Atrial fibrillation (AFib) is a problem with your heart's electrical activity. With AFib, your heart quivers, beats irregularly, or skips beats. It can't pump blood through its chambers and out to your body as well as it should. Sometimes, blood can pool in the heart and form clots, which could lead to a stroke.
You have treatment options if your symptoms become too severe.
Treatment for AFib, such as medications, nonsurgical procedures, and surgery, can slow your heartbeat and bring it back into a normal rhythm. AFib treatments can also prevent clots and help keep your heart healthy.
AFib Medications
These can prevent clots and strokes, slow your heart rate, and control your heart rhythm.
Blood thinners. These medications prevent blood clots to lower your odds of having a stroke. But they can raise your risk of bleeding, so you might have to cut back on activities that can lead to injuries. The most common blood thinners are:
- Apixaban (Eliquis)
- Aspirin
- Dabigatran (Pradaxa)
- Enoxaparin (Lovenox)
- Heparin
- Rivaroxaban (Xarelto)
- Warfarin (Coumadin, Jantoven)
Blood thinners can make you more likely to bruise or bleed too much. Depending on which blood thinner you're taking, you might need an occasional blood test to make sure the medication is working and you're on the right dose.
Heart rate medicines. The most common way to treat atrial fibrillation is with drugs that control your heartbeat. These slow your rapid heart rate, helping your heart pump better.
You may need other drugs. Some are called beta-blockers. They also slow your heart rate. Some examples are:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta, Ziac)
- Carvedilol (Coreg)
- Metoprolol (Lopressor, Toprol)
- Propranolol (Inderal, Innopran)
- Timolol (Betimol, Istalol)
Others are known as calcium channel blockers. They slow your heart rate and tone down contractions. You might get:
- Diltiazem (Cardizem, Dilacor)
- Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)
Antiarrhythmic drugs. These medications slow your heart's electrical signals to bring your heartbeat into what’s called a normal sinus rhythm. These treatments are sometimes called chemical cardioversion. You might get:
Sodium channel blockers, which slow your heart's ability to conduct electricity:
- Flecainide (Tambocor)
- Propafenone (Rythmol)
- Quinidine
Potassium channel blockers, which slow the electrical signals that cause AFib:
- Amiodarone (Cordarone, Nexterone, Pacerone)
- Dofetilide (Tikosyn)
- Sotalol (Betapace, Sorine, Sotylize)
You might get them in your doctor's office or at a hospital. Your doctor will monitor you to make sure the medicine is working.
AFib Procedures
If meds for atrial fibrillation don't work for you or cause too many side effects, there are surgical and nonsurgical options for treating it. They include:
Electrical cardioversion
During this procedure, you'll get a mild electric shock to your heart to "reset" your heart back to a more normal rhythm. It only takes a few minutes, and you won't feel any pain. Here's how it works:
- First, someone from your health care team will give you a medicine (sedative) through an IV, which will make you sleepy and prevent pain during the cardioversion.
- Your doctor will place several large patches with electrodes on your chest and sometimes on your back. These are connected to a machine that monitors your heart rate.
- The machine quickly sends low-energy shocks to your heart through the patches to restore it to a normal rhythm.
Most people only need one procedure, and you can usually go home the same day. Your skin may be irritated where the electrodes were, but your doctor can recommend a lotion to help with pain or itching.
Atrial fibrillation ablation
It works by disrupting irregular electrical pathways in your heart. A doctor typically inserts a catheter (a very thin, flexible tube) into a blood vessel in your neck or groin and guides it to your heart. Then your doctor can use one of many types of ablation to create scarring on your heart to prevent your abnormal heart rhythm. You and your doctor will decide which is the best type of ablation for your condition.
Here are some types of atrial fibrillation ablation and the methods they use on your heart:
- Radiofrequency ablation: Uses heat to destroy abnormal tissue in your heart
- Cryoablation: Uses extreme cold to destroy abnormal heart tissue
- Pulsed-field ablation: Uses short bursts of high energy called irreversible electroporation to destroy abnormal heart tissue
- Pulmonary vein isolation ablation: Uses the catheter tip to destroy tissue
- Maze procedure: This procedure is more invasive and usually is done while you’re under anesthesia. It uses heat, cold, and scalpels to create a maze of scars to disrupt electrical pathways.
- Mini maze procedure: Uses surgery and catheter methods to create the scar tissue.
- AV node ablation: Uses radiofrequency energy to destroy a tiny bit of tissue between the upper and lower chambers of your heart (AV node), preventing electrical signals (including abnormal ones that cause AFib) from passing through. Because your AV node is damaged, you'll have to have a pacemaker implanted to help keep your heart’s rhythm normal.
Pacemaker
This is a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it's beating too slowly. It’s made up of a small device called a generator that holds a battery and a tiny computer. Very thin wires called leads connect the pacemaker to your heart.
Getting a pacemaker is a relatively minor procedure. First, your doctor inserts a needle into a large vein near your shoulder, which guides the leads into your heart. The pacemaker then goes into your chest through a small cut. Once it's in place, your doctor tests it to make sure it works. Sometimes, the impulses your pacemaker sends to your heart can make you feel dizzy or have throbbing sensations in your neck. And you'll have to stay away from machines with strong magnetic fields, such as metal detectors and MRI machines, as they can affect your pacemaker's electrical signals.
Risks of atrial fibrillation ablation
For some people, ablation restores a normal heart rhythm better than medications. It’s generally safe, but it does have some risks, including:
- Bleeding around your heart or where the catheter is inserted
- Hole in the heart
- Stroke
- Narrowing of the pulmonary vein
- Damage to the esophagus, the tube that carries food from your mouth to your stomach
Also, your AFib can come back in the first few months after you have ablation. In that case, you may need to have the procedure again or take heart rhythm drugs.
Treating the Causes of AFib
If your AFib is a result of problems such as high blood pressure, cholesterol, or an overactive thyroid, you'll need to treat the root cause. Your doctor might prescribe medications to get those conditions under control.
Your doctor may also recommend screening and treatment for sleep apnea, a disorder in which your breathing starts and stops throughout the night.
Some other types of health problems can also lead to AFib symptoms, too. Make sure you keep your other medical conditions under control, including:
- Heart problems, such as a congenital heart defect or heart failure
- Heart valve disease
- Diabetes
- Obesity
- Lung diseases such as pneumonia
- Thyroid disease
Other things that might cause AFib:
- Drinking alcohol and caffeine
- Using illegal drugs
- Smoking
- Medicines that have stimulants
Complementary Treatments
We need more research into alternative and complementary treatments for AFib. But a few have shown some promise in early studies. They include:
- Omega-3 fatty acids
- Antioxidant vitamins, such as vitamins C and E
- Herbal supplements such as berberine, cinchona bark, and Shensong Yangxin (a traditional Chinese mixture)
Always check with your doctor before you try a complementary treatment.
AFib Lifestyle Changes
Your doctor may suggest some simple steps to help keep your heart healthy:
- Eat heart-healthy, low-salt food. Go for fruits, veggies, and whole grains.
- Get more exercise. More physical activity strengthens your heart.
They may also suggest other changes to lower your odds of heart disease, as well as conditions like diabetes and lung disease that can contribute to AFib:
- Quit smoking.
- Stay at, or try to reach, a healthy weight.
- Control your blood pressure.
- Manage your cholesterol.
- If you drink alcohol, do it in moderation.
Your doctor will likely advise you to avoid stimulants, which can trigger AFib episodes. These include over-the-counter cough medicines that contain pseudoephedrine as well as recreational drugs like cocaine and amphetamines.
Don't ignore your emotional health. Stress may make atrial fibrillation worse, so find ways to manage it. You might try:
- Yoga, tai chi, or other mind-body techniques
- Spending time with family and friends
If you have symptoms of anxiety or depression, like long-lasting sadness or trouble concentrating, ask your doctor to refer you to a mental health specialist.
Can AFib Be Cured?
Right now, there's no cure for it. But certain treatments can make symptoms go away for a long time for some people.
Treatments include medications, procedures such as cardioversion or ablation, and lifestyle changes such as exercising and eating a healthy diet. In some cases, AFib may resolve on its own. But more commonly, it's a persistent issue that requires ongoing management.
The most effective course of treatment depends on the underlying cause of AFib, the severity of symptoms, and the overall health of the patient.
AFib Treatment FAQs
How do blood thinners work in treating AFib?
The irregular heart rhythm caused by AFib can make blood fill up in your heart's two upper chambers where it can form blood clots. If these clots break off and travel to your brain, they can cause a stroke; if they get stuck in your blood vessels, they can block blood from flowing to your other organs. Blood thinners can help prevent your blood from clotting and lower your risk of having a stroke if one does form because of AFib.
Can lifestyle changes impact the management of AFib?
Research suggests they can. By focusing on a eating healthy diet, exercising more, lowering your stress, and sleeping better, you can help address your AFib without surgery or medications.
Is there a cure for atrial fibrillation?
There is no cure for AFib. But there are many different options for treating AFib, so you can manage the condition and help prevent severe symptoms.
