How to Treat Acute Atrial Fibrillation

Atrial fibrillation (AFib) is a common type of irregular heartbeat that can lead to serious complications if not properly managed. When AFib occurs suddenly, prompt treatment is essential to restore normal heart rhythm and prevent further health issues. There are three primary treatment approaches for acute atrial fibrillation, each with its own benefits and success rates.

1. Radiofrequency Catheter Ablation

Radiofrequency catheter ablation is considered one of the most effective treatments for atrial fibrillation. This procedure involves using heat energy to destroy the abnormal electrical pathways in the heart that cause irregular rhythms. In cases of newly diagnosed AFib, the success rate of this treatment typically ranges between 70% and 80%. However, if the condition progresses to chronic persistent AFib, the success rate may decrease to around 60%.

2. Electrical Cardioversion

Another effective method for treating sudden-onset atrial fibrillation is electrical cardioversion. This procedure uses a controlled electric shock delivered through a defibrillator to reset the heart's rhythm. The shock is synchronized with the heartbeat to minimize risk and ensure effectiveness. Electrical cardioversion is often used in emergency situations and has a high rate of immediate success.

Procedure Overview

During the procedure, small paddles or patches are placed on the chest or one on the chest and one on the back. A brief, low-energy shock is then delivered while the patient is under sedation. Most patients experience rapid restoration of normal heart rhythm following the treatment.

3. Pharmacological Cardioversion

Medication is another viable option for managing acute AFib. Among the various drugs used, amiodarone hydrochloride (commonly known by the brand name Cordarone) is often the first-line treatment. For patients experiencing a sudden episode of AFib, a loading dose of approximately 600 mg is typically administered, followed by a long-term maintenance dose. This regimen usually continues for 3 to 6 months, depending on the patient's response and overall condition.

Key Considerations

Pharmacological treatment requires careful monitoring due to potential side effects and drug interactions. It is often used when immediate cardioversion is not possible or when maintaining sinus rhythm after successful rhythm restoration is the goal.

Ultimately, the choice of treatment depends on several factors including the patient's overall health, the duration of AFib, and the presence of other medical conditions. Consulting with a cardiologist or electrophysiologist is crucial in determining the most appropriate treatment plan for acute atrial fibrillation.