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.

Your provider may recommend adopting the following heart-healthy lifestyle changes:

• Aim for a healthy weight to reduce the severity and number of atrial fibrillation episodes you have.
• Limit or avoid alcohol or stimulants that may increase your heart rate.
• Be physically active.
• Reach out for help if you are trying to stop using illegal or street drugs.
• 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).
• Choose heart-healthy foods. Follow heart-healthy eating practices such as the DASH eating plan, which reduces salt intake to help lower blood pressure.

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Your healthcare provider may consider treating your atrial fibrillation with medicines that help prevent blood clots from forming and medicines that work by slowing your heart rate or by restoring your heart’s normal rhythm.

• Beta blockers help slow the rate at which the heart’s lower chambers pump blood throughout the body. Rate control is important because it gives 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. If the dose is too high, the heart may beat too slowly. People who have COPD, a slow heart rate (bradycardia) or other types of arrhythmias should not take beta blockers because they can worsen those conditions. People with low blood pressure should not take beta blockers because they also lower blood pressure.
• Blood thinners such as warfarin or direct-acting oral anticoagulants (DOACs) such as apixaban, dabigatran, rivaroxaban or edoxaban prevent blood clots and lower the risk of stroke. You may need to take blood thinners if you are at risk of a stroke. Blood-thinning medicines carry a risk of bleeding.
• Calcium channel blockers control the rate at which the heart’s lower chambers pump blood throughout the body. Patients with lung problems who cannot take beta blockers may take calcium channel blockers. However, some calcium channel blockers reduce the pumping action of the heart, so are not used in patients with hearts that don’t strongly contract. Similar to beta blockers, patients with a slow heart rate or low blood pressure may not be able to take calcium channel blockers.
• 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 an 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 or an overactive thyroid, lower high blood pressure, manage high blood cholesterol, control or prevent diabetes, or help you quit smoking.

Your provider may recommend a procedure, especially if lifestyle changes and medicine alone do not improve your symptoms. Typically, your provider will consider a surgical procedure to treat your atrial fibrillation only if you will be having surgery to treat some other heart condition. This may be done in an emergency or if medicines have not worked.

• Electrical cardioversion restores your heart rhythm using low-energy shocks to your heart. 
• 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 infection, bleeding or stroke. The risk that atrial fibrillation will reoccur is highest in the first few weeks after the procedure. If this happens, your provider 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.
• 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 conduction disorders like sick sinus syndrome. If you have surgery to receive a pacemaker, you will also need to take blood-thinning medicines.
• Plugging, closing, or cutting off the left atrial appendage (a small sac in the muscle wall of your left atrium) prevents clots from forming in the area and causing a stroke if you cannot take blood thinners. Your provider may do this at the same time as surgical ablation or cardiac surgery. It can be difficult to close off the appendage entirely, and any leaking contributes to ongoing clotting risk.
• Surgery called the Maze procedure creates scars within the left atrium that  help restore the heart’s normal rhythm. It is usually done in people having open heart surgery for other reasons such as heart valve disease or coronary heart disease.