Treatment procedures for
atrial fibrillation

If you have been diagnosed with atrial fibrillation – also known as AF or AFib – your doctor (a GP or a cardiologist) may consider and discuss a number of treatment options with you to decide which treatment plan is the most appropriate for you.1,2 Your treatment plan you will be decided based on several factors. These include (among others):1,3

  • Your age1
  • Your overall health status1
  • The type of AF that you have been diagnosed with, and how long you have had it1,3
  • How much your symptoms affect your daily life1
  • Whether you have an underlying condition, such as thyroid disorder, which is causing your AF and requires treatment1,3

If an underlying condition is causing your AF, it may be enough to treat this underlying condition.1 However, if this is not the case, your treatment options may include:1,2

  • Medicines to treat different aspects of your AF to help keep your heart from beating too quickly1
  • Procedures, such as cardioversion, catheter ablation or a pacemaker1

Having these treatments or procedures can help your doctor manage your AF. However, even after successfully getting your heart back to it is normal rhythm, you may need to see your doctor regularly.1

Watch a short animation on how your heart rate and rhythm may be restored

Your doctor may suggest to treat your AF with a procedure called cardioversion, which takes place in a hospital and is typically a short, 10-minute procedure. While in hospital, you will be closely monitored throughout.1 Most patients go home on the same day as their cardioversion is done, but on rare occasions you may need to stay in the hospital overnight to monitor your recovery.4

What to expect during cardioversion

Cardioversion usually involves giving a short electric shock to your heart, using sticky pads or patches that will be placed onto your chest. This encourages your heart to signal correctly and helps to restore your heart’s normal rhythm.1,3

Your healthcare team will give you all the information that you need to help you feel as comfortable as possible. They will also give you a sedative, so you will not feel the electric shock.3 If you are concerned about your cardioversion, speak to your doctor.

If your AF has lasted longer than 2 days, cardioversion may increase the risk of a blood clot

In this case, your doctor will usually give you a medication called an anticoagulant for 3 to 4 weeks before the procedure takes place and for at least 4 weeks after cardioversion.1 This medicine will help decrease the chance of you having a stroke as a result of a blood clot formed by your AF, so it is very important to take your medication exactly as prescribed.1 If you need to have cardioversion in an emergency, you may not have time to take medication beforehand. In this case, pictures of your heart will be taken beforehand and throughout the procedure to check for potential blood clots.1

Even after successfully restoring your heart back to its normal rhythm, you may need to continue taking an anticoagulant to help reduce the risk of a stroke, if your doctor is concerned that you are still at risk of blood clots forming.1

Like all medical procedures, cardioversion may have some risks

However, if your doctor has suggested cardioversion to treat your AF, it is because they consider the benefits of the procedure to outweigh the risks. If your doctor recommends cardioversion to treat your AF, they will discuss its potential risks with you.4

How to prepare for cardioversion

Your healthcare team will usually schedule your cardioversion some time before the procedure actually takes place, unless cardioversion is required as an emergency.4

You should not eat or drink for about 8 hours before cardioversion. If your doctor has told you that you need to continue to take your usual medicine and you require water to swallow tablets, drink only enough water to allow you to do so.4

You may need to have another procedure called transoesophageal echocardiogram, also known as TEE, before cardioversion to check for potential blood clots in your heart. However, not everyone needs TEE before cardioversion.4 Your doctor may decide that you need TEE if they are concerned that cardioversion may dislodge blood clots in your heart, which could lead to complications.

If your healthcare team finds any blood clots during TEE your cardioversion may be delayed for 3 to 4 weeks, while you take medicines, to reduce the risk of new blood clots forming.4

Sometimes AF cannot be treated with cardioversion, and medicines may not be effective in controlling your AF or you may not tolerate them. If this is the case, your doctor may consider treating you with a procedure called cardiac ablation, which also takes place in a hospital.1,3 However, this procedure is not considered a surgery.5

What to expect during cardiac ablation

  • During cardiac ablation, your doctor will insert thin, long and flexible tubes, known as catheters through a vein or artery in your groin1,3,5
  • These catheters are then guided into your heart through your blood vessels1,3,5
  • After reaching your heart, the catheters can record your heart’s electrical activity to find out where the irregular heart rhythm (arrhythmia) is coming from1
  • Then, the end of one of the catheters will generate either heat or extreme cold (cryotherapy) on the tissues of the heart causing the irregular rhythm1,3,5
  • This helps the signalling return to normal, restoring an even heart rhythm1,3

Cardiac ablation will take about 2 to 3 hours

You may need general anaesthesia, in which case you will be unconscious during the procedure.1 Often you will need to spend the night in the hospital so that your recovery can be monitored.1

Usually, recovery from cardiac ablation is quick

You should be able to continue with your normal life the day after the procedure. However, you should avoid lifting anything heavy overexerting yourself for 2 weeks, and driving for the first 2 days. Therefore, ensure you have alternative travel arrangements when leaving the hospital.1

Like all medical procedures, cardiac ablation may have some risks

However, if your doctor has suggested cardiac ablation to treat your AF, it is because they consider the benefits of the procedure to outweigh the risks. If your doctor recommends a cardiac ablation to treat your AF, they will discuss its potential risks with you.5

How to prepare for cardiac ablation

Before your procedure, your doctor will evaluate your overall health status. Some tests to assess your AF will be carried out.5

You should stop eating and drinking the night before cardiac ablation. Your doctor will tell you whether you need to follow any specific instructions before and after the procedure and/or whether you should continue taking your regular medicines.5

If you have an implanted heart device – such as a pacemaker or implantable cardioverter – defibrillator – your doctor will let you know whether there are any special precautions that you should take.5

Your doctor may consider placing a pacemaker in your heart to treat your AF if medicines have not been effective or are not recommended due to your age. Usually, this happens in people aged 80 years and older.1

A pacemaker is a small electrical device - about the size of a matchbox or smaller and weighing 20 to 50 grams - with a battery and a tiny computer circuit1,6

This device will be surgically implanted under the skin in your chest, just below your collarbone. When implanted, a pacemaker will send weak electrical signals to ‘set a pace’ and help keep your heart in rhythm.1,6

What to expect when a pacemaker is implanted

A pacemaker implantation will usually take just a few hours and you will probably be conscious. However, your healthcare team will give you all the information that you need before the procedure to help you feel as comfortable as possible. Besides, you will be given medication through your vein to help you relax and the area where the pacemaker is inserted will be numbed using local anaesthesia.1,6,7

During a pacemaker implantation, your doctor will insert one or more insulated and flexible wires into a major vein and under the skin in your chest, just below your collarbone. Then, your doctor will guide one end of this wire into the correct position in your heart using X-ray images, while the other end is attached to a pulse generator that is implanted under the skin below your collarbone.6,7

You may need to stay in the hospital for a day after your pacemaker implantation. Your doctor will programme your pacemaker so that it sets the right pace for you.7

After you leave the hospital, you should not drive

Therefore, you should organise to have somebody take you home.7

Like, all medical procedures, insertion of a pacemaker may have some risks

However, if your doctor has suggested insertion of a pacemaker to treat your AF, it is because they consider the benefits of a pacemaker to outweigh the risks. If your doctor recommends a pacemaker to treat your AF, they will discuss the potential risks of this procedure with you.7

How to prepare for a pacemaker implantation

You will have a few tests before your procedure to find the cause of your AF. These tests may include (among others):7

  • An electrocardiogram, also known as an ECG – this measures the electrical signals from your heart to determine your heart’s rate and rhythm7
  • Holter monitoring, which is a portable version of an ECG - this test is used to detect irregular heart rhythms that happen at unpredictable times7
  • Stress test – this test that puts extra stress on your heart to see how it responds to working hard and beating fast8
  • Echocardiogram – a non-invasive test that uses sound waves to see the structure and function of the heart7,8

If you have any questions about your treatment, always ask your doctor or nurse.

1. NHS. Treatment – atrial fibrillation. April 2018. Available at https://www.nhs.uk/conditions/atrial-fibrillation/treatment/. Last accessed November 2020.

2. Stroke Association. Atrial fibrillation. Available at https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/atrial-fibrillation. Last Accessed November 2020.

3. Mayo Clinic. Atrial fibrillation – Diagnosis. June 2019. Available at https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630. Last accessed November 2020.

4. Mayo Clinic. Cardioversion. May 2020. Available at https://www.mayoclinic.org/tests-procedures/cardioversion/about/pac-20385123. Last accessed November 2020.

5. Mayo Clinic. Cardiac ablation. September 2019. Available at https://www.mayoclinic.org/tests-procedures/cardiac-ablation/about/pac-20384993. Last accessed November 2020.

6. NHS. Pacemaker implantation. October 2018. Available at https://www.nhs.uk/conditions/pacemaker-implantation/. Last accessed November 2020.

7. Mayo Clinic. Pacemaker. June 2019. Available at https://www.mayoclinic.org/tests-procedures/pacemaker/about/pac-20384689. Last accessed November 2020.

8. WebMD. How atrial fibrillation is diagnosed. May 2018. Available at https://www.webmd.com/heart-disease/atrial-fibrillation/afib-diagnosis. Last accessed November 2020.

PP-ELI-HKG-0647 JUN 2021