Atrial Fibrillation Treatment Options

Atrial fibrillation (afib) is a heart rhythm abnormality. In this condition, the upper chambers of your heart beat rapidly and irregularly. This can cause symptoms like fatigue and shortness of breath. It can also lead to dangerous problems such as stroke and heart failure.

Most people who have repeated episodes of atrial fibrillation or permanent afib need treatment. There are generally three goals of atrial fibrillation treatment:

  1. Preventing blood clots and reducing stroke risk

  2. Establishing rate control, which can mean slowing down your heart

  3. Getting your heart in a normal rhythm

Treatment options to achieve these goals include medications, lifestyle changes, and surgical procedures. The best treatment for you depends on many factors, including your symptoms and other medical conditions you may have.

Treatment Options: Preventing Blood Clots

Because your heart is beating abnormally, blood can pool in the upper chambers of your heart and form a clot. If a blood clot forms, breaks loose, and travels to your brain, it can cause a stroke and brain damage. That's why clot prevention is so important.

The type of clot prevention medication you take depends on your level of stroke risk. Risk factors include age, diabetes, heart failure, high blood pressure, and a previous history of stroke. If you are at low risk, you may only need to take aspirin. If you are at higher risk, you may need to take a blood thinner, such as warfarin.

What you need to know:

  • Aspirin may reduce your risk of stroke by about 45%, warfarin by about 65%.

  • Both aspirin and warfarin can cause bleeding, so let your doctor know if you have any abnormal bruising or bleeding.

  • If you take warfarin, you'll need to be monitored with monthly blood tests to make sure your clotting time is in the safe range.

  • There are several new blood thinners now available if warfarin doesn't work well for you.

Treatment Options: Slowing Down Your Heart

Most people with atrial fibrillation need medication to slow down the heart. Even though your heartbeat may stay irregular, you will probably feel better and function better when taking one of these drugs. The goal is to get your heart rate down to about 80 beats per minute.  

What you need to know:

  • Heart rate control medications include drugs called beta-blockers, calcium channel blockers, and digoxin.

  • Heart rate control medications are often combined with medications to prevent blood clots.

  • These medications do not cure atrial fibrillation, and you may need to take one for the rest of your life.

  • All these medications have side effects including fatigue, dizziness, and shortness of breath. Discuss the pros and cons carefully with your healthcare provider.

Treatment Options: Getting Your Heart Into a Normal Rhythm

If you don't respond well to heart rate control, a heart rhythm control medication, or antiarrhythmic, may be needed. These medications have many side effects, and you may need to be monitored in a hospital when you first start taking one.  

What you need to know:

  • Antiarrhythmics are only effective 30 to 60%of the time.

  • Antiarrhythmics may lose their effectiveness over time.

  • You may need to try several different drugs to find the one that works best and has the fewest side effects for you.

  • These medications are less likely to help if you've had atrial fibrillation for a long time.

When antiarrhythmics don't help, there are several medical procedures available to return a rapid, irregular heart rhythm to normal.

  • Cardioversion is a procedure done at the hospital after you have been put to sleep. Your heart receives a brief, low-energy electrical charge through wires attached to your chest. This procedure may interrupt the abnormal rhythm.

  • Catheter ablation is done at the hospital, and you may be awake during this procedure. A long, thin tube called a catheter is threaded into your heart, usually from a vein in your leg. Radio wave energy is used to destroy or disrupt areas in the heart that are causing atrial fibrillation. A newer type of ablation freezes these areas.

  • Maze surgery is a type of open-heart surgery that makes burns or cuts inside the upper chambers of the heart to block the abnormal electrical signals causing atrial fibrillation. This procedure is usually only done if you have other heart problems that require open-heart surgery.

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Did You Know?

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Atrial fibrillation makes a person 5 times more likely to have a stroke.