Heart Health: Atrial Fibrillation

7. How do I prevent stroke and what are the different anticoagulants that can be used?

Anticoagulant agents, like Warfarin (Coumadin), Dabigatran (Pradaxa), Apixaban (Eliquis), and Rivaroxaban (Xarelto), are the main anticoagulants used to prevent stroke. Coumadin has been around for many years but recently the newer anticoagulants have become more of the standard of care because they require no monitoring of levels, and the levels do not fluctuate with diet. Also, the dose is constant and does not need to be adjusted. Aspirin can be used in patients who have very low risk of a stroke as determined by certain risk scores. Patients can be risk stratified by certain criteria and the appropriate stroke prevention strategy should be discussed with your doctor.

9. What are the different drugs used to control the rate and rhythm with atrial fibrillation?

Rate control is an important part of the treatment of atrial fibrillation to prevent symptoms and complications. Beta blockers, like Metoprolol (Toprol XL), Atenolol, and Propranolol (Inderal), and calcium channel blockers, like Diltiazem (Cardizem) and Verapamil, are commonly used to slow down the heart rate. In addition, the drug digoxin can be added to either a calcium channel blocker or a beta blocker for better rate control.

Antiarrhythmic drugs, like Amiodarone and Dronedarone, are also an option in patients who continue to have symptoms, even when the rate of the atrial fibrillation is controlled. In these cases, it is important to maintain sinus rhythm and these drugs work to restore sinus rhythm.

9. What is an atrial fibrillation ablation and who is a good candidate for this procedure?

Catheter ablation is a minimally invasive procedure used to treat atrial fibrillation. Most often this is done when medications are ineffective for controlling symptoms. During this procedure, a catheter is inserted into a vein, typically in the groin, and travels up into the heart. This catheter is used to deliver high energy, locally delivered radiofrequency signals to “ablate” the heart tissue where the abnormal impulses are originating from. This forms a scar or multiple scars that form a barrier that prevents electrical impulses from crossing between the damaged heart tissue to the surrounding healthy tissue. This will stop the conduction of the arrhythmia. There are a few risks to catheter ablations that include mainly bleeding and infection. One of the greatest drawbacks of atrial fibrillation is the need to redo the procedure for recurrent atrial fibrillation. This can occur about 30 percent of the time. The largest success rate is in patients who are under the age of 80 and have a normal ejection fraction.

10. How can I prevent atrial fibrillation?

To prevent atrial fibrillation, the key is to modify risk factors and avoid known triggers.

  1. Keep your weight in a normal range.
  2. Control high blood pressure.
  3. Avoid excessive amounts of alcohol and caffeine.
  4. Eat a heart healthy diet that is low in salt, saturated fats and cholesterol.
  5. Don’t smoke.
  6. Get regular activity.e

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  • M. M. Greenebaum February 27, 2017 at 12:28 pm

    Greetings. I read this with interest, thank you. Having had atrial fib from the time I was a young child, I was able to control it by squatting down, holding my breath, and applying pressure on my solar plexis. Eventually, as an adult, this solution worked less and less reliably! and I finally had an ablation which solved the problem. During the years before the ablation, however, I often was sent to the emergency room, by my cardiologist, where I was given an injection (sorry not to remember what) which immediately corrected it.