Heart & Vascular Institute - Texas Medical Center

1. Medication
   Cardiologists on staff normally prescribe medications as the first course of treatment for atrial fibrillation, including rate-control medications, antiarrhythmic drugs and anticoagulants.
      
2. Electrical Cardioversion
   Depending on the results of the patient’s examination and diagnosis, electrophysiologists may recommend electrical cardioversion to restore the heart to its natural rhythm. Following administration of a short-acting general anesthetic, a synchronized electric shock delivered to the chest wall restores natural rhythm in 70-90 percent of cases. Arrhythmia recurs in about 75 percent of patients.

Invasive Treatment Options

1. Catheter Radio Frequency Ablation
   Radiofrequency ablation (RFA) is offered to patients who do not respond to or tolerate medication. The electrophysiologist isolates areas in the atria that trigger fibrillation, then uses a small, flexible catheter capped with an electrode to ablate lesions outside the pulmonary veins. The procedure is repeated around all four pulmonary veins where they connect with the left atrium, forming lesions that create a circular electrical barrier around the veins to block abnormal impulses. The minimally invasive procedure stops, or greatly suppresses, atrial fibrillation in 70-80 percent of cases.

1. Pacemaker Implantation
   Pacemakers are occasionally used in combination with an invasive procedure that disconnects the ventricles from the atria to control pulse rate during atrial fibrillation.
      
   
2. Minimally Invasive Surgery
   In open-heart maze surgery, surgeons make a series of precise incisions in the muscles of the atria, allowing scar tissue to form and block abnormal electrical impulses. While open surgery has shown a high success rate in treating atrial fibrillation, it requires a sternotomy and heart-lung support.
   
   The minimally invasive approach requires three small incisions on both sides of the chest. Guided by a tiny camera, the physician inserts a special device through the ribs to clamp the sections of the atria where the disruptive electrical impulses originate. Radiofrequency ablation creates thermal lesions that interrupt abnormal electrical signals. Surgeons reduce the risk of postoperative clotting by removing the left atrial appendage, an extraneous structure where blood clots can form.
   
   Minimally invasive maze surgery stops atrial fibrillation in 80-90 percent of cases. Patients normally return to work in a few days, compared to four to six weeks for the traditional open surgery.

1. Risks and Treatment
   Identifying people at high risk for sudden VT death is the most important step in treatment. Risks for the disorder include:
• A long QT on ECG
• Hypertrophic cardiomyopathy
• Electrolyte abnormalities\
• Family history of sudden cardiac death
• A weakened heart
      
2. Medications
   Noninvasive treatment includes rate-control medications to slow the heart rate and antiarrhythmic drugs.
     
3. ICD Insertion
   Implantable cardioverter defibrillators (ICDs) implanted in the chest below the collarbone continuously monitor heart rhythm and deliver electrical shocks to restore rhythm and prevent sudden cardiac arrest. ICDs work through cardioversion (a low-energy shock delivered at the same time as the heartbeat), a higher energy shock and antitachycardia pacing.
      
4. Catheter Radio Frequency Ablation (RFA)
   RFA has a success rate of more than 90 percent in patients who qualify for the procedure. A cardiologist uses fluoroscopy to guide a thin, flexible catheter through a blood vessel to the heart cells causing the abnormal rhythm. Radiofrequency energy emitted from an electrode on the catheter’s tip destroys the abnormal cells.
      
5. Resynchronization Therapy
   Modifications of defibrillator configurations can help to restore the symmetry of cardiac contractions, improving the efficiency of the heartbeat. This adjunctive therapy is useful in improving heart failure symptoms in some patients.