¿Qué tratamiento para la fibrilación auricular es adecuado para usted?

A diagnosis of atrial fibrillation (AFib) can be scary. But it’s a condition that affects millions of Americans and—thanks to advances in the field of electrophysiology—is manageable in the vast majority of cases.

In fact, the question typically now is no longer, “Can anything be done to manage it?” But rather, “What is the best treatment approach?”

AFib treatment: What to know

Any treatment strategy for AFib must address two factors. First, the abnormal heart rhythm and symptoms it causes (like dizziness, chest pain and fainting), and second, the increased risk of stroke. People living with AFib, plus other risk factors such as high blood pressure or diabetes, are at a 450 to 500% higher risk of stroke.

The right AFib treatment plan to address both factors is based on many variables:

• Años
• Género
• Your risk factors
• Historial médico
• Presence of other cardiovascular conditions, like heart failure

The most important consideration when determining a treatment is the type of AFib you are experiencing:

• Paroxística: dura una semana o menos y se detiene por sí sola
• Persistente de corta duración: dura más de una semana y menos de un año
• Persistente de larga duración: dura más de un año.

Medicamentos

There are several medications that treat rhythm-related issues associated with AFib, with even more medications available to help manage your stroke risk.

Si tiene episodios breves e infrecuentes de fibrilación auricular (paroxística), es posible que le receten medicamentos para que los tome solo cuando los necesite, de forma similar a un inhalador de rescate para las personas con asma leve. Sin embargo, a la mayoría de las personas se les recetan medicamentos para que los tomen de forma continua a intervalos regulares para evitar que ocurra un episodio de AFib.

Some medications must initially be given in a hospital setting before transitioning home, while others can be prescribed in the doctor’s office. Sometimes even with an electrocardiogram or other blood tests and visits with a specialist, it can be difficult to predict which medicine will be effective, but they’re usually prescribed considering which will be the safest and most effective for you.

Here are some tips for working with your physician on choosing and using the best medication for your AFib:

• Discuta los riesgos y beneficios de cada medicamento con su médico
• Comparta su historial médico personal y familiar, y cualquier otro factor de riesgo potencial
• Cumplir con todas las recomendaciones de dosificación y tiempo de dosificación de cerca.
• Haga un seguimiento con el consultorio de su médico si experimenta algún efecto secundario y para recibir atención de rutina.

Debido a la naturaleza progresiva de la fibrilación auricular, los medicamentos suelen ser un punto de partida o se usan junto con otra terapia.

It is not uncommon to try different anti-arrhythmic medications or use them in combination with the ablation procedure and lifestyle changes for a more effective, long-term suppression of the arrhythmia.

Ablación con catéter

Catheter ablation is a minimally invasive procedure that uses wires and balloons threaded through tubes to isolate the tissue—usually in or around the pulmonary veins—causing AFib and cut the pathways that impact heart rhythm. An ablation procedure uses heat or extreme cold to neutralize the problematic area.

La ablación con catéter es un procedimiento seguro con una alta tasa de éxito (aunque las tasas de éxito pueden variar según el tipo de AFib). Debido a esto, a diferencia de muchos procedimientos médicos, no se considera un "último recurso" y, a menudo, es un método de tratamiento preferido incluso en personas más jóvenes y saludables con el objetivo de ahorrarles medicamentos de por vida.

However, ablation is not always used to attempt to cure AFib. For people with persistent or longstanding AFib, the goal of the procedure may simply be to better control it. This is referred to as a rate-control strategy rather than a rhythm-control strategy and is often used together with medication.

Ablación quirúrgica

En lugar de usar el acceso a través de los vasos sanguíneos de la pierna, el cirujano hace pequeñas incisiones entre las costillas para realizar la ablación desde el exterior del corazón. Esto crea tejido cicatricial que, con el tiempo, ayudará a normalizar el flujo eléctrico en el corazón y el ritmo cardíaco.

Si bien se puede usar como un procedimiento independiente, se realiza con mayor frecuencia junto con otro procedimiento cardiovascular, como una cirugía de derivación, una cirugía de válvula o una reparación de aneurisma.

Left Atrial Appendage Occlusion (LAAO) procedure

A Left Atrial Appendage Occlusion (LAAO) procedure is a minimally invasive procedure that may be considered as an alternative to blood thinners if your AFib is not caused by a heart valve problem. An LAAO implant is a cardiac device that is roughly the size of a quarter. The procedure is performed in a catheterization lab, and your cardiologist inserts a parachute-shaped implant into the left atrium (LAA), located at the top of the heart to help prevent the forming and circulation of blood clots.

Cardioversión

People who develop persistent AFib could also have their heart rhythm reset to a normal sinus rhythm through a procedure known as cardioversion.

Cardioversion is a highly effective way of restoring normal rhythm. It consists of delivering a controlled electrical shock to the heart to reset the electrical activity in the heart muscle. This procedure is very safe for people who have been on uninterrupted anticoagulation, which is the continuous use of blood thinners for three weeks or more.

Terapia con dispositivos y más allá

People with persistent AFib that has led to a slower heart rate—or who are on medications that have slowed their heart rate—may need a pacemaker, a commonly used implant for people with AFib. Pacemakers help regulate the pace of the heart rhythm and are more likely to be used in those with congestive heart failure in addition to AFib. There are other therapies such as cardioversion, which uses electric shocks to restore a normal rhythm in certain people with AFib.

There are also exciting new therapies currently in clinical trials that will further expand treatment options in the coming years.

3 main treatment goals for people living with AFib

There are three main treatment goals for people living with AFib.

1. Avoid a stroke

It’s important to control your heart rhythm so you can do all you can to prevent a stroke or stroke recurrence when living with AFib. Several medications, such as blood thinners, can be used to help control the risk of stroke. Other things you can do to help lower this risk includes:

• Mantener un peso saludable
• Eat foods that positively impact your health
• Ejercicio
• Getting quality sleep
• Avoiding alcohol or smoking.

2. Prevent damage to the heart muscle

It is important to prevent damage to the heart muscle from beating too fast for too long, a condition known as tachycardia-induced cardiomyopathy or heart failure. Living a healthy lifestyle and managing risk factors can help to minimize the strain on your heart and reduce the likelihood of AFib episodes causing further damage.

3. Restore your well-being

The overall goal is to eliminate any ongoing symptoms you may be experiencing from AFib, including:

• Molestias en el pecho
• Dificultad para respirar
• Mareo
• Fatiga
• Palpitaciones del corazón

While ideally, we would like to correct the arrythmia, AFib is often recurrent and difficult to completely eliminate. Ongoing treatments and monitoring are commonly necessary. However, treating other conditions and adopting lifestyle changes may help prevent the recurrence or progression of AFib.

Between what is already available and what is sure to come, you have more ways than ever before to keep your heart healthy—so you don’t have to skip a beat.

Want to learn more about AFib treatments? Find heart care near you.