How Atrial Fibrillation Is Treated

The treatment goals for atrial fibrillation are to reset the heart rhythm or control the rate, prevent blood clots, and decrease the risk of strokes. The rate control approach is the default, using anticoagulants (blood thinners) and medications to control your heart rate. The rhythm control approach attempts to restore and maintain a normal heart rhythm through electrical cardioversion, by using antiarrhythmic medications, or with invasive ablation techniques (see below).

Deciding on the "right" treatment for any individual with atrial fibrillation is most often a compromise, and the advantages and disadvantages of each will be weighed carefully by your healthcare team. Lifestyle changes aimed at preventing heart disease and stroke are also a part of treatment.

Prescriptions

You will be prescribed medications that aim to reduce your risk of blood clots and strokes. Depending on the treatment approach, you may also be prescribed antiarrhythmic medications or heart rate control medications.

Anticoagulant Medications

Coumadin (warfarin) has long been the standard oral medication for anticoagulant therapy. It works by inhibiting vitamin K, which is needed for the body to make many of the blood's clotting factors.

When on Coumadin, you must have your blood tested frequently to see if the dose needs to be adjusted. If the dose is too low, you are at risk for clots and strokes. If it is too high, you are at risk for bleeding.

Many foods, herbs, and supplements interfere with Coumadin, so you must pay special attention to dietary restrictions and report anything you are taking to your doctor or pharmacist. One advantage of Coumadin is that its effects can be quickly reversed by giving vitamin K.

Novel anticoagulant (NOAC) drugs are a newer category that directly inhibit certain clotting factors. NOACs currently approved in the U.S. include:

  • Eliquis (apixaban)
  • Pradaxa (dabigatran)
  • Savaysa (edoxaban)
  • Xarelto (rivaroxaban)

They don't need frequent blood tests, dosage adjustments, or dietary restrictions. While just as effective as Coumadin, they are far more expensive.

Heart Rate Control Medications

Digitalis or Lanoxin (digoxin) used to be the standard prescription given to slow the heart rate. However, it is best for controlling heart rate at rest and doesn't work as well during activity. The difference between a therapeutic dose and a toxic dose is small, so there is a significant risk of digoxin toxicity. You must be monitored regularly if you are on this drug.

The preferred alternative is usually a combination of beta-blocking drugs or calcium channel blockers. Like digoxin, they work slowing the conduction of the electrical impulse through the AV node, which reduces the heart rate.

AntiArrhythmic Medications

Several antiarrhythmics are used intravenously to try to stop atrial fibrillation and restore a normal rhythm (an effort known as drug cardioversion). These include:

  • Corvert (ibutilide)
  • Rhythmol (propafenone)
  • Tambocor (flecainide)
  • Tikosyn (dofetilide)

However, these drugs will successfully restore a normal rhythm only 50% to 60% of the time, and there can be side effects.

Your doctor may also prescribe oral antiarrhythmic medications after cardioversion (either drug or electrical, see below). These might be taken on an ongoing or as-needed basis when you feel symptoms. In addition to the drugs used in drug cardioversion, amiodarone and sotalol may be used in these cases.

The drugs can cause nausea, dizziness, and fatigue, and there is a rare risk that they will cause dangerous ventricular arrhythmias.

Over-the-Counter (OTC) Therapies

Aspirin is available over-the-counter and may be recommended in rare cases for use as an anticoagulant. It works by inhibiting platelets, the cells that come together to form a clot.

Aspirin poses a risk of bleeding, like other anticoagulants. You must be sure to take only the dosage recommended.

When you are on anticoagulant therapy, you must take extra care when using any OTC cold, flu, allergy, or sleep products. Sometimes they contain aspirin, which could interact with anticoagulants. Be sure to discuss any OTC medications with your doctor.

Surgery and Specialist-Driven Procedures

There are several procedures that may be done under different circumstances, depending on your treatment approach and many other factors.

Electrical Cardioversion

Electrical cardioversion may be done in an emergency situation or when medications haven't worked to restore the heart's normal rhythm. You will be placed in a light, anesthesia-induced sleep while the doctor administers an electrical discharge to your chest using a set of paddles. This procedure is painless, quick, safe, and nearly always effective.

Catheter Ablation

The ablation procedure aims to kill the cells creating the abnormal rhythm. The source of your arrhythmia is mapped, localized, and then destroyed by using cauterization or freezing through a long thin tube (catheter). Ablation is performed either during an electrophysiology study or in the surgical suite.

While many forms of cardiac arrhythmias have become readily curable using ablation techniques, atrial fibrillation has remained a challenge. The three-year success rate is 50% and can be as high as 80% with repeated procedures. However, these rates are similar to the success rates of antiarrhythmic drug therapy.

The ablation procedure has risks including stroke, bleeding, and death, which must be considered.

Maze Procedure

The surgical maze procedure is done during open-heart surgery. It uses incisions, radiofrequency, or cryotherapy to create scars on the upper chambers of the heart to disrupt the electrical signals that create arrhythmia.

Due to the risks of open-heart surgery, it is usually done only for those who don't respond to other treatments or when open-heart surgery is required for another cardiac problem.

Pacemaker

Some people with atrial fibrillation may benefit from having a pacemaker implanted to regulate their heartbeat. This is most often done if you have a slow heart rate, or bradycardia. This can develop during treatment with antiarrhythmic drugs, in which case a pacemaker might be a temporary measure while getting the drug levels up to the desired point. Or, it may be needed permanently.

Left Atrial Appendage Closure

This catheter procedure aims to reduce the risk of blood clots that typically form in the left atrial appendage, which is a small sac in the upper left heart chamber. A small device is inserted to close the sac.

Home Remedies and Lifestyle

You can do many things to take control of your health when you have atrial fibrillation. These can reduce your symptoms and improve the condition, as well as reduce your risks of heart disease and stroke.

Lifestyle changes are part of the recommended treatment program. They include:

  • Adopt a heart-healthy eating pattern: This may be a Mediterranean-style diet or the DASH diet, which reduces salt to help keep your blood pressure under control.
  • Lose weight if you are overweight: Even a 10% reduction can help improve your condition.
  • Get regular exercise and reduce the time you spend sitting.
  • Use stress management strategies, as stress and anxiety can worsen symptoms.
  • Quit smoking.
  • Only drink alcohol in moderation.
  • Do not use street drugs.

Complementary and Alternative Medicine (CAM)

There are CAM therapies that might have benefit for atrial fibrillation. Yoga, acupuncture, and relaxation-based therapies show the most promise. These have the advantage of being safe from interactions with medications. However, they should only be used as adjuncts to standard medical therapy.

There is more risk if you use herbal medicines or dietary supplements as you must be careful to avoid interactions with medications. Be sure that you report everything you take to your doctor or pharmacist.

A Word From Verywell

If you have atrial fibrillation, there's a lot to consider in choosing the right treatment approach: the severity of your symptoms; your underlying medical and cardiac problems, if any; the frequency and duration of your episodes of atrial fibrillation; your personal preferences; and the opinions of your doctors. This decision always needs to be individualized.

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