(1) Restoring sinus rhythm Only by restoring sinus rhythm (normal rhythm) can atrial fibrillation be completely treated, so any patient with atrial fibrillation should try to restore sinus rhythm.
(2) Controlling the rapid ventricular rate For patients with atrial fibrillation who cannot recover sinus rhythm, drugs can be used to slow down the rapid ventricular rate.
(3) In the prevention of thrombosis and stroke atrial fibrillation, anticoagulants can be used to prevent thrombosis and stroke if sinus rhythm cannot be recovered.
For some diseases, such as hyperthyroidism, acute alcoholism and drug-induced atrial fibrillation, atrial fibrillation may disappear by itself after removing the cause.
2. Drug therapy
At present, drug therapy is still an important method to treat atrial fibrillation. Drugs can restore and maintain sinus rhythm, control ventricular rate and prevent thromboembolism complications.
Drugs to convert sinus rhythm (normal rhythm): For new-onset atrial fibrillation, because of its high proportion of spontaneous sinus conversion within 48 hours (about 60% within 24 hours), it can be observed first, or oral propafenone or fluorouracil. If atrial fibrillation has lasted for more than 48 hours but less than 7 days, intravenous drugs can be used for cardioversion, such as flucamide, dofetidine, propafenone, Ibuprofen, amiodarone, etc., and the success rate can reach 50%. When the onset of atrial fibrillation lasts for more than a week (persistent atrial fibrillation), the effect of drug conversion is greatly reduced. The commonly used and proven effective drugs are amiodarone, Ibuprofen, Dofepristone and so on.
Drugs for controlling ventricular rate (frequency control): Controlling ventricular rate can ensure the basic function of the heart and minimize the cardiac dysfunction caused by atrial fibrillation. Commonly used drugs include:
(1) beta blockers are the most effective, commonly used and often used alone;
(2) Calcium channel antagonists, such as verapamil, diltiazem, etc., can also be effectively used to control the ventricular rate during atrial fibrillation, especially in exercise, which is superior to digoxin, and the effect of combining with digoxin is also superior to that of single use. Especially for patients without organic heart disease or normal left ventricular systolic function and with chronic obstructive pulmonary disease;
(3) Digitalis is the first-line drug to control the ventricular rate of atrial fibrillation in emergency, and it is mostly used to control the ventricular rate with left heart failure in clinic at present;
(4) Amiodarone can reduce the ventricular rate during atrial fibrillation, and it is not recommended for long-term ventricular rate control of chronic atrial fibrillation. Amiodarone and digitalis can only be preferred when other drugs are ineffective or contraindicated, and atrial fibrillation complicated with heart failure requires urgent control of ventricular rate.
(5) Anticoagulant therapy is a necessary means to prevent thrombosis and embolism in patients with atrial fibrillation. Patients with atrial fibrillation over 65 years old should be treated with anticoagulant therapy; Previous history of stroke or transient ischemic attack; Congestive heart failure; Hypertension; Diabetes; Coronary heart disease; Enlargement of left atrium; Echocardiography found left atrial thrombosis. Anticoagulation treatment must be guided by experts. Excessive anticoagulation may lead to bleeding, while insufficient anticoagulation strength has no preventive effect.
3. Non-drug therapy
Non-drug treatment of atrial fibrillation includes cardioversion (conversion to sinus rhythm), radiofrequency ablation and surgical maze surgery (radical treatment of atrial fibrillation).
(1) electrical cardioversion refers to the method of restoring sinus rhythm by placing two electrode pads in the appropriate part of the patient's chest and releasing current through the defibrillator. Electrical cardioversion is suitable for: acute atrial fibrillation (such as myocardial infarction, extremely fast heart rate, hypotension, angina pectoris, heart failure, etc.). ), atrial fibrillation that patients with severe symptoms can't tolerate, and atrial fibrillation that has no drug to maintain recurrence after the last successful cardioversion. Electrical cardioversion is not a radical method for atrial fibrillation. Patients with atrial fibrillation often recur, and some patients need to continue taking antiarrhythmic drugs to maintain sinus rhythm.
(2) Catheter ablation therapy is suitable for the vast majority of patients with atrial fibrillation, with minimal trauma and easy acceptance by patients.
(3) At present, the surgical maze operation is mainly used for patients with atrial fibrillation who need heart surgery because of other heart diseases. The surgical effect is good, but the trauma is great.