Atrial Fibrillation Treatment
Each case of AFib is unique and requires customized treatment. Your treatment will likely depend on how severe your symptoms and how long you've had the condition.
The goals of AFib treatment are to:
- Normalize and control your heart rate.
- Prevent blood clots.
- Decrease symptoms.
At the UPMC Heart and Vascular Institute's Center for Atrial Fibrillation, we're certain we can find the right treatment for you.
AFib treatments on this page
Your doctor may suggest one or more of the following to treat your AFib:
- Medicine
- Cardioversion
- Implantable devices, such as pacemakers and defibrillators
- Surgery
- Catheter-based procedures
- The Watchman device
Medicine to treat atrial fibrillation
Doctors can control some less severe cases of AFib with drugs. Different drugs produce different results.
Blood thinners to prevent clots from forming and help reduce risk of stroke include:
- Warfarin (Coumadin®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
- Dabigatran (Pradaxa®)
- Edoxaban (Savaysa®)
- Aspirin
Rate control drugs to slow the heart rate, such as:
- Digitalis or Digoxin
- Verapamil
- Diltiazem (Cardizem®)
- Metoprolol (Lopressor® or Toprol-XL®)
- Atenolol
Rhythm control drugs to maintain a regular heart rhythm:
- Sotalol (Betapace®)
- Dofetilide (Tikosyn®)
- Flecainide (Tambocor®)
- Propafenone (Rhythmol®)
- Amiodarone (Pacerone® or Cordarone®)
- Dronaderone (Multaq®)
Based on your unique case, our AFib experts can decide if medical management is right for you.
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Cardioversion for atrial fibrillation
Cardioversion is a noninvasive treatment that restores the heart's normal rhythm with a shock or drug.
Electrical shock cardioversion:
- Sends a jolt of electricity through the chest wall to the heart.
- Interrupts the abnormal heart rhythm of AFib and often sets it right.
Most often, doctors will give you anesthesia before having this outpatient treatment.
Chemical cardioversion uses medicine to achieve the same effect.
The Cardiac Electrophysiology Program at UPMC's Heart and Vascular Institute offers both types for AFib and other heart arrhythmias.
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Implantable devices for atrial fibrillation
Some cases of AFib need regulation of the heart's functions.
Your UPMC doctor may suggest implanting one of the following devices to help control how the heart beats:
- Pacemakers adjust the heart's electrical impulses to improve pumping.
- Defibrillators give the heart a small electrical jolt that resets the rhythm if it strays from normal.
In both options, an electrophysiologist implants the device and connects its electrodes to the heart.
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Surgery for atrial fibrillation
If you have severe AFib and haven't responded to other treatments, the experts at UPMC's Center for Atrial Fibrillation may suggest surgery.
Surgery may be a more favorable choice for better long-term results when:
- Less invasive AFib treatments haven't worked.
- Changes to the heart's structure exist — such as enlarged heart chambers or a leaking valve.
Open MAZE surgery
MAZE surgery is the gold standard open approach to treat AFib.
During MAZE surgery, surgeons make tiny cuts in the heart to create a maze-like pattern of scars in the atria. These scars block the transmission of erratic electrical impulses.
Surgeons at UPMC's Center for Atrial Fibrillation are experts in the MAZE procedure. Our research and practice have helped evolve this treatment for AFib.
Minimally invasive MAZE surgery
For some people, surgeons use a minimally invasive approach that doesn't involve opening the breast bone.
Minimally invasive MAZE surgery for AFib:
- Offers the exclusion of the heart's left atrial appendage — the main region responsible for causing stroke in people with AFib.
- Allows many people to safely go off of long-term Warfarin (Coumadin®).
Isolated left atrial appendage ligation
Surgeons may suggest this type of surgery if you aren't a good candidate for MAZE surgery and can't take blood thinners. This minimally invasive approach closes off or ligates the left atrial appendage.
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Catheter-based ablation for atrial fibrillation
Ablation is minimally invasive and can help the heart achieve and maintain a normal rhythm. It removes or destroys (ablates) a small amount of tissue causing the abnormal heart rhythm of AFib.
At the Center for Atrial Fibrillation, our experts at ablation techniques have authored and published book chapters and research on the subject.
Types of ablation
- Radiofrequency ablation uses radio energy to apply heat to the tip of the catheter to burn the heart tissue.
- Cryoablation uses extreme cold to freeze and scar the heart tissue.
What to expect during ablation
Your doctor:
- Inserts a small tube or thin wire (catheter) in the veins to gain access to your heart's electrical conduction system.
- Uses advanced imaging techniques to observe and guide the treatment.
- Applies either heat or cold to the heart tissue.
Watchman™ device
The Watchman device offers a choice over blood thinners to lower the risk of stroke in some people with AFib.
The Watchman is a parachute-shaped, implanted device that closes off the left atrial appendage. This is the part of the heart most commonly linked to clot formation that could lead to stroke in people with AFib.
Many people take blood thinners to lower their stroke risk, but they aren't safe for everyone.
Some people who might benefit from the Watchman including those who:
- Have AFib not caused by heart valve disease.
- Have an increased risk of stroke and can't safely take blood thinners.
During a Watchman procedure, your doctor:
- Finds a vein in your leg.
- Uses special moving x-ray imaging, called fluoroscopy, to guide a catheter holding the device to your heart.
- Places the device in your left atrial appendage to close it off using ultrasound and x-ray guidance.
In most cases, a Watchman implant takes a little more than an hour. Over time, scar tissue forms around the device and closes off the left atrial appendage forever.
Finding new treatments for atrial fibrillation
Doctors around the world recognize our experts at the UPMC Heart and Vascular Institute for their research into the causes of arrhythmia. And in using their findings to design improved methods for diagnosing and treating AFib and other arrhythmias.
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