Treatment for atrial fibrillation (AF) depends on how severe or frequent the symptoms are and whether you already have heart disease. General treatment options include medicines, medical procedures, and lifestyle changes.
Treatment of AF is designed to:
- Prevent blood clots from forming, and thereby reduce the risk for stroke.
- Control how many times a minute the ventricles contract. This is called rate control. Rate control is important because it allows the ventricles enough time to completely fill with blood. With this approach, the irregular heart rhythm continues, but the person feels better and has fewer symptoms.
- Restore the heart to a normal rhythm. This is called rhythm control. Rhythm control allows the atria and ventricles to work together again to efficiently pump blood to the body.
- Treat any underlying disorder that's causing or raising the risk of AF-for example, hyperthyroidism.
Who Needs Treatment for Atrial Fibrillation?
People with no symptoms and no related heart problems may not need treatment. AF may even go back to a permanent normal heart rhythm on its own. In some people who have AF for the first time, doctors may choose to use an electrical procedure or medicine to restore the heart rhythm to normal.
Repeated episodes of AF tend to cause changes to the electrical system of the heart, leading to persistent or permanent AF. Most people with persistent or permanent AF need treatment to control their heart rate and prevent complications.
Specific Types of Treatment
Blood Clot Prevention
The risk of a blood clot traveling from the heart to the brain and causing a stroke is increased in people who have AF. Preventing the formation of blood clots is probably the most important part of treating AF. Doctors prescribe blood-thinning medicines to prevent blood clots. These medicines include warfarin (Coumadin), heparin, and aspirin.
Warfarin is the most effective medicine in people with risk factors for stroke. People taking warfarin must have regular blood tests to check how well the medicine is working.
Doctors also prescribe medicines to slow down the rate at which the ventricles are beating. These medicines help bring the heart rate to a normal level.
Rate control is the recommended strategy for most patients with AF, even though the heart rhythm continues to be abnormal and the heart doesn't work as efficiently as it could. Most people feel better and can function well if their heart rate is well controlled.
Medicines used to control the heart rate include beta blockers (for example, metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil), and digitalis (digoxin). Several other medicines also are available.
Doctors use medicines or procedures to restore and maintain the heart's rhythm. This treatment approach is recommended for people who aren't functioning well with rate control treatment or who have only recently started having AF.
The longer you have AF, the less likely it is that an abnormal heart rhythm can be restored to a normal heart rhythm. This is especially true for people who have had AF for 6 months or more.
Restoring a normal rhythm also becomes less likely if the atria become enlarged or if any underlying heart disease becomes more severe. In these situations, the chance that AF will recur is high, even if you're taking a medicine to help convert AF to a normal rhythm.
Medicines. Medicines used to control a person's heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, and occasionally older medicines such as quinidine, procainamide, and disopyramide.
Medicines must be carefully tailored to the person taking them because they can cause a different kind of irregular, slow, or rapid heartbeat (arrhythmia) or can be harmful in people who have underlying diseases of the heart or other organs. This is particularly true for those patients who have an unusual heart rhythm problem called Wolff-Parkinson-White syndrome.
To convert AF to a normal heart rhythm, people can be given AF medicines regularly by injection at a doctor's office, clinic, or hospital. Or, to try to control AF or prevent recurrences, people may take pills on an ongoing basis. If the doctor knows how a person will react to a medicine, a specific dose may be prescribed according to the "pill in the pocket" technique. This means that a patient takes a specific dose of a medicine as needed only if he or she has an episode of AF, but not on a regular, daily basis.
Procedures. Doctors use several procedures to restore a normal heart rhythm, including:
- Electrical cardioversion, which is a jolt of electricity delivered to the heart to "convert" the rhythm from AF back to a normal heart rhythm. This shock can break the pattern of abnormal electrical signals and restore a normal rhythm. Electrical cardioversion isn't the same as the emergency heart shocking procedure often seen on TV programs. It's planned in advance and done under carefully controlled conditions with the person heavily sedated.
- Before doing electrical cardioversion, the doctor may recommend a transesophageal echocardiogram (TEE) to rule out the presence of blood clots in the atria. If clots are present, the patient may need to receive blood-thinning medicines to help eliminate the clots before the electrical cardioversion.
- Radiofrequency ablation, which is used to restore a normal heart rhythm when medicines or electrical cardioversion don't work. In this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart. Radiowave energy is sent through the wire to destroy abnormal tissue that's believed to be disrupting the normal flow of electrical signals. This procedure is usually done in the hospital and is performed by an electrophysiologist.
- Maze procedure, in which a surgeon makes small cuts or burns in the atria to reduce the chances of chaotic electrical activity happening in the atria. This procedure requires open-heart surgery, so it's usually performed when a person requires heart surgery for other reasons, such as for valve disease, which can increase the risk of AF.
Approaches To Treating Underlying Causes and Reducing Risk Factors
The doctor also may suggest other approaches designed to treat the underlying condition that may be causing AF or to reduce risk factors for AF. These approaches include prescribing medicines to treat an overactive thyroid, reduce blood pressure and overweight, or treat other underlying causes of AF.
The doctor also may recommended lifestyle changes, such as reducing stress, quitting smoking, reducing salt intake (to help lower blood pressure), and eating healthily. Limiting or avoiding stress as well as alcohol, caffeine, or other stimulants that may increase your heart rate also may help to reduce the risk of AF.
National Heart, Lung, and Blood Institute