Treatment of Atrial fibrillation

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The treatment will vary from case to case and requires expert attention from a heart specialist (cardiologist). The first step is to be sure whether the cause of the atrial fibrillation is known and can be treated. If so, this may be all the treatment that is required.

The initial treatment is aimed at reducing the beating rate of the left ventricle to between 60 and 100 beats per minute, by the use of drugs such as the heart-strengthening digoxin, the beta blockers [CC1] or the calcium-channel blockers, or a combination of these drugs. Some combinations, however, can produce dangerous slowing of the heart.

Anticoagulant drugs [CC2] are commonly used to prevent problems such as strokes from blood-clot embolism. In any case that is diagnosed early, a decision also has to be made about whether to attempt to reverse the fibrillation with electrical shock (cardioversion). This procedure is most likely to be successful when the atrial fibrillation has lasted only a short time.

In patients who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation and embolism. In such cases anticoagulant treatment with warfarin [CC3] (a drug used to prevent the blood from thickening into clots) is given for three weeks before cardioversion and for at least four weeks afterwards. Electrical cardioversion has a success rate of more than 90% when given to those patients who are most likely to benefit from it.

When anticoagulation treatment is required but there are medical reasons for not using warfarin or the patient does not wish to take it, a good effect can be achieved from taking a quarter of a standard aspirin tablet (75 mg) each day. Research suggests that in low-risk patients with atrial fibrillation, aspirin is as effective as warfarin in preventing stroke.

There have been recent concerns about the effects of cranberry juice on the effectiveness of warfarin. The Committee on Safety of Medicines is is currently reviewing reports, which suggest that cranberry juice acts to increase the potency of warfarin and may therefore increase the risk of haemorrhage. Present advice is to avoid or limit drinking cranberry juice if you are taking warfarin, until the situation has been investigated further.

Another possibility is to implant an artificial pacemaker to replace the job of the atrioventricular node. This treatment may be considered in patients in whom medication is ineffective or unsuitable.