Atrial Fibrillation Ablation, Pharmacological Therapy, and Cardioversion

Goals of Atrial Fibrillation Therapy

If you have been diagnosed with atrial fibrillation, it is highly likely that your cardiologist has also prescribed medication and given you advice on how to modify your lifestyle to help your heart regain its rhythm.

The initial treatment of this type of arrhythmia has two objectives:

• Restore the heart's rhythm and regularize the pulse;
• Prevent the formation of blood clots (thrombi), which in turn cause strokes and emboli, and therefore to regularly "coagulate" the blood and keep it fluid;

Pharmacological Treatment of Atrial Fibrillation

Antiarrhythmics in the Treatment of Atrial Fibrillation

In the case of drug or pharmacological treatment of atrial fibrillation, antiarrhythmic drugs are prescribed, which act on the electrolytes (sodium, potassium, calcium, magnesium) responsible for allowing electrical passage through the membrane of the sinoatrial node cells, such as:

• Class I antiarrhythmics (A, B, C), which act by blocking sodium channels;
• Class II antiarrhythmics, or beta-blockers, which also act on blood pressure, reducing it;
• Class III antiarrhythmics, which block potassium channels;
• Class IV antiarrhythmics or calcium channel blockers;

Anti-arrhythmic drugs have significant side effects because they interfere with the contractility of the heart.

Anticoagulants to Treat Atrial Fibrillation

In order to thin the blood and prevent the formation of blood clots in the heart, anticoagulants are prescribed, which may be taken for life, especially if there are other risk factors for stroke, such as being diabetic, hypertensive, or having already had heart disease or a heart attack.

Treatment of Atrial Fibrillation by Cardioversion

Types of Cardioversion

Cardioversion is a non-invasive procedure that can treat some forms of atrial fibrillation. There are two main types, the first being electrical. In practice, it is possible to restore the correct electrical impulse by generating a regular sinus rhythm through the application of a transthoracic device that sends a direct current via electrodes that harmonizes with the heart's electrical activity. In this way, the arrhythmia is interrupted and the heart's rhythm is "adjusted", without damaging the heart. The other type of cardioversion is pharmacological, which also modifies the heart's electrical activity in order to regulate the sinus rhythm using specific molecules.

When Can Cardioversion Be Used in Cases of Atrial Fibrillation?

However, of the two types of cardioversion, electrical cardioversion is undoubtedly the most effective, indicated for arrhythmic patients who belong to the following categories:

• Individuals with persistent atrial fibrillation and a compromised vascular and circulatory situation who do not respond to pharmacological cardioversion;
• Individuals suffering from persistent atrial fibrillation that does not stop after seven days;
• Individuals suffering from persistent atrial fibrillation who are treated with antiarrhythmic drugs to replace this treatment;
• Individuals with severe symptoms of atrial fibrillation and a very high heart rate;

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Atrial Fibrillation Ablation

What Does Atrial Fibrillation Ablation Involve?

There is a widely used method to treat this type of arrhythmia: atrial fibrillation ablation, which can be performed traditionally via catheter, or using "cold". It is a safe, minimally invasive and above all effective procedure, both in the short and long term, as it allows you, a young or relatively young patient, to resume a normal life without having to take the anti-arrhythmic drugs mentioned above, with their side effects. However, you should not stop anticoagulant treatment.

How is Atrial Fibrillation Ablation Performed?

Atrial fibrillation ablation is a procedure that solves the arrhythmia problem at its root, by causing small burns (ablations), which scar the areas of the atrium where the abnormal impulse begins. It is recommended for all patients suffering from arrhythmia, that is to say those who suffer from paroxysmal, persistent or permanent atrial fibrillation, refractory to medication and cardioversion, or who have concomitant heart disorders or other diseases such as diabetes. The standard procedure involves inserting a catheter into the heart from a vein in the groin.

Here are the steps of atrial fibrillation ablation:

• A catheter is inserted into a groin vein, under local anesthesia, with a metal tip capable of releasing hot energy, which is passed up to the heart;
• The procedure is monitored by fluoroscopy, a radiographic technique that allows continuous visualization of the inside of the vessels;
• Once in the heart, at the point of the atrium from which the fibrillation originates, the catheter emits radiofrequency energy that eliminates the fibrillation;
• At the end of the ablation itself, the catheter is removed;

The procedure is performed as a day hospital procedure under local anesthesia and sedation, lasts between two and four hours and is considered safe and minimally uncomfortable for the patient. Anticoagulant treatment must be followed before and after the procedure.

New Atrial Fibrillation Ablation Techniques

There is also a brand new atrial fibrillation ablation technique, called cryoablation, which involves inserting an inflatable balloon into a pulmonary vein, or even all four, because the electrical anomaly that leads to fibrillation often originates in these large vessels, and not just in the sinoatrial node. The balloon, once in place, is inflated and frozen to a temperature of -50° C, in order to "burn" (thanks to the energy of the cold), the defective point. This is also how atrial fibrillation ablation is performed.

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