Treatment Options for Chronic Atrial Fibrillation

Atrial fibrillation (AFib) can be classified into different types, including idiopathic or lone AFib, which is not associated with other heart diseases. Managing chronic atrial fibrillation involves a comprehensive approach aimed at restoring normal heart rhythm, controlling heart rate, and preventing complications such as blood clots and stroke.

Rhythm Control Strategies

One of the primary goals in treating atrial fibrillation is to restore and maintain a normal sinus rhythm. This can be achieved through various methods including pharmacological therapy, electrical cardioversion, or surgical interventions. Antiarrhythmic drugs like amiodarone, ibutilide, and sotalol are commonly prescribed to help restore normal heart rhythm. Electrical cardioversion, which involves delivering a controlled electric shock to the heart, is another effective option. In cases where medications are not effective, procedures such as radiofrequency ablation, cryoballoon ablation, or the Maze procedure may be considered. These procedures have high success rates, especially in patients with smaller atrial sizes, with reported success rates of 80–90% for drug-refractory AFib and 70–80% for persistent AFib.

Heart Rate Management

For patients who are unable to achieve rhythm control or who have long-standing permanent AFib, managing heart rate becomes a key treatment focus. The goal is to keep the heart rate within a safe range to prevent symptoms and complications. Typically, a resting heart rate between 60 and 80 beats per minute is recommended, with a maximum of 110 beats per minute during physical activity. Beta-blockers and digoxin are commonly used to achieve this goal, helping to reduce symptoms and improve quality of life.

Prevention of Blood Clots and Stroke

One of the most critical aspects of managing atrial fibrillation is reducing the risk of blood clots and subsequent stroke. Due to irregular heartbeats, blood can pool in the heart's upper chambers, increasing the likelihood of clot formation. To prevent this, anticoagulant medications such as warfarin or newer direct oral anticoagulants like rivaroxaban are often prescribed. Additionally, for patients who cannot tolerate long-term blood thinners, a minimally invasive procedure known as left atrial appendage closure may be performed. This procedure involves sealing off the left atrial appendage, where most blood clots form, thereby significantly reducing the risk of stroke.