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If you have AF, non-invasive treatments include the following:

• Preventing blood clots . An anticoagulant drug called warfarin (Coumadin) is given. Anticoagulants are a group of drugs used to treat and prevent abnormal blood clotting. By disrupting the blood clotting mechanism, these drugs prevent an abnormal blood clot from forming. When a blood clot already exists, these drugs stop it from enlarging and reduce the risk of it breaking off and traveling to the brain. Aspirin is also an anticoagulant, but doctors prefer warfarin. Taking warfarin requires periodic monitoring of how well it is keeping the blood thin. This is done by taking a blood test to monitor clotting times. Based upon the results of the test, the dose of warfarin may be either increased or reduced.
• Reducing heart rate . There are three classes of heart-function drugs that can be used alone, or in combination to reduce the heart rate. They are digitalis drugs, beta blockers drugs and calcium channel blocker drugs. Digitalis drugs such as digoxin (Lanoxin) are used to increase the force of heart muscles contractions, making the heart work more efficiently. They also slow down abnormally rapid nerve impulses as they pass through the atria to the ventricles. This action allows the ventricles time to fill up with blood and empty normally with each contraction. Beta blockers such as atenolol (Tenormin), metoprolol (Lopressor), or propranolol (Inderal) are used to slow heart rate and reduce the force of contraction of the heart muscle. Calcium channel blockers such as verapamil (Isoptin) or diltiazem (Cardizem) are used to slow the passage of nerve impulses through the heart muscle.
• Restoring normal heart rhythm . To put patients back into "normal sinus rhythm" (NSR) doctors will sometimes use cardioversion or defibrillation. There are two types of cardioversion, drug cardioversion and electrical cardioversion. Drug cardioversion uses Type 1 antiarrhythmic medications such as Quinidine, Procainamide and Amiodarone to correct irregular heartbeats to a normal rhythm and to slow an overactive heart. The electrical cardioversion (defibrillation) is the choice of most doctors. This technique delivers an electrical current to the heart through two metal plates (paddles) placed on the chest. The sudden burst of electricity through the heart converts the fibrillation back into NSR.

After heart rhythm returns to normal, warfarin should be continued for a month. Some patients, with other heart diseases may need an anticoagulant for the remainder of their life. Most patients also need ongoing therapy with beta blockers, calcium channel blockers or other heart-function drugs.

Invasive treatments

In 10 percent of all cases, AF cannot be managed with medications and patients continue to have episodes despite drug treatment. In such cases, there are several invasive procedures available.

The most common is called catheter ablation (CA). A flexible tube called a catheter and miniature instruments are inserted into the heart through a blood vessel. Using radiofrequency energy the atrioventricular node is destroyed. This prevents the fibrillating atria from sending excess electrical impulses to the ventricles. In almost all cases this procedure causes a complete block of the heart's electrical impulses and a pacemaker must be installed to establish normal heart rhythm.

More recently, a procedure called pulmonary vein isolation (also called pulmonary vein ablation) has been developed. This procedure uses radiofrequency energy to create scars on the four pulmonary veins to prevent them from initiating electrical impulses to the atria, thus preventing AF. The procedure has shown promise, with success rates greater than 80% in some centers. There are some complications, however, related to the scarring.

Additionally, there is a surgical procedure called the Maze Procedure. In this open-heart surgery, a maze of incisions made in the atria blocks the flow of excess electrical impulses within the chambers. This prevents the development of a chaotic atrial rhythm and allows the impulse from the sinoatrial node only to get to the atrioventricular node. This procedure is reserved for patients whose symptoms are severe, the AF cannot be controlled by medications, and for patients with AF who are undergoing heart surgery for other reasons.

Questions To Ask Your Doctor About Paroxymal Atrial Fibrillation