Atrial Fibrillation Treatment

Lifestyle Management of Atrial Fibrillation

If you’ve been diagnosed with atrial fibrillation (AF) or are at risk for developing it, making certain lifestyle changes can significantly improve your heart health and reduce AF episodes. Here is a simple guide to lifestyle modifications that can help manage atrial fibrillation.

• Maintaining a healthy weight – Excess weight can negatively contribute to AF, therefore, losing weight through healthy eating and regular physical activity can help to reduce AF episodes.¹  The American Heart Association confirms that obesity is a risk factor for AF, and weight loss can reduce AF burden.
• Eat Heart-Healthy Foods – Prioritise a diet rich in fruits, vegetables, whole grains, lean proteins (fish, poultry, beans, nuts), and low-fat dairy products. Try to limit your consumption of saturated fats, trans fats, cholesterol, and sodium, and avoid processed foods and sugary beverages.
• Exercise regularly – Aim for at least 150 minutes of moderate-intensity aerobic exercise per week. Activities like brisk walking, swimming, or cycling can help maintain a healthy weight, lower blood pressure, and improve overall cardiovascular health.
• Manage stress – Chronic stress can trigger episodes of AF. Implement stress-reducing techniques such as deep breathing, meditation, yoga, and ensuring enough quality sleep every night.
• Limit alcohol and caffeine – Alcohol and caffeine can trigger AF in some patients. Limit your intake of alcoholic beverages and caffeinated drinks like coffee and tea.
• Quit smoking – Smoking is a significant risk factor for cardiovascular disease, including AF. Quitting smoking can significantly improve your heart health and reduce AF episodes.¹ 
• Monitor blood pressure and cholesterol – High blood pressure and cholesterol levels can increase the risk of AF. Monitor these levels regularly and work with your healthcare provider to manage them.¹ 

In the video below, Cardiac Electrophysiologist Dr Ihab El-Sokkari discusses how healthy eating, regular physical activity and health checks are essential for overall heart health when it comes to lifestyle management of AF.

Medical Treatment of Atrial Fibrillation

The therapeutic goals of Atrial Fibrillation (AF) can be divided into three common goals:

Goals of Atrial Fibrillation (AF) Management

Atrial fibrillation (AF) is a condition that increases the risk of serious health complications, including stroke and other cardiovascular issues. Effective management of AF involves individualised care tailored to each patient’s needs, aiming to reduce symptoms and prevent complications. Below are the key goals of AF management:

1. Reducing Thromboembolic Risk
AF increases the likelihood of blood clots forming in the heart’s chambers. These clots can travel to critical areas such as the brain, lungs, or other parts of the body, potentially causing strokes or other serious conditions.

• Your doctor will assess your individual risk of blood clots, which may depend on factors such as diabetes, high blood pressure, or a history of previous strokes.
• Treatments like blood-thinning medications (anticoagulants) are often prescribed to reduce this risk and protect against complications.

2. Rate Control
Rate control focuses on managing your heart rate to prevent it from beating too fast, which can reduce symptoms like fatigue or shortness of breath.

• The goal is typically to maintain a resting heart rate of under 100 beats per minute.
• Medications such as beta-blockers, calcium channel blockers, or digoxin may be used, and sometimes a combination of two or more medications is necessary to achieve effective control.

3. Rhythm Control

Rhythm control aims to restore and maintain a normal heart rhythm (called sinus rhythm), reducing symptoms like palpitations or irregular heartbeats.

• This approach often involves antiarrhythmic medications that help stabilise the heart’s electrical activity and prevent episodes of AF.
• In some cases, procedures like electrical cardioversion or catheter ablation may be recommended to achieve long-term rhythm control.

Procedural Management of Atrial Fibrillation

There are many patients with symptomatic Atrial Fibrillation (AF) who are unable to tolerate medication due to the side effects or patients with severe symptoms of AF where medical management may no longer be an ongoing option due to the impact on lifestyle. Atrial Fibrillation ablation may be a treatment to help manage AF.

There are two main types of energy used to ablate the myocardium to treat AF:

• Radiofrequency ablation
• Cryotherapy ablation
• Pulsed-field ablation

AF ablation is a catheter-based therapy usually performed in a Cardiac Catheter Lab (CCL) where small electrical catheters are passed through large vessels in the groin and moved into the heart, where a stimulus / therapeutic modality aims to ablate or alter the abnormal electrical pathways that are thought to be responsible for AF.

The procedure aims to isolate the electrical stimulus within the atria that may cause AF and prevent these abnormal electrical stimuli from initiating further episodes of AF. However, this type of treatment is not suitable for all patients with AF and a patient’s Cardiologist will be best suited to explore individualised treatment options⁷.

How has the Ablation Procedure evolved?

Cardiologist Electrophysiologist Dr Wai Kah Choo explains how the Catheter Ablation procedure for atrial fibrillation has evolved over the years and delves into the goal of this therapy and long term considerations.

Surgical Ablation for Atrial Fibrillation

Cardiac Surgeons can also treat patients with AF by utilising therapies to ablate the problematic electrical pathways, usually during either open heart or minimally invasive cardiac surgery. This procedure is often referred to as a “Cox-Maze” procedure and involves a MAZE like a pattern ablation of the left atrium when the patient requires cardiac surgery. The goals are the same as a catheter-based ablation, which is to isolate the electrical triggers that may cause AF.

Cardiac Surgeons may also use the following treatment modalities to ablate the desired area of the left atrium:

• Radiofrequency energy
• Cryotherapy 

Surgical Ablation for Atrial Fibrillation

The use of pacemakers for AF management

In some cases, a person’s heart rate can become abnormally slow, a condition known as bradycardia. Bradycardia is generally defined as a heart rate of less than 60 beats per minute, though this threshold can vary depending on individual health factors. This can cause symptoms such as dizziness, lightheadedness, fainting and in extreme cases losing consciousness.

One potential cause of a slow heart rate is the use of certain medications prescribed to manage atrial fibrillation (AF). While these medications help control fast or irregular heart rhythms, they can sometimes overly suppress the heart’s electrical activity, leading to bradycardia. If bradycardia becomes severe or persistent, it may require additional medical intervention.

For some patients, a pacemaker might be recommended. A pacemaker is a small device implanted under the skin that helps regulate your heartbeat, ensuring it doesn’t drop too low. A doctor may implant one, two or sometimes three leads into your heart and connect them to a small device that stimulates the heart to increase the heart rate. By maintaining a healthy heart rate, a pacemaker can reduce symptoms like dizziness and fainting, helping to prevent injuries caused by falls or collapses.

Once implanted the device may send important information about your AF and the heart rates that can be used to evaluate the effectiveness of current medical treatment. This is often performed wirelessly in newer pacemaker devices that transmit this data to your cardiology clinic for review.

Left Atrial Appendage Devices

Within your left atrium, there is a small “pouch” that may allow small amounts of blood to pool and “clot” when patients experience AF. These small clots can leave the heart and flow to other parts of the body and may cause stroke or death in some cases.

In some patients who are unable to tolerate oral anticoagulants (blood thinners), these devices can help reduce the risk of these small clots leaving the heart and causing strokes. These devices are known as Left Atrial Appendage Occlusive devices (LAA) and can be used for specific patient groups who are contraindicated for anticoagulation.

Examples of a left atrial appendage device:

Left Atrial Appendage Closure Device Animation

Ongoing Cardiac Monitoring for Asymptomatic Atrial Fibrillation

Many patients may have AF and not have the typical signs or symptoms such as:

• Shortness of breath,
• Palpitations or racing or fluttering feeling in the chest,
• Decreased exercise tolerance,
• Fatigue,
• Lightheadedness,
• Chest pain¹⁰.

This can lead to many patients being unaware of their risk for stroke and other associated risks of AF. If a doctor suspects that a patient may have AF, then they may require external cardiac monitoring at home to detect if they do have AF. These forms of monitoring may include:

• 24 hour Holter monitoring,
• 7 day Holter monitoring,
• > 7 days Holter monitoring. 

These wearable cardiac monitors can record heart rates over the specified period of time and then will be reviewed by a medical team to diagnose if the patient is having periods of AF.

Example of Holter Monitoring

There are also wearable technology monitors that can be worn for short periods of time. This technology can be less restrictive and record your individual heart rate which can be shared via telemetry and other forms of communication with a doctor. These can be used for a number of days and can automatically transmit the relevant information to the patients’ medical team.  

Below are some examples of wearable cardiac technology. There are also many smartwatches that have a similar capacity to monitor/ record heart rates that are available. Some of this technology may not be approved in Australia for medical use yet.

Wearable Biosensor Wireless Remote Sensing Device

QardioCore Wearable ECG Monitor

Patient Disclaimer: All content on the Hope For Hearts site is created and published online for general information purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Please see your doctor if you have any questions or concerns.