How Is Atrial Fibrillation Treated?

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.

Goals of Treatment

The goals of treating AF include:

• Preventing blood clots from forming, thereby reducing the risk of stroke.
• Controlling 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.
• Restoring a normal heart rhythm. This is called rhythm control. Rhythm control allows the atria and ventricles to work together to efficiently pump blood to the body.
• Treating any underlying disorder that's causing or raising the risk of AF—for example, hyperthyroidism (too much thyroid hormone).

Who Needs Treatment for Atrial Fibrillation?

People who have AF but don't have symptoms or related heart problems may not need treatment. AF may even go back to a normal heart rhythm on its own. (This also can occur in people who have AF with symptoms.)

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 heart's electrical system, leading to persistent or permanent AF. Most people who have persistent or permanent AF need treatment to control their heart rates 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 blood clots from forming 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 who have risk factors for stroke. People taking warfarin must have regular blood tests to check how well the medicine is working.

Rate Control

Doctors 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 treatment for most patients who have AF, even though an abnormal heart rhythm continues and the heart doesn't work as well as it should. Most people feel better and can function well if their heart rates are 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.

Rhythm Control

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 cases, the chance that AF will recur is high, even if you're taking medicine to help convert AF to a normal rhythm.

Medicines. Medicines used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. Occasionally, older medicines, such as quinidine, procainamide, and disopyramide, are used.

Your doctor will carefully tailor the dose and type of medicines he or she prescribes to treat your AF. This is because medicines used to treat AF can cause a different kind of arrhythmia. They also can harm people who have underlying diseases of the heart or other organs. This is particularly true for patients who have an unusual heart rhythm problem called Wolff-Parkinson-White syndrome.

Your doctor may start you on a small dose of medicine and then gradually increase the dose until your symptoms are controlled. Medicines used for rhythm control can be given regularly by injection at a doctor's office, clinic, or hospital. Or, you may routinely take pills to try to control AF or prevent recurrences.

If your doctor knows how you'll react to a medicine, a specific dose may be prescribed for you to take on an as-needed basis if you have an episode of AF.

Procedures. Doctors use several procedures to restore a normal heart rhythm. Electrical cardioversion is a procedure used to restore a fast or irregular heartbeat to a normal rhythm. For the procedure, low-energy shocks are given to your heart to trigger a normal rhythm. You're temporarily put to sleep before the shocks are given.

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.

Before doing electrical cardioversion, your doctor may recommend transesophageal echocardiography (TEE) to rule out the presence of blood clots in the atria. If clots are present, you may need to take blood-thinning medicines for a period of time to help get rid of the clots before the procedure.

Catheter ablation may be used to restore a normal heart rhythm when medicines or electrical cardioversion don't work. During this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart.

Radio wave energy is sent through the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals. An electrophysiologist usually does this procedure in a hospital.

Sometimes catheter ablation is used to destroy the atrioventricular (AV) node. The AV node is where the heart's electrical signals pass from the atria to the ventricles. This procedure requires your doctor to surgically implant a device called a pacemaker to maintain a normal heart rhythm.

Research to examine the benefits of catheter ablation as a treatment for AF is still ongoing.

Another procedure to restore a normal heart rhythm is called "maze" surgery. During this procedure, the surgeon makes small cuts or burns in the atria that prevent the spread of disorganized electrical signals.

This procedure requires open-heart surgery, so it's usually done 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

Your doctor also may recommend other treatments for an underlying condition that may be causing AF or to reduce AF risk factors. For example, he or she may prescribe medicines to treat an overactive thyroid or reduce blood pressure.

Your doctor also may recommend lifestyle changes, such as following a healthy diet, cutting back salt intake (to help lower blood pressure), quitting smoking, and reducing stress.

Limiting or avoiding stress and alcohol, caffeine, or other stimulants that may increase your heart rate also may help reduce the risk of AF.