Treatment of AFib

Reviewed by: HU Medical Review Board | Last reviewed: January 2024

Atrial fibrillation, or AFib, is the most common type of arrhythmia. An arrhythmia is a heart rhythm disorder. AFib causes your heart to beat too fast or slow and at an irregular pace. More specifically, the heart's upper chambers (atria) beat out of sync with the lower chambers (ventricles).1

The main goal of AFib treatment is to restore the heart to its normal rhythm. If left untreated, AFib can lead to heart attack and stroke. The longer you have AFib, the harder it can be to treat it. This means early detection is key.1,2

What are the treatment options for atrial fibrillation?

The first step toward effective treatment is an accurate diagnosis. Next, your treatment plan will depend on the type of AFib you have, how severe your symptoms are, and your overall health. Treatment plans may include medicines and surgical or nonsurgical procedures.2-5

Medicines

One of the main approaches to managing AFib is using drugs to control heart rate, restore normal rhythm, and prevent blood clots. Common medicines used to treat AFib include:2-5

  • Beta-blockers – These drugs slow down the heart rate, reducing the strain on the heart. Common beta-blockers include atenolo (Tenormin®), bisoprolol, and metoprolol (Loressor®, Toprol-XL®)
  • Calcium channel blockers – Like beta blockers, they also help to control heart rate. Examples of calcium channel blockers include diltiazem (Cardizem®, Cartia XT®, Tiazac®) and verapamil (Calan SR®, Veralan®). If you have a history of heart failure or low blood pressure, you may need to avoid this type of drug.
  • Digoxin – This drug slows down the electrical currents coming from the atria to the ventricle.
  • Heart rhythm controllers (antiarrhythmics) – These drugs help regulate the heart's rhythm by preventing or controlling irregular heartbeats and keeping the heart in normal rhythm. Examples include flecainide and amiodarone (Pacerone®).
  • Blood thinners (anticoagulants) – This type of drug thins the blood to reduce the risk of blood clots (a common complication of AFib). Examples include warfarin (Jantoven®), dabigatran (Pradaxa®), rivaroxaban (Xarelto®), edoxaban (Savaysa®), and apixaban (Eliquis®).

Nonsurgical procedures

Certain nonsurgical procedures aim to "reset" the heart. These are called cardioversion procedures. Two types are available:3-6

  • Electrical cardioversion – A low-level electric shock is delivered to the heart to reset its rhythm. The controlled shock is delivered through patches or paddles. It is usually performed in a hospital or doctor’s office.
  • Drug cardioversion – Medicines, such as antiarrhythmics, are given to help restore normal heart rhythm. These drugs are given either by mouth or through a vein (intravenous).

Surgical procedures

If medicines or nonsurgical procedures do not work, surgery may be needed. Possible surgeries include:3-5,7

  • AV node ablation with pacemaker – This surgery removes a portion of the atrioventricular (AV) node. The AV node is the part of the heart responsible for sending electrical signals between the atria and ventricles. A pacemaker is then implanted to control the heart rate.
  • Pulmonary vein ablation (PVA) – A thin, flexible tube (catheter) is placed into a vein and guided to the heart. The surgeon then removes abnormal tissue in the heart that is causing the irregular heartbeat.
  • Pacemaker – A device is implanted under the skin and then sends electrical signals to the heart to get it back into a normal rhythm.
  • Maze procedure – This surgical option is usually performed during open-heart surgery. It involves creating a series of controlled scars in the atria. This redirects electrical signals and restores a normal rhythm.

Is atrial fibrillation preventable?

Some risk factors for AFib cannot be changed, including age and family history. However, certain lifestyle habits can help prevent AFib. These include:3,5

  • Eating a healthy diet – Adopt a diet rich in fruits, vegetables, lean proteins, and whole grains. Limit processed and salty foods.
  • Getting regular exercise – Engage in safe, moderate exercise regularly, as it contributes to overall heart health. Always talk to your healthcare provider before starting any new exercise routine.
  • Maintaining a healthy weight – Being overweight can increase the risk of AFib. Losing excess weight through diet and exercise can help.
  • Managing stress – Practice calming techniques like meditation, deep breathing, or yoga.
  • Limiting alcohol and caffeine – Excessive alcohol and caffeine can trigger AFib episodes. Drink them in moderation.
  • Stopping smoking – Smoking is a major risk factor for heart disease, including AFib. Get the support you need to quit smoking.

Work with your healthcare team

Living with AFib may require a combination of medicine and procedures tailored to your situation. Work with your healthcare team to determine the best treatment plan for you.

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Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.