AFib Treatment Options

Patients researching AFib symptoms,causes, risks, and treatment can be overwhelmed with all the information available online. The fact is that much of this information is posted by bloggers and others who have no medical background and base their posts on hearsay and personal opinions. Whether you choose the Mini-Maze as your treatment option or not, our objective is to provide the most accurate information from a medical, surgical, and current research perspective.  This article will guide you through the different options available with their pros and cons. Should you have any question, please do not hesitate to contact us for an answer.

Use the information provided to consult with doctors and family, collaborate with other AFib patients, and decide on an informed action plan.


An overview of AFib treatment options video
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A common condition — searching for a treatment

As stated in another article, AFib is one of the most common abnormal heart rhythm conditions, expecting to affect over 12.1 million people in the USA by 2030. Translation... You are not alone!. There are thousands of patients right now looking for information on AFib. In fact, you most probably know someone else suffering from the same condition.

The following treatment matrix for AFib was initially developed by one or our patient, Ross Wroblewski. He was a guest of one of DeBakey CV live seminars on November 20, 2020. You can watch the video here.

Option 1 – DO NOTHING


  • No medications
  • No surgical risk
  • Ongoing research could discover new treatments



  • Without treatment, 1 in 3 people living with AFib will have a stroke in their lifetime
  • AFib progression (paroxysmal to persistent) at 1 yr 10%-20%, after 12 yrs 50%-77%
  • Persistent AFib leads to heart changes, thickening, stiffening, and scaring walls
  • Heart muscle remodeling eventually makes AFib more difficult to treat
  • Declining left ventricular ejection fraction rate
  • Events cause lightheadedness, fatigue, shortness of breath, and confusion
  • Unable to maintain physical conditioning for a healthy lifestyle
  • Increased potential for future dementia, fibrosis, oxidation, or shortened lifespan
  • May eventually need pacemaker, defibrillator, or heart transplant Over time; physical, psychological, emotional stress greatly diminish quality of life.
older woman holding chest



  • No surgical risk
  • Cardioversion (chem/electrical) may restore Normal Sinus Rhythm (NSR) for some
  • Anticoagulant helps reduce stroke risk by ~60%
  • Meds slow heart rate (HR), lower blood pressure, increase blood flow
  • May slow progression of AFib-related heart damage


  • Cardioversion (chemical or electrical) often needed to restore NSR
  • Cardioversion success rate often not long-lasting (<1 yr ~50-90%, >1 yrs ~50%)
  • Without rhythm/rate control, heart damage listed under option 1 continues
  • Meds manage symptoms, do not block source of chaotic electrical impulses
  • Antiarrhythmic/anticoagulant medication out of pocket drug costs
  • Requires strict medication regimen, typically loses effectiveness over time
  • Potential negative interactions with other medications (now or future)
  • Drugs (i.e. amiodarone, digoxin) can cause organ damage (liver, thyroid, lung, eyes)
  • Side effects: low blood pressure, light sensitivity, confusion, impaired reactions
  • Suppressed HR/BP causes fatigue, tiredness, restricts physical conditioning
  • Capillaries weaken with age, increases future risk of anticoagulant-related bleeding
  • Future surgeries require anticoagulant pause, increasing chance for clots/stroke
  • Anticoagulant restricts hazardous occupations and X-sports participation
  • AFib psychological/emotional stress most likely still a factor.



If successful, pulmonary vein isolation (PVI) restores NSR, stops further AFib-related heart damage Success Rates:

Single Procedure

Optimal Candidate: 60-80%
Moderate Candidate: 45-65%
Poor Candidate: 35-50%

Multiple Procedure

Optimal Candidate: Data forthcoming
Moderate Candidate: Data forthcoming
Poor Candidate: Data forthcoming

Significantly reduces AFib psychological/emotional stress. May be able to stop antiarrhythmic drugs. Tackle AFib now; reduce future compounding health issues associated with multiple age-related illnesses.

The left atrial appendage (LAA) may later be ablated as it is a source of AFib. Some medical centers offer separate mechanical LAA occlusion or ligation procedures to reduce the chance of clots and stroke. If PVI ablation operation later followed by LAA occlusion or ligation operation, it may be able to stop the use of anticoagulant drugs.


  • Varied success rates
  • Many patients may have multiple PVI catheter ablations with suboptimal results
  • No direct view of the beating heart while ablating
  • Potential for  suboptimal  transmural lesions, burn/freeze injury to  nerves/esophagus
  • Ablation pattern  creates a “spot weld” pattern which can leave gaps for Afib ectopic foci
  • Burn/freeze patterns often require repeat touchup ablations to close gaps
  • PVI alone does not eliminate LAA possible electrical source for AFib
  • Patient will remain on anticoagulants due to LAA potential for blood clots/stroke
  • Implanted LAA mechanical occlusion device may leak and LAA remains as an AFib source
  • PVI catheter ablation require a second operations to add LAA occlusion or ligation



  • If successful, NSR stops further AFib-related heart damage
  • 15+ years, over 2000 cases)
  • Documented success rate: paroxysmal (92%), persistent (85%), long-standing persistent (75%)
  • One operation (PVI+LAA excision), no need for X-ray fluoroscopy
  • Precise, measured transmural lesions using bipolar RF ablation clamp
  • Video-assisted procedure allows direct visualization of the ablation lines
  • Ganglionated Plexi stimulated/tested/ablated as appropriate
  • LAA excision removes potential AFib impulse/clot source
  • Does not require a heart-lung machine (extracorporeal circulation)
  • Very likely able to stop anticoagulant/antiarrhythmic drugs
  • LAA removal significantly decreases hypertensive systolic BP
  • Ends AFib psychological/emotional stress
  • Able to return to active lifestyle/X-sports


  • Pre-operative anxiety
  • Time, costs, logistical arrangements associated with travel to Texas for procedure
  • Minimally-invasive ablation operation still has small complication/morbidity risks Typical surgery post-op discomfort/minor scaring

surgical ablation


Your medication options for treating AFib:

There are three primary goals in the treatment of AFib:

  1. Slow the heart rate
  2. Prevent clots and strokes
  3. If possible, restore the heart to its regular sinus rhythm

Blood-thinning medications, including aspirin and warfarin, may help reduce stroke risk. In fact, long-term use of warfarin has been proven to prevent up to 80% of strokes in people suffering from AFib. Aspirin is an option when the risk of stroke is not too high. To reduce heart rate, many people can be treated with medications such as digoxin, alone or in combination with beta-blockers and calcium channel blockers, as well as other medications. Your treatment will depend on your age, physical condition and history of heart disease.

Atrial fibrillation associated anticoagulant medicine

Many patients use anticoagulant medicine to avoid the complications of blood clots forming in the left atrial appendage.One of the objectives of the Mini-Maze procedure is that our patients do not need these drugs and their potential complications for AFib related reasons. Some of the most prominent medications in use are:

  • Warfarin (also known as Coumadin and Jantoven)
  • Apixaban (also known as Eliquis)
  • Rivaroxaban (also known as Xarelto)
  • Aspirin
  • Enoxaparin (also known as Lovenox)
  • Clopidogrel (also known as Plavix)
  • Heparin
  • Dabigatran (also known as Pradaxa)

If you use the Wolf Mini Maze, these can all become Atrial fibrillation drugs to avoid. You don’t have to rely on them. You can enjoy the health you want for the rest of your life. This breakthrough in atrial fibrillation treatment makes it possible without extensive open-heart surgery, without medication and without worry.

Beta-blocker medications

Beta-blocker medications slow the heart rate and decrease how forcefully the heart contracts, reducing the amount of oxygen the heart needs to work. Beta-blockers are often used to treat heart conditions, including high blood pressure, heart failure, fast or irregular heart rates, and mitral valve prolapse, and to help decrease or prevent chest pain. Beta-blockers are also used for migraine headaches, social anxiety disorder, glaucoma, and a common type of movement disorder called essential tremor.

Examples of Beta-Blockers Include

  • Acebutolol hydrochloride (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone)
  • Bisoprolol (Zebeta)
  • Carteolol (Ocupress)
  • Carvedilol (Coreg)
  • Esmolol (Brevibloc)
  • Labetalol (such as
  • Normodyne or Trandate)
  • Metoprolol (such as
  • Lopressor or Toprol XL)
  • Nadolol (Corgard)
  • Penbutolol sulfate (Levatol)
  • Pindolol (Visken)
  • Propranolol (Inderal)
  • Sotalol (Betapace AF)
  • Timolol (Blocadren)

Calcium channel blockers

Calcium channel blocker medications prevent calcium from entering muscle cells and blood vessels. As a result, blood vessels relax, slowing the heart rate and increasing blood flow to the heart muscle while reducing blood pressure.

Calcium channel blockers are used to treat heart conditions, including high blood pressure, chest pain caused by coronary artery disease, heart failure, and fast or irregular heart rhythms. They are also used to treat severe headaches.

Examples of these medications include:

  • Amlodipine besylate (Norvasc)
  • Diltiazem hydrochloride (Cardizem, Dilacor-XR, Tiazac)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nicardipine hydrochloride (Cardene)
  • Nifedipine (Procardia XL)
  • Verapamil (Calan SR, Isoptin SR)
  • Nisoldipine (Sular)

Cardiac glycosides

Cardiac glycosides are medications that can help the heart beat slower and stronger, which helps the heart pump more blood with each beat. Cardiac glycosides are used to treat heart failure and may also be used to treat irregular rapid heartbeats in the upper heart chamber (AFib).

Examples of cardiac glycosides include:

  • Digoxin (such as Lanoxicaps, Lanoxin)
  • Digitoxin (Crystodigin)

High levels of a cardiac glycoside in the bloodstream can slow the heart rate below normal (bradycardia). This is most likely to occur in people who are receiving medication to help reduce water retention (water pills or diuretics), especially those with decreased kidney function.

Antiarrhythmic medications

Antiarrhythmic medications may be used to return an irregular heartbeat (arrhythmia) to its normal rhythm, prevent the occurrence of an arrhythmia, or control the heartbeat during an arrhythmia. These drugs work mostly by stabilizing the heart muscle tissue or slowing the heart rate.

Recent studies show that antiarrhythmic drugs have a success rate of only 30-35% at one-year follow-up (citation)

Amiodarone is one of the most effective drugs in this group, with up to 65% of patients in sinus rhythm at 1-year follow-up; Unfortunately long-term use of this drug is not receommended because of its cumulative dose-dependent toxicity to organs, such as  lungs, thyroid and liver (Europace 2018, 20, 731–732)

Examples of antiarrhythmic medications are:

  • Ibutilide (Corvert)
  • Amiodarone (such as Cordarone or Pacerone)
  • Flecainide (Tambocor)
  • Sotalol (Betapace AF)
  • Procainamide (Procanbid)
  • Propafenone (Rythmol)
  • Quinidine (such as Quinidex)
  • Disopyramide (Norpace)
  • Dofetilide (Tikosyn

Many of these medications have side effects and interactions with other medications. A person taking any of these medications should be in good communication with his or her health professional.

The Cox-Maze procedures

Developed by Dr. James Cox, this procedure has evolved over the years, so you may hear from the Cox-I to the Cox-IV procedure. In this type of surgery the atria are divided into small, isolated sections either by cutting and sewing or using RF ablation devices. The premise of the procedure is that the chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the scars that separate the sections of the atria. There are many variations of the same procedure both open and minimally invasive. The philosophy behind this procedure is based on the intrinsic conduction system of the heart and does not take into account the autonomic nervous system, as does the Wolf Mini-Maze. It is more invasive in the sense that it requires a sternotomy (cutting through the breastbone), takes more time, and uses more RF lines of ablation.

In this type of procedure it is necessary to stop the heart as the surgery is performed in a non-beating heart. To do this the patient is cooled heparinized, and a chemical agent is infused inside the aorta, or in the coronary sinus, requiring catheters and entry locations. This is called cardioplegia *. Once the heart is stopped the patient requires extracorporeal circulation (a heart-lung machine) with the potential complications associated with the use of this medical device, a condition some anesthesiologists call "pumphead".

This type of procedure is another option that you may be presented and used for people with severe AF that can’t be controlled with medication, or for people undergoing heart surgery for other reasons.

* "Cardioplegia" ; ; i - National Library of Medicine Stat Pearls