What are my treatment options for A Fib?
Wilber Su, MD, is a cardiologist and cardiac electrophysiologist at Banner Good Samaritan Medical Center.
Question: What are my treatment options for A Fib?
Answer: There are four categories of treatment for atrial fibrillation:
- Medication - using heart rate control medication or anti-arrhythmic medications
- Ablation - catheter minimal invasive surgery for potential cure
- Surgical MAZE, or
- Pacemaker implantation and AV node ablation
Medication: Medical therapy of atrial fibrillation are complex. Life-long medication are usually required and typically medication will lose its effectiveness after some time because atrial fibrillation is a progressive disease.
Studies show that even the best of the medication therapies will be only effective in less than 40 to 50% of patients in just one year after initiation of therapy. Often, side effects are the main limitations of these medications.
Ablation: Catheter ablation of atrial fibrillation is a potential curative procedure that has been developed by minimally-invasive method. Some patients may be very good candidates for atrial fibrillation ablation for potential cure. This is a procedure that has been evolving over the past decade, and many advancements have been made to make this as safe as possible.
Catheter ablation is performed by heart electrophysiologists who have undergone special training to perform this procedure. Studies show that the success rate and complication rate are highly dependent upon the physician, and experience is crucial.
Surgical MAZE: This is a procedure performed by a heart surgeon, either through open-chest surgery or a minimally-invasive thorascopic procedure. Incisions are made on the chest and similar ablation procedures are attempted to eliminate the triggers of atrial fibrillation. This is the procedure of choice if you have the need to perform heart surgery for other reasons, such as heart by-pass surgery or valve replacement surgery.
Pacemaker and AV node ablation: For some patients, atrial fibrillation may be extremely difficult to eliminate. In order to control the heart rate, a simpler procedure may be performed.
In this combined procedure an AV (atrium/ventricle) node ablation is performed after a pacemaker is implanted. The AV node ablation is a short procedure where a simple ablation is performed on the right side of the heart to disconnect the entire top chamber's electrical activity from the bottom. This in effect will eliminate the need for any drug therapies to slow down the heart. However, the heart will then beat too slow. Therefore, a pacemaker will need to be inserted to make the heart beat regularly.
The end result is that the heart will be beating regularly based on the setting of the pacemaker and the heart becomes dependent on the pacemaker.