Aging & Health A to Z
Care & Treatment
A first step in treating atrial fibrillation is to identify and treat other medical conditions that can cause the problem, such as heart disease, high blood pressure, or an overactive thyroid gland.
The atrial fibrillation itself can usually be managed with medication. In most cases, blood thinners, such as warfarin or dabigatran, can decrease the risk of stroke. Other drugs, such as beta-blockers or digitalis, can help slow the heart rate. These drugs usually don’t stop the fibrillation, but they can help to manage the symptoms and risks.
There are two broad types of medicines that are used to reduce risk of stroke in people with atrial fibrillation: blood thinners and anti-arrhythmic drugs. Both types of medicines reduce risk of stroke, but can have important side effects. The main risk of blood-thinners is excess bleeding. Anti-arrrhythmic medications have a long list of potential side effects.
It is recommended that most older adults with atrial fibrillation take one of these kinds of medications on a regular basis, to reduce risk of stroke. There are some older adults whose heart has the irregular atrial fibrillation rhythm some of the time, and who can feel when they are in that abnormal rhythm. Some people with this situation can take drugs only when they feel themselves going into atrial fibrillation. This is called the “pill in a pocket” approach. It helps reduce the side effects that can result from taking the medication every day.
Anti-arrhythmic drugs and blood thinners interact with many other medications, and some interact with grapefruit juice. Before you start taking an anti-arrhythmic or blood thinner drug, be sure to discuss all your medications with your healthcare professional. Some common blood thinners are warfarin, dabigatran, rivaroxaban, and apixaban. Some common anti-arrhythmic drugs for atrial fibrillation are: procainamide, propafenone, quinidine, and sotalol. There are others as well.
Another commonly used anti-arrthymic drug is amiodarone. This drug has more side effects than many other anti-arrthymic drugs that can be used to treat atrial fibrillation. As a result, amiodarone should not be a first-choice medication for many older adults. However, there are certain situations in which this drug is appropriate as a first choice for atrial fibrillation, and as a second choice if other drugs don’t work or have burdensome side effects.
Ventricular Arrhythmias and Ventricular Fibrillation
Ventricular arrhythmias often occur as a result of other heart conditions. Treatment involves managing these problems with medication and lifestyle changes, including exercise, losing weight, and quitting smoking.
Anti-arrhythmic drugs are also used to treat ventricular arrhythmias.
In some cases,ventricular arrhythmias can lead to ventricular tachycardia or ventricular fibrillation, which is a life-threatening emergency. In ventricular fibrillation, the heart does not beat properly, and blood stops circulating.
Ventricular fibrillation is a life-threatening emergency. Call 911 and preform CPR.
Immediately stopping the fibrillation is key—you’ve probably seen the procedure on TV shows. Using a defibrillator, emergency personnel place paddles that deliver an electric shock to the chest. This shocks the heart back into a normal rhythm. In the past, this lifesaving procedure required trained medical professionals. But these days, automated defibrillators are available in many public places, and can be easily handled by lay people with some training.
If you have episodes of life-threatening ventricular arrhythmias, your healthcare professional may recommend you have a small defibrillator implanted in your chest, like a pacemaker. These tiny automatic devices detect ventricular tachycardia and ventricular fibrillation, and can give an small electric shock to the heart to restore a more normal heart rhythm. They are the most effective way to improve survival in older adults who have this problem.
Bradycardia (slow heart rhythm)
The first step in treating bradycardia is to identify and treat the cause, which might involve changing your medications or adjusting your levels of minerals, such as potassium. If the problem continues, your cardiologist might implant an internal electronic pacemaker (see below) that sends electrical signals to your heart to keep it beating at a faster rate.
Procedures to Treat Arrhythmias
This is a procedure sometimes used to treat atrial fibrillation or other heart arrhythmias. The healthcare professional inserts a catheter into a blood vessel in the thigh, groin, neck, or elbow and feeds the catheter up into your heart while watching the path of the catheter on an x-ray. A wire in the catheter sends out heat or freezing cold and destroys the tissue in the heart that is causing the irregular heartbeat. The parts of heart tissue that are destroyed are very small, so this procedure does not keep the heart from being able to do its job.
This is a procedure during which an electric current is used to reset the heart's rhythm back to its normal pattern.
Pacemakers can be used to control arrhythmias and their symptoms. A pacemaker is a small, flat device that’s inserted just under the skin, beneath your collarbone, during a minor surgical procedure.
Thin wires attached to the pacemaker are threaded through small blood vessels into your heart. The pacemaker contains a computer chip programmed to send low-level electrical signals to your heart to control your heartbeat. When you have a pacemaker inserted, you’ll probably stay in the hospital overnight so that medical personnel can monitor how it’s working.
The pacemaker's computer chip also records your heartbeat’s rate and rhythm. Your doctor will use these recordings to check and adjust your pacemaker periodically so it works best for your type of arrhythmia.
The pacemaker can be adjusted externally, in your doctor’s office, or sometimes even over the telephone or the Internet. The pacemaker uses a battery, similar to a watch battery, that gets replaced about every six or seven years. This also requires minor surgery. This surgery is simpler than when the pacemaker is placed in your body.
If you have a pacemaker, you will need to be careful about having close or continuous contact with certain electrical devices when they are turned on, such as cell phones, music players (like iPods), or microwave ovens. These can interfere with the electrical signals your pacemaker is sending to your heart. You also need to avoid certain medical procedures that can disrupt your pacemaker, such as MRIs.
Tell your healthcare providers, dentists, and medical technicians that you have a pacemaker. Also tell airport security people about your pacemaker. You can walk through airport security at your normal pace, but you should not have a metal detector wand held over the site of your pacemaker or sit too close to airport metal detectors.
Your healthcare professional can give you a card that states what kind of pacemaker you have. Carry this card with you at all times. You can also wear a medical ID bracelet or necklace that shows you have a pacemaker. These are helpful in the case of a medical emergency.
Updated: September 2015
Posted: March 2012