Living with Atrial Fibrillation

Exploring your treatment options

Your healthcare professional will talk to you about your personal history and lifestyle when they tailor your AF treatment. There are two main parts of managing AF:

1. Reducing your risk of stroke
2. Managing your symptoms.

There are a range of medications and procedures that will help you do this, and living a healthy lifestyle makes a big difference too.

Whatever medication you’re prescribed, make sure to take it as instructed. Never stop taking it without speaking to your doctor first. Even if you don’t feel any symptoms, your medication could be saving your life.

Anticoagulants

To lower your stroke risk, it’s very likely you’ll be prescribed a type of medicine called an anticoagulant. Anticoagulants are a type of medicine that stops harmful blood clots from forming. They’re sometimes called ‘blood thinners’ but they don’t actually thin your blood, they just make your blood take longer to form a clot.

You’ll usually be prescribed one of two common types of anticoagulant:

• Warfarin
• Novel oral anticoagulants (NOACs)

If you’re prescribed warfarin

How much warfarin you need will be unique to you, so you’ll need regular blood tests to make sure you’re getting the right amount. This test is called an International Normalised Ratio (INR). When you first start taking warfarin, you may need to be tested up to three times a week, but this will decrease in time, once you’ve found the dose that’s right for you.

If you’re taking warfarin, you’ll also need to watch what you eat. Foods high in vitamin K (such as Brussel sprouts or broccoli) can stop it from working as effectively. Cranberry juice and cranberries can increase the effect of warfarin, so it’s advisable to avoid them. However, you can still eat a healthy, balanced diet with lots of fruit and vegetables.

Learn more about warfarin

If you’re prescribed novel anticoagulants

Novel oral anticoagulants (NOACs) are a newer type of blood clot preventing drug. Often they’re prescribed when a person’s AF isn’t associated with a heart valve problem. They work in a similar way to warfarin, as they prevent blood clots from forming, so they reduce the risk of a stroke.

The most commonly prescribed types of NOACs in the UK are: apixaban, rivaroxaban and dabigatran.

NOACs are less affected by diet and other medications than warfarin and you won’t usually need regular blood tests.

Read more about NOACs

Anti-arrhythmic medications & ICDs

While anticoagulants reduce your risk of stroke, there are other medications that can help with the symptoms of AF. A group of medications called anti-arrhythmics are often prescribed to prevent or lessen your episodes of AF.

If your AF symptoms are prone to coming and going, you may be recommended the ‘pill in the pocket’ method. This is when you take your medication when your symptoms are bothering you. If you’re one of the people who have more consistent AF symptoms, you’re more likely to need regular medication that helps prevent the change in rhythm in the first place.

More on anti-arrhythmic drugs

If you had a heart attack that has left you with heart muscle damage, drugs alone may not be as effective at protecting you from more dangerous abnormal heart rhythms, so it may be appropriate to have an implantable cardioverter defibrillator (ICD).

An ICD is a small device that can be placed under the skin to monitor your heart, and can deliver pacing, cardioversion or defibrillation whenever your heart needs it.

Read more about ICDs

Ablations and cardioversions

There are some alternatives to anti-arrhythmic medications that it’s useful to know about.

One of these is cardioversion. It aims to get your heart beating in a normal pattern again. During a short general anaesthetic, electrodes attached to your chest will give you controlled electric shocks from a defibrillator. Cardioversions can work in certain, simple cases of AF or in the short term but they aren’t always successful at keeping a normal rhythm in the long run.

Read more on cardioversions

Another treatment is called an ablation (or catheter ablation). This uses heat or freezing on the area of your heart that’s causing the abnormal rhythm, breaking up abnormal electrical circuits and destroying any heart muscle that’s causing your arrhythmia. However, many patients need more than one ablation for it to be successful.

Read more in ablations

Tips for talking to your doctor

1. Ask about all your options and the pros and cons of each. There are a number of treatment options and yours will depend on factors personal to you. Ask your healthcare team about all the treatments and why you’re being recommended some over others.

2. Ask about side effects and how to manage them. Some people may have unexpected side effects from medications and want to stop taking it straightaway. It’s really important to keep taking your medication, but speak to your doctor if you have any concerns.

3. Ask for reliable resources where you can learn more about your treatments. There’s a lot of misleading information out there but your doctor will be able to guide to organisations like the British Heart Foundation where you can be certain you’re reading up-to-date, medically approved information.

4. Ask about timings. It may be you don’t have to make a decision straight away. If that’s the case, ask your doctor for some time to think over your options so you can make a calm, informed decision.

Next: Supporting you through treatments

What we will cover next:

• More information on cardioversion and ablation.
• How AF affects other medical treatments.
• How to get back to life as usual after treatment.