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Non-surgical Treatment

Get your heart back to beating the way it should.

Non-surgical Treatments for AFib

Depending on the patient’s individual needs, there are a number of treatment options available. Treatment is designed to reduce the risk of stroke and either cure or manage AFib.

The choice of treatment depends upon the severity of the symptoms, the likelihood of response to a particular treatment, and consideration of the risks versus the benefits of treatment.

Historically, treatment of AFib has taken one of six forms:

  • Medications to restore a normal heart rhythm and blood thinner to prevent stroke
  • Cardioversion, to shock the heart back into normal rhythm
  • Pacemakers, to prevent slow heart beating during AFib or from drugs used as treatment
  • Ablation, a procedure to create scar tissue and removes areas of the heart that cause fibrillation
  • Cryoablation, a new and safe method of treating and often eliminating the most common irregular heartbeats (arrhythmias) in both children and adults, with less chance of complications than other treatments.
  • Experimental treatments

Medications

Blood thinners (anticoagulants) are prescribed to prevent blood clots that could lead to a stroke. Warfarin (Coumadin™) until about ten years ago was the most commonly prescribed drug and is shown to reduce the risk of stroke by 68-85% compared to no treatment at all. Now a newer class of drugs called NOACs (Novel Oral Anticoagulants) or DOACS (direct oral anticoagulants) is available. They include drugs like Xarelto™, Eliquis™, Pradaxa™ and Savaysa™. These drugs have the advantage in that they are less likely to cause bleeding in the brain, easier to administer and do not require blood tests for monitoring. ALL blood thinners have an undesirable side effect of bleeding. The most common site of bleeding is in the GI tract which can be life threatening. Rarely patients can bleed inside their brain which is typically fatal. However, a new form of therapy called left atrial appendage occlusion is available that in over 95% of patients avoids the need for any blood thinner other than a baby aspirin.

To achieve this level of protection, it is important to maintain the correct level of warfarin in the blood. Too little and clots can form; too much and severe bleeding problems can occur. Since many other drugs, dietary supplements, and foods can affect warfarin levels in the blood, it is important for patients to follow their doctor's instructions closely and have blood levels checked regularly. The newer agents, DOACS and NOACs do not require any blood monitoring, but are dosed based on kidney function, age and weight.

Rate-control drugs control the heart rate during AFib and rhythm control drugs (anti-arrhythmics) try to bring the heart back into normal rhythm. These drugs can offer a degree of success, but many patients have problems tolerating side effects or cannot use them due to interactions with other drugs they may be taking. Often, antiarrhythmic drugs lose effectiveness over time.

Cardioversion

For most individuals with chronic atrial fibrillation, or those whose symptoms do not improve with medications, a normal heart rhythm can be restored by applying a controlled electric shock to the heart. Called cardioversion, the procedure breaks the pattern of abnormal electrical signals, and is performed under careful medical supervision. Short-acting sedatives are used so patients do not feel pain or discomfort. It is possible to restore the heart's normal rhythm using medication, but attempts at drug cardioversion are limited because of the potential for serious side effects.

Pacemaker

A pacemaker is a small device implanted under the skin near the collarbone that monitors the heart's rhythms and sends a controlled electrical pulse to the heart muscle if it identifies a slow rate. A permanent pacemaker is only considered for patients who are unresponsive to medical therapy (i.e., medication and cardioversion) and have significant symptoms.

Placement of a pacemaker occurs in a lab. In some instances, the physician will need to sever the atrio-ventricular node (AV), part of the heart’s electrical conduction system that runs from the heart’s atrium (upper part) to the ventricle (lower part). This routine procedure immediately slows the heart's rhythm. However, once the electrical impulses to the ventricle are cut, the heart rate will drop to about 40 beats per minute. Consequently, a pacemaker is implanted to establish a reliable, vigorous beat.

The procedure is typically performed in under two hours, and patients are usually symptom-free as a result. Patients are required to see their caregiver regularly for a pacemaker check. Because of the special characteristics of the procedure, most patients are not eligible for ablation of the AV node and pacemaker. Even though the heartbeat is now regular, the upper chambers continue to fibrillate and the risk of stroke persists. We are worldwide pioneers of conduction system pacing which is a unique technique that restores the normal activation of the heart muscle by the specially inserted pacing leads.

Ablation

The heart produces, in essence, electricity. During ablation, one or more flexible catheters are inserted via X-ray into the blood vessel and directed to the heart muscle. Tiny electrodes at the end of the catheter help the doctor detect faulty electrical sites that are causing the heart to beat irregularly and too fast.

The doctor can then send a burst of heat in the form of radiofrequency energy to destroy tissues that are creating abnormal electrical signals responsible for the irregular heartbeat. Catheter ablation can take four to six hours and typically requires a one- or two-night hospital stay. When successful, catheter ablation ends the need for taking heart rhythm medications. Our specialists have performed over 500 radiofrequency ablation procedures. 

We are one of the first three centers in the world to pioneer ablation for treatment of atrial fibrillation and we have performed this procedure in over 10,000 patients for now more than 23 years. We have one of the most experienced teams in the country for safely and effectively performing these procedures. We continue to study virtually all new therapies for controlling atrial fibrillation including new ways to map and individualize therapy for patients with atrial fibrillation. Several recent studies have highlighted the superiority of ablation over drugs and in particular earlier therapy with ablation to prevent progression to persistent or permanent atrial fibrillation.

We are currently testing new forms of energy to treat atrial fibrillation. The latest is electroporation which has the unique promise of incredible safety and efficacy.

Cryoablation

Cryoablation is a new and safe method of treating and often eliminating the most common irregular heartbeats (arrhythmias) in both children and adults, with less chance of complications than other treatments. This technique uses a painless freezing method, rather than heat, to disable arrhythmias permanently.

This freezing technique is also called cryotherapy. It involves threading a small catheter into the heart and freezing the tissue causing the heart to beat irregularly.

Unlike current methods for treating arrhythmias, cryoablation allows cardiologists the advantage of testing the site for accuracy before carrying out the actual procedure. By threading a catheter through veins from the groin into the heart, cardiologists can map the heart's electrical impulses and freeze tissue suspected of creating a disturbance.

Physicians test potential ablation sites by temporarily chilling tissue in the target area. Cells that prove to be non-targets are returned to normal temperature and function before the physician repositions the catheter. Once the target site is pinpointed, the catheter tip is cooled to negative-75 degrees Celsius to freeze the affected tissue.

We have pioneered the cryoballoon technology for ablating the pulmonary veins since its first initial clinical trials over a decade ago. Cryoballoon ablation has some advantages in terms of safety and simplicity and cryoballoon ablation has been performed in patients up to 90 years of age.

WATCHMAN®
A new area of treatment at Pauley Heart Center involves use of the WATCHMAN®, a device designed to keep harmful blood clots that form in the left atrial appendage from entering the blood stream and potentially causing a stroke. The WATCHMAN® is permanently placed at the opening of the left atrial appendage, under common catheterization procedures. The procedure takes less than 1-2 hours. After 1-2 months almost all patients can stop their blood thinners and transition to a baby aspirin. We have had substantial experience and safety in performing this procedure, especially in elderly patients who cannot tolerate blood thinners due to bleeding. We are currently testing the WATCHMAN® as first line therapy to avoid blood thinners for most patients who have atrial fibrillation.