physician

Jim Cheung