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Treatment

Treatment for atrial fibrillation or flutter usually depends on the underlying cause of the problem. The doctor will probably recommend lifestyle changes such as eating a heart-healthy diet; cutting back on sodium, caffeine, and alcohol; exercising regularly; losing weight if you are overweight; quitting smoking if you smoke; and managing stress.

Doctors frequently prescribe digitalis drugs to help improve the efficiency of the heart by slowing the contractions of the ventricles. The doctor may prescribe beta blockers to improve the efficiency of the ventricles by slowing the electrical impulses from the sinoatrial node (the heart’s natural pacemaker). Antiarrhythmic drugs can help return the heart rhythm to normal. The doctor may also prescribe an anticoagulant drug to help prevent blood clots from forming.

If your heart is basically healthy, or if the underlying cause of atrial fibrillation or flutter persists despite treatment, your doctor may recommend a treatment called cardioversion (see below). In this procedure, the doctor administers an electrical shock to your heart while you are under mild anesthesia. Cardioversion is frequently successful in restoring normal heart rhythm.

Cardioversion

Cardioversion is a procedure that is used to restore normal heart rhythm. During the procedure, you are connected with electrodes to an ECG and are given medication intravenously (through a vein) to help you relax. You are given supplemental oxygen through a nasal catheter. A device called a pulse oximeter is attached to your finger to monitor the oxygen content of your blood. Two large pads are attached to your chest; the pads are connected to a machine called a defibrillator. The defibrillator delivers a series of electrical charges through the pads to your heart in an attempt to correct the arrhythmia. Because you are sedated, you do not feel the electrical charges. The procedure lasts about 30 minutes. After the procedure, you will rest in bed until you are fully awake.

Ectopic Heartbeats

Ectopic heartbeats are irregular beats among otherwise normal heartbeats that feel as though the heart has either missed or gained a beat. This condition is common and usually does not require treatment.

If you are bothered by an occasional irregular heartbeat, your doctor may prescribe medication to treat the condition. Frequent ectopic heartbeats may result from using too much caffeine, alcohol, or nicotine. If you use these substances, quit smoking and cut down on alcohol and coffee, tea, soft drinks, and other beverages that contain caffeine.

Heart Block

The heart rate is controlled by a natural pacemaker called the sinoatrial node, a group of specialized cells in the wall of the right atrium (the upper right chamber of the heart). The sinoatrial node transmits electrical impulses between the atria and ventricles (the lower chambers of the heart), causing rhythmic contractions of the heart muscle, or heartbeats. If the sinoatrial node malfunctions, the beating of the atria is not coordinated with the beating of the ventricles.

In first-degree heart block, the electrical impulses take longer to travel from the atria to the ventricles. In second-degree heart block, some of the electrical impulses fail to reach the ventricles, causing an irregular heartbeat. In third-degree heart block, electrical impulses do not reach the ventricles, which continue beating slowly, independently of the sinoatrial node and the atria.

In healthy people, the heart rate increases during times of increased demand on the circulatory system, such as during exercise or periods of emotional stress. But in people who have heart block, heart rate does not increase despite an increased demand for blood, and the brain and other body tissues do not receive enough blood and oxygen to function properly.

Heart block often occurs as a result of heart disease (see page 558) or a heart attack (see page 567). An overdose of a digitalis drug used to treat an irregular