Atrial Fibrillation
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Atrial Fibrillation

Atrial Fibrillation Treatment

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Atrial fibrillation is treated with lifestyle changes, medicines, and procedures, including surgery, to help prevent blood clots, slow your heartbeat, or restore your heart’s normal rhythm.

Your doctor may also treat you for an underlying disorder that is raising the risk of atrial fibrillation, such as overweight or obesity, sleep apnea, or an overactive thyroid gland.

Lifestyle changes

Your doctor may recommend adopting heart-healthy lifestyle changes, including those listed below.

  • Aim for a healthy weight to reduce the severity and number of atrial fibrillation episodes you have.
  • Be physically active.
  • Get help if you are trying to stop using illegal or street drugs.
  • Limit or avoid alcohol or other stimulants that may increase your heart rate.
  • Manage stress.
  • Quit smoking.Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Use heart-healthy eating practices such as the DASH eating plan, which reduces salt intake to help lower blood pressure.

Medicines

Your doctor may consider treating your atrial fibrillation with medicines to slow your heart rate or to make your heart’s rhythm more even.

  • Beta blockers, such as metoprolol, carvedilol, and atenolol, help slow the rate at which the heart’s lower chambers pump blood throughout the body. Rate control is important because it allows the ventricles enough time to fill with blood completely. With this approach, the abnormal heart rhythm continues, but you may feel better and have fewer symptoms. Beta blockers are usually taken by mouth, but they may be delivered through a tube in an emergency. If the dose is too high, the heart may beat too slowly. These medicines can also make COPD and arrhythmia worse. Some people with low blood pressure cannot take beta blockers because they also lower blood pressure.
  • Blood thinners like edoxaban, dabigatran, warfarin, heparin, and clopidogrel prevent blood clots and lower the risk of stroke. You may not need to take blood thinners if you are not at risk of a stroke. Blood-thinning medicines carry a risk of bleeding. Other side effects include indigestion and heart attack.
  • Calcium channel blockers including diltiazem and verapamil control the rate at which the heart’s lower chambers pump blood throughout the body. 
  • Digitalis, or digoxin, controls the rate blood is pumped throughout the body. It should be used with caution, as its use can lead to other arrhythmias.
  • Other heart rhythm medicines slow a heart that is beating too fast or change an abnormal heart rhythm to a normal, steady rhythm. Rhythm control is an approach recommended for people who continue to have symptoms or otherwise are not getting better with medicines that control heart rate. Rhythm control also may be used for people who have only recently started having atrial fibrillation or for highly physically active people and athletes. These medicines may be used alone or in combination with electrical cardioversion. Your provider may prescribe some of these medicines for you to take as needed when you feel symptoms of atrial fibrillation. Some heart rhythm medicines can make arrhythmia worse. Other side effects include low blood pressure, indigestion, and effects on the liver, lungs, and other organs.

Your provider may recommend treatments for an underlying cause or to reduce atrial fibrillation risk factors. They may prescribe medicines to treat overweight and obesity, an overactive thyroid, lower high blood pressure, manage high blood cholesterol, control or prevent diabetes, or help you quit smoking.

Procedures or surgery

Your provider may recommend a procedure, especially if lifestyle changes and medicine alone do not improve your symptoms. Typically, your doctor will consider a surgical procedure to treat your atrial fibrillation only if you will be having surgery to treat some other heart condition.

  • Electrical cardioversion restores your heart rhythm using low-energy shocks to your heart. This may be done in an emergency or if medicines have not worked.
  • A pacemaker reduces atrial fibrillation when it is triggered by a slow heartbeat. Typically, a pacemaker is used to treat atrial fibrillation only when it is diagnosed along with another arrhythmia such as a slow heart rate or sick sinus syndrome. If you have surgery to receive a pacemaker, you will also need to take blood-thinning medicines.
  • Catheter ablation destroys the tissue that is causing the arrhythmia. Ablation is not always successful and in rare cases may lead to serious complications, such as stroke. The risk that atrial fibrillation will reoccur is highest in the first few weeks after the procedure. If this happens, your doctor may repeat the procedure. In some cases, you may have a pacemaker placed at the time of the procedure to make sure your heart beats correctly once the tissue causing problems is destroyed.
  • Surgical ablation destroys the damaged heart tissue that is generating faulty electrical signals. The doctor usually performs surgical ablation at the same time as a surgery to repair heart valves, but in some cases, surgical ablation can be done on its own.
  • Plugging, closing, or cutting off the left atrial appendage prevents clots from forming in the area and causing a stroke if you cannot take blood thinners. Your doctor may do this at the same time as surgical ablation. It can be difficult to close off the appendage entirely, and any leaking contributes to ongoing clotting risk.
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