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Atrial fibrillation treatment focuses on two main goals: resetting and controlling the heartbeat and preventing blood clots. Your cardiologist will work with you to choose the treatment options that are right for you. These can include cardioversion, invasive or surgical treatment options, and medication.
Atrial fibrillation, or AFib, occurs when the upper chambers of the heart (known as the atria) beat irregularly. AFib is an arrhythmia, a condition where the heart beats too quickly, too slowly, or irregularly.
AFib treatments that focus on resetting your heart rhythm include cardioversion and various surgical methods. These procedures use drugs, electrical shocks, and other techniques to help restore your heart’s normal rhythm and maintain it. The right treatment for you may depend on:
You may have heard your condition described as “valvular” or “nonvalvular” AFib, but these are outdated terms. The American College of Cardiology and the American Heart Association no longer make a distinction between valvular and nonvalvular AFib when recommending treatments.
AFib is an abnormal heart rhythm, which can also increase your heart rate. Doctors can reset the heart to its normal rhythm using cardioversion. There are two ways to do this, with electrical stimulation or with medication.
Electrical cardioversion uses electric paddles or patches that give short, electrical shocks to the chest and heart. The goal is to shock your heart back into its normal rhythm. Electrical cardioversion takes less time than medicated cardioversion, and your doctor can instantly see whether the procedure worked or not. It’s the preferred method of cardioversion for people younger than 65 who have recently been diagnosed with AFib.
Before the procedure begins, you will be sedated so you don’t feel the shocks. You may also be given anti-arrhythmic medications to help reset your heart rhythm.
Sedation can be risky for some people, so your doctor may prefer to try medicated cardioversion. Drugs called anti-arrhythmics work to reset your heart rhythm back to normal. This is typically done in a hospital where doctors can continuously monitor your heart rate.
In cases when AFib is not well controlled with cardioversion or medication, your doctor may recommend ablation. These procedures create tiny scars in the upper chamber of your heart. In a person with AFib, the area near the pulmonary veins makes abnormal electrical signals, and scarring it can restore the normal heart rhythm. Invasive and surgical options for AFib include catheter ablation, the maze procedure, atrioventricular (AV) node ablation, and left atrial appendage closure.
During catheter ablation, long, thin tubes — or catheters — are inserted into the groin and up through the blood vessels to the heart. The tip of the catheter may use cryotherapy (extreme cold), radiofrequency waves, pulsed field energy, or heat to destroy cells in the atrium that promote arrhythmia. The scar tissue that forms helps the heart return to its normal rhythm.
Catheter ablation is a first-line treatment for some with paroxysmal atrial fibrillation or with heart failure with reduced ejection fraction. It may also be recommended if AFib medications have failed or if you’re unable to take the medications. Although a catheter ablation can be initially successful, there is a chance AFib can develop again. If this happens, your doctor may recommend trying the procedure again or may suggest another option.
The maze procedure most often requires open-heart surgery, and the doctor will use a scalpel, radiofrequency waves, or cryotherapy to create lines of scar tissue in the atrium. This invasive procedure often accompanies valve replacement or coronary surgery. It’s generally successful, but AFib can still come back. This procedure may not be appropriate for some people who have had heart surgeries in the past.
The maze procedure has an 80 percent to 90 percent success rate, and it offers a long-term solution for treating AFib. It can be used when catheter ablation has failed and for people who have a history of blood clots or stroke.
An AV node ablation targets a different area of electrical signaling than catheter ablation or maze procedures. It’s reserved for people with high pulse caused by AFib that could not be slowed by procedures and medications. AV node ablation destroys the tiny AV node (a cluster of cells) found between the upper and lower chambers of the heart. However, the atria will still quiver after this procedure, so a pacemaker is needed to keep the heart beating properly.
People with AFib are at a higher risk for stroke due to the formation of blood clots. Often, these clots form in a small pouch in the top left chamber of the heart, known as the left atrial appendage. To prevent these clots from forming, your doctor may suggest left atrial appendage closure.
In this procedure, your doctor inserts a catheter through a vein in your leg up to your atrium, and a device closes the left atrial appendage. This method is an option for people with an increased risk of blood clots who cannot take blood thinners and don’t have heart valve problems.
Medications are a less invasive way to treat AFib, and they can be used in combination with other treatment methods. There are several types of medication that each work differently, including anti-arrhythmics, beta-blockers, calcium channel blockers, and blood thinners.
After cardioversion, your doctor will want to be sure your arrhythmia is under control. You may be prescribed anti-arrhythmic drugs to help prevent AFib from developing again. There are two main types of anti-arrhythmic drugs that target different ion channels in the heart: potassium channel blockers and sodium channel blockers.
Potassium channel blockers slow the electrical signals sent through the heart, helping control rhythm. Examples include amiodarone (Pacerone), dronedarone (Multaq), and sotalol (Betapace, Sotylize).
Sodium channel blockers slow the heart’s ability to conduct electricity, helping control rhythm. Examples include flecainide and propafenone.
Your doctor may also prescribe beta-blockers. These medications can slow your heart rate, which will most likely be increased for people with AFib. Some examples of beta-blockers include metoprolol, nadolol, and propranolol.
Digoxin is used to help slow the heart’s electrical signals and make it easier for the heart to pump blood. It works best for controlling resting heart rate (when you aren’t active). Digoxin is usually combined with other medications such as beta-blockers or calcium channel blockers.
Calcium channel blockers can have several effects on the heart, including reducing the strength of the heart muscle’s contractions and slowing heart rate. Examples of these drugs include diltiazem and verapamil.
AFib greatly increases your risk of stroke, so your doctor may prescribe medication to prevent blood clots. These drugs are called anticoagulants, or blood thinners. They include apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin.
AFib is a heart condition, and maintaining heart health and overall wellness can improve your quality of life. In addition to other treatments, such as surgery and medication, lifestyle changes can help alleviate symptoms and reduce your risk of severe complications.
Lifestyle changes may include:
On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.
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I underwent electrical cardioversion roughly 2 years ago and purchased a BP cuff with heart rate recorded, oxygen meter and one of those A-Fib devices. All vitals have been good but I am dizzy, tired… read more
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