Therapy of atrial fibrillation and atrial flutter
If possible, a causal therapy of the atrial fibrillation should be aimed at, which treats the underlying disease. Atrial fibrillation that occurs acutely usually disappears spontaneously after initiation of therapy. If it remains, a decision must be made between two equivalent therapy concepts: Frequency control and rhythm control.
The main therapeutic objective of both concepts is to improve the circulatory situation and to prevent complications caused by blood clots. 1st frequency control: (the speed of the heart‘s action should be reduced) Drug-induced frequency control: This therapy is used in conjunction with digitalis preparations (especially in cases of additional cardiac insufficiency) and Class II antiarrhythmics (beta blockers, e.g. in cases of underlying hyperthyroidism) or calcium channel antagonists such as verapamil. Problems arise from the side effects of the drugs.
The problem is that antiarrhythmic drugs (especially class I antiarrhythmic drugs) can themselves trigger arrhythmias as side effects, especially in the case of a damaged heart. The prescription of this type of medication must therefore be very carefully considered. If, in rare cases, drug therapy is not sufficient to bring the frequency under control, there is the possibility of AV node ablation (ablation = removal and obliteration of unwanted tissue by means of current doses) with subsequent use of a pacemaker.
2. rhythm control: = regularization (also called cardioversion) of atrial flutter/flicker = conversion to a sinus rhythm. Precondition: The chances of success in regularization attempts are reduced: If atrial flutter/flicker persists for longer than 48 h, anticoagulation therapy (which removes any blood clots) must be administered for four weeks before attempting regularization (see below for therapy with anticoagulants). After regularization, anticoagulation (drug-based blood thinning) is always performed.
- Atrial flutter/flicker no longer exists for approx. 12 months
- The treatable causes are eliminated
- No presence of advanced heart disease
- Too much stretching of the atrium
- Heart failure (cardiac insufficiency)
- Too long a period of time in which the arrhythmia persists
The pros and cons of both therapeutic approaches: Pro-Rhythm Control: Pro-Frequency Control:
- Frequency control alone usually does not solve the circulatory problems, the atria still beat irregularly, the pumped blood volume fluctuates.
- Is particularly suitable if the atrial fibrillation is short (less than 48 h) or has occurred in the context of acute diseases and there is no great extension of the atrium
- Low subjective and objective symptoms
- In all cases where rhythm control is not particularly suitable (long existence, atrial distension, multiple recurrences)
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