therapeutical options
In case of Atrial Fibrillation, there are various options that can help to solve or manage the problem.

First of all, your doctor will choose one among two therapeutical strategies; rhythm control or rate control.
These treatment strategies should be supported by an anti-thrombotic therapy. A thrombus is a blood clot that can potentially cause a stroke.
The rhythm control strategy aims at bringing the patient's sinus rhythm back to normal. This can be done in two ways: through cardioversion, allowing the interruption of the arrhythmia, or through medical therapies aiming at the prevention of the arrhythmias' recurrences.

CARDIOVERSION
The cardioversion can be electrical, namely carried out using the procedure of defibrillation, or pharmacological, with the administration of anti-arrhythmic drugs. ritmo
PREVENTION OF THE ARRHYTHMIA'S RECURRENCES
The prevention of the arrhythmias' recurrences can be pharmacological, with the administration of anti-arrhythmic drugs, or non-pharmacological, through an operation called ablation.
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PHARMACOLOGICAL THERAPY
Anti-arrhythmic drugs modify the heart's electrical properties, preventing recurrences of the arrhythmia.
ritmo More specifically, they act at the cell membrane level, obstructing sodium and/or potassium ion channels. This reduces the electrical impulse, and the cells aren't excitable for a longer time.

Today, the most common drugs are amiodarone, flecainide, propaphenone and sotalol. However, these drugs only guarantee a relative effectiveness, as fibrillation recurs in about half of the cases within a year of treatment. Moreover, these drugs can have important side effects and can sometimes be more harmful than useful, thus reducing the potential benefits for the sinus rhythm. For example, they can create more serious arrhythmias than atrial fibrillation, and affect the pumping function of the heart. Amiodarone is the most effective among these drugs, even if the least tolerated: it follows that other drugs are preferred at first, and amiodarone is generally used as the second alternative.
DRONEDARONE
A new molecule, dronedarone, has recently been discovered; it has proved to be reasonably effective and, above all, easier to tolerate.
Compared to treatment with a placebo, a dronedarone-based treatment of paroxysmal and persistent atrial fibrillation significantly reduces the arrhythmias' recurrences, the cardiovascular hospitalization (- 26%), the cardiovascular mortality rate (- 29%) and the risk of stroke (- 34%).

 

NON-PHARMACOLOGICAL THERAPY: ABLATION
Ablation is an alternative to anti-arrhythmic drugs: it is an operation that destroys the area of the heart where the arrhythmia begins and thrives, and can be either transcatheter or surgical.
ritmo In transcatheter ablation, several catheters are inserted into the femoral access, in the groin area, and directed to the heart through the vessels. The catheters reach the right atrium and, after having pricked the septum dividing the two upper chambers of the heart, two of them are pushed into the left atrium, next to the pulmonary veins.

 

At this point, the first catheter maps the electrical impulse from the veins to the atrium, and the second one destroys the area around the veins' opening. In this way, the left atrium is electrically isolated from the pulmonary veins, the main cause of the electrical impulses that generate fibrillation. In some cases - above all in long-lasting and persistent fibrillation - in order to prevent the arrhythmia, it may be necessary to create lesions in other parts of the atria, too.

 

When ablation is surgical, either an operation in which the thoracic cage is opened, or a mini-endoscopic thoracotomy are carried out.

 

Ablation has a success rate of around 70%. The risks of serious complications linked to this procedure are around 3-4%.


 
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