Treating AF and other arrhythmias

Atrial fibrillation (AF) is the most common arrhythmia and affects over 2 million people in the U.S. alone. With age, AF affects an increasing number of people: a little over 2% of people over 40; roughly 6% of people over 65; and about 10% of people in their 80s.

Why treat AF?

There are some very good reasons for treating AF and restoring regular heart rhythm. First, it makes the person feel better by preventing the symptoms associated with AF. In addition, side effects associated with medications may in some cases feel worse than the symptoms of the AF.

Another reason is to reduce the higher risk of stroke that is associated with AF.

An important consideration in treating people with AF is the presence of structural heart disease: heart valve problems, strength of the left ventricle, and the size of the left atrium. If patients have a weak left ventricle, if they have blockages in the heart arteries, or if they have had a heart attack, certain medications used to get the rhythm back to normal are too risky. The bigger the left atrium, the smaller the chance that normal rhythm can be safely restored and maintained by medications or ablation procedures.

In atrial fibrillation, erratic electrical signals make the atria quiver rather than beat in a normal manner

Treating arrhythmias

The recommended treatment for abnormally fast heart rhythms depends on the type of arrhythmia, the severity of symptoms, and whether other heart problems are present. The most widespread treatments for arrhythmias are antiarrhythmic medication, an implantable defibrillator, and catheter ablation.

Medication

There are various medications that can help restore normal heart rhythm and prevent further episodes of arrhythmia. However, they may not work as effectively as patients would like. Antiarrhythmic medications may also cause unwanted side effects, such as lethargy, and must be taken indefinitely – together, these two factors may add up to an unacceptable burden on otherwise healthy patients.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD) is a small electronic device placed inside the body where it monitors heart rhythm. When the ICD detects a potentially dangerous arrhythmia, it sends shocks to the heart to restore a normal heart rhythm. This is an effective way of dealing of dangerous arrhythmias such as ventricular tachycardia. Surgery is required to place the ICD inside the body. While an ICD is a form of treatment for tachycardias, it does not address the underlying problem that causes the arrhythmia.

Catheter ablation

Catheter ablation is used to disable parts of abnormal electrical pathways that cause rapid heart rhythms. During catheter ablation, an electrophysiologist inserts an electrode catheter – a long and flexible wire – through a vein right to the heart, where it targets the abnormal pathway. As it is a fairly low-risk procedure that can replace heart surgery, ablation is the preferred option for many patients. Catheter ablation is for patients who:

  • Want to be cured of their tachycardia
  • Don’t want to take heart rhythm medication for the rest of their lives
  • Don’t want to have to rush to the ER every time during arrhythmia episodes
  • Don’t want to have to worry about not being able to get to a hospital easily (for example, when traveling overseas or camping in a wilderness area)

Various energy sources may be used to disable abnormal electrical pathways, including heat (in the form of high-frequency radio waves) and cold energy, known as RF ablation and cryoablation, respectively.