Atrial Fibrillation - Treatment - Treatment

Your doctor may recommend adopting heart-healthy lifestyle changes, such as the following:

• Heart-healthy eating patterns such as the DASH eating plan, which reduces salt intake to help lower blood pressure
• Being physically active
• Getting help if you are trying to stop using street drugs
• Limiting or avoiding alcohol or other stimulants that may increase your heart rate
• Managing stress
• Quitting smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they 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).
• Aiming for a healthy weight to reduce the severity and number of episodes

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, to 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 situation. If the dose is too high, it can cause the heart to beat too slowly. These medicines can also make COPD and arrhythmia worse.
• Blood thinners to prevent blood clots and lower the risk of stroke. These medicines include edoxaban, dabigatran, warfarin, heparin, and clopidogrel. 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 to control the rate at which the heart’s lower chambers pump blood throughout the body. They include diltiazem and verapamil.
• Digitalis, or digoxin, to control 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 to 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 rate control medicines. 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. Or your doctor 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 effects on the liver, lung, and other organs, low blood pressure, and indigestion.

Your doctor may recommend treatments for an underlying cause or to reduce atrial fibrillation risk factors. For example, he or she 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.

Your doctor may recommend a procedure, especially if lifestyle changes and medicine alone did 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.

• Catheter ablation to destroy 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, your doctor will place a pacemaker at the time of the procedure to make sure your heart beats correctly once the tissue causing problems is destroyed.
• Electrical cardioversion to restore your heart rhythm using low-energy shocks to your heart. This may be done in an emergency or if medicines have not worked.
• Pacemaker to reduce 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. For example, if you are diagnosed with a slow heart rate or sick sinus syndrome, a pacemaker implanted for that condition can also prevent atrial fibrillation. If you have surgery for a pacemaker, you will need to take blood-thinning medicines.
• Plugging, closing, or cutting off the left atrial appendage to prevent 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 leaking can contribute to ongoing clotting risk.
• Surgical ablation to destroy heart tissue generating faulty electrical signals. The surgeon usually does surgical ablation at the same time as surgery to repair heart valves, but in some cases, surgical ablation can be done on its own.

• Living With will explain what your doctor may recommend, including lifelong lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications.
• Research for Your Health will explain how we are using current research and advancing research to treat people with atrial fibrillation.
• Participate in NHLBI Clinical Trials will discuss our open and enrolling clinical studies that are investigating treatments for atrial fibrillation.