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The treatment of atrial fibrillation, depending on the patient’s condition and appropriate medical checks, can take place in different ways. The atrial fibrillation therapy can be both pharmacological – that surgical. Before establishing how to treat atrial fibrillation, a careful evaluation of the patient is carried out which takes into account the type of arrhythmia, of the severity level and of the possible concomitance with other cardiac pathologies.
Depending on the severity, duration and manner in which it occurs, atrial fibrillation is distinguished in different types.
“Paroxysmal” means a sudden form of arrhythmia and tends to stop on its own. It has a transitory character that is intermittently, and can be resolved even within a week. It is also distinguished by a very high frequency: in cases of paroxysmal atrial fibrillation, the beat reaches a value of more than 140 beats per minute, against the normal frequency of between 60 and 100 beats per minute. Although paroxysmal fibrillation it can come back on its own, it is good to consult a specialist, an arrhythmologist to be precise, because intervening late can expose you to risks and make treatment more difficult.
There is the possibility of treating atrial fibrillation with drug therapy which includes antiarrhythmic drugs, beta-blockers, calcium antagonists, anticoagulants (the latter having the effect of eliminating the danger of cerebral stroke), capable of maintaining the normal heart rate. In fact, anti-arrhythmic drugs are used that can modify the electrical activity of the heart, determined by the ions and its response to stimuli, in order to prevent or stop the arrhythmias.
Other times the treatment of atrial fibrillation should be based on blood thinners (anticoagulants) that reduce the risk of blood clotting, reducing the likelihood of a stroke. In the presence of other risk factors (hypertension , diabetes mellitus , heart failure, age) the anticoagulant drugs will be prescribed for life.
In some rare cases, if the risk of stroke is very low or if the episodes of atrial fibrillation have disappeared completely, then it may be possible to stop taking medication.
The decision on what to do in case of atrial fibrillation and which drug is the most appropriate for the patient will be taken following a discussion with the specialist who will assess the individual risk of stroke and the risk of bleeding with the drug.
When drug therapy is ineffective, atrial fibrillation involves an intervention that today can be performed with advanced and minimally invasive techniques that go to restore the regular heart rhythm.
Cardioversion for the treatment of atrial fibrillation
To stop atrial fibrillation, electrical or pharmacological cardioversion is performed.
The pharmacological cardioversion of atrial fibrillation employs drugs that act by modifying the electrical properties of the heart to reduce outbreaks that give rise to irregular activities and facilitate the return to regular rhythm.
In electrical cardioversion, the arrhythmologist, by means of electric shocks, basically tries to reset the heart rhythm and restart it on a regular basis.
From a technical point of view, electrical cardioversion of atrial fibrillation consists of the transthoracic application of direct current synchronized with the electrical activity of the heart.
There Electrical cardioversion for atrial fibrillation is the most effective method: success rates are between 70 and 99% of cases. This depends on several factors, such as the characteristics of the patients and the waveform used for the shock.
The clinical variables that can influence the result of electrical cardioversion are: duration of atrial fibrillation the presence of other cardiopathies, the size of the left atrium, the highly sensitive reactive C protein and the sleep apnea syndrome.
The following patients are candidates for electrical cardioversion:
- patients with persistent atrial fibrillation associated with severe hemodynamic impairment, for which pharmacological cardioversion is not sufficient
- patients with persistent atrial fibrillation longer than seven days, in whom the restoration of sinus rhythm is considered appropriate
- patients with persistent atrial fibrillation lasting less than seven days, as an alternative to drug treatment
- patients with particularly high heart rates with severe symptoms
- patients on chronic treatment with antiarrhythmic drugs