Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, characterized by chaotic and irregular contractions of the atria. This condition may cause fatigue, shortness of breath, palpitations, and significantly increases the risk of stroke. Treatment is aimed at restoring normal heart rhythm, preventing complications, and improving the patient’s quality of life.
Main goals of treatment
- Heart rate control. Reduction of ventricular rate to decrease cardiac workload.
- Restoration of sinus rhythm. Return to a normal, coordinated heart rhythm.
- Prevention of thrombus formation. Reduction of the risk of stroke and systemic thromboembolism.
- Treatment of the underlying cause. Management of conditions contributing to AF, such as hypertension, valvular heart disease, or hyperthyroidism.
Atrial fibrillation management in Belarus
Pharmacological therapy
- Rate-controlling drugs. Used to slow the heart rate.
- Cardiac glycosides. May be added for rate control, particularly in elderly patients.
- Antiarrhythmic drugs. Used to restore and maintain sinus rhythm.
- Anticoagulant therapy. Prescribed to prevent thrombus formation.
Cardioversion
- Electrical cardioversion. Application of a synchronized electrical shock to restore sinus rhythm. Used when pharmacological therapy is ineffective.
- Pharmacological cardioversion. Use of antiarrhythmic medications to convert AF to sinus rhythm.
Catheter ablation
- Radiofrequency ablation (RFA). Destruction of pathological foci or conduction pathways responsible for arrhythmia. Particularly effective in patients with paroxysmal AF.
- Cryoablation. Use of freezing energy to isolate the pulmonary veins, which are common sources of AF triggers.
Indications for ablation
- Ineffectiveness of pharmacological therapy.
- Frequent recurrences of atrial fibrillation.
- Intolerance to antiarrhythmic medications.
Device implantation
- Pacemaker implantation. Indicated in patients with bradycardia or sick sinus syndrome.
- Implantable cardioverter-defibrillator (ICD). Used in patients at high risk of life-threatening ventricular arrhythmias.
Surgical treatment
- Maze procedure. A surgical technique creating scar lines in the atria to block abnormal electrical impulses. Usually performed during open-heart surgery (e.g., valve replacement).
Minimally invasive (interventional) procedures
- Left atrial appendage occluder implantation. Used for stroke prevention in patients with high thromboembolic risk and contraindications to long-term anticoagulation.
Lifestyle modification and prevention
- Physical activity. Moderate exercise (walking, swimming) is beneficial for cardiac function.
- Diet. A diet low in salt, fat, and sugar, rich in fruits, vegetables, and whole grains.
- Blood pressure and weight control. Reduction of excess body weight and adequate control of hypertension lower the risk of AF recurrence.
- Avoidance of harmful habits. Smoking and excessive alcohol consumption increase the risk of arrhythmias.
- Stress management. Use of relaxation techniques such as meditation and yoga.
Treatment outcomes
- Symptom control. In most patients, symptoms are significantly reduced or completely resolved.
- Reduction of stroke risk. Properly selected anticoagulant therapy reduces the risk of stroke by 60–70%.
- Life expectancy. With adequate treatment and control of risk factors, patients with AF can live long and active lives.
Atrial fibrillation management requires a comprehensive approach focused on rhythm or rate control, prevention of thromboembolism, and elimination of underlying causes. Modern methods, such as catheter ablation and anticoagulant therapy, significantly improve patient prognosis. Regular follow-up with a cardiologist, timely adjustment of therapy, and a healthy lifestyle help maintain stable condition and reduce the risk of complications.
