Atrial fibrillation is a condition in which the upper chambers of the heart, known as the atria, beat too fast and with an irregular rhythm. People with atrial fibrillation have a higher risk of stroke or heart failure. Atrial fibrillation management varies according to the individual's risk of stroke and whether the condition is recent or long-standing. Available treatments include drugs which can slow the heart rate, create a regular heart rhythm and lower the risk of blood clots and strokes. A technique known as electrical cardioversion uses electric shocks to correct the heart rhythm, and artificial pacemakers can be used to control the heartbeat permanently if required.
Older people are more frequently affected by atrial fibrillation. It is a common disorder and is most often caused by high blood pressure. Other causes may include heart disease, alcohol abuse and an overactive thyroid gland. Symptoms of shortness of breath, dizziness, palpitations and pain in the chest can occur. Atrial fibrillation management aims to lower the heart rate, in most cases, and to restore a normal rhythm where possible.
As part of atrial fibrillation management, an anticoagulant drug is usually given, which acts to reduce the risk of blood clots forming in the heart chambers. There is a chance that blood clots could occur inside the atria because atrial fibrillation stops the chambers from emptying completely, leaving blood sitting inside. A clot could then travel in the circulation and become lodged inside a brain artery, giving rise to a stroke.
In addition to anticoagulant medication, atrial fibrillation management generally includes the use of drugs such as beta blockers and digoxin to slow the heart rate. AV node ablation therapy is a technique in which a thin tube called a catheter is passed into the heart. It is used to direct electrical energy, which destroys the AV node that connects the upper and lower heart chambers. After the procedure, although the atria still beat abnormally, this no longer affects the ventricles, or lower chambers, of the heart. An artificial pacemaker can then be inserted to control the rate at which the ventricles contract and pump blood from the heart.
Atrial fibrillation management may also involve restoring the heart's regular rhythm. Cardioversion is more likely to be used for patients who are younger, and whose fibrillation has started recently. It is also more likely to be chosen as an atrial fibrillation treatment where there is an underlying cause which has been found and corrected. People for whom atrial fibrillation is worsening an existing heart condition, such as angina, may also benefit from cardioversion. For other patients, including those who have had atrial fibrillation for a long time, drug treatment may be the preferred option to restore a regular heartbeat.