Atrial fibrillation (AF or afib) involves abnormal electrical activity in the upper chambers (atria) of your heart, which causes the organ to beat quickly and irregularly.
This abnormal beating results in too little blood being pumped throughout your body, and can cause symptoms such as fatigue, shortness of breath, and chest pain.
The goals of treatment for atrial fibrillation are to restore your heart’s natural rhythm and rate, help prevent blood clots, and reduce your stroke risk. Treatment should also involve addressing any underlying health problems that have caused or contributed to the condition. (2,3)
Lifestyle Changes to Keep Your Heart Regular
A number of heart-healthy lifestyle changes may help to address atrial fibrillation. They include:
Heart-Healthy Eating Following a diet designed to reduce your risk of heart disease — such as the DASH diet, which aims to lower blood pressure — can help improve atrial fibrillation and reduce your risk of complications.
Being Physically Active Even if you don’t lose weight, physical activity can help keep your heart muscle in good shape and improve your blood pressure.
It’s important, though, to exercise in a way that’s safe and doesn’t make the condition worse.
Managing Stress In some people, stress can contribute to high blood pressure and make your condition worse. Try stress-relief techniques like meditation, guided relaxation, or gentle exercise, like yoga .
Limiting or Avoiding Alcohol and Other Drugs Heavy drinking, in particular, can worsen atrial fibrillation in some people.
So can certain stimulant drugs, whether legally prescribed, in over-the-counter (OTC) products like cough or cold medications, or in illegal street drugs.
Caffeine is a stimulant that can trigger atrial fibrillation symptoms in some people.
Not Smoking Smoking tobacco can contribute to atrial fibrillation and raise your risk for complications. If you smoke, talk to your doctor about getting help to quit. (1,2,4)
Medications for An Irregular Heartbeat
Your doctor may prescribe drugs related to your atrial fibrillation for a few major reasons:
- To control your heart’s rhythm
- To control your heart’s rate
- To help prevent blood clots and reduce stroke risk
Controlling Heart Rhythm A number of drugs may be used to help return your heart to its normal rhythm (often called sinus rhythm), or to maintain this rhythm.
Some of the most commonly used drugs include:
- amiodarone (Cordarone)
- dofetilide (Tikosyn)
- flecainide (Tambocor)
- propafenone (Rythmol)
- dronedarone (Multaq)
- sotalol (Betapace) (2,5)
- dronedarone (Multaq)
When you first start taking drugs to control your heart rhythm, you may need to stay in the hospital for monitoring.
It’s possible that your doctor will test different drugs to figure out which one is right for you.
Antiarrhythmic drugs are effective about 30 to 60 percent of the time, according to the Cleveland Clinic. (2)
Controlling Heart Rate Your doctor may also prescribe drugs that help slow your heart rate, such as:
- Beta blockers, including acebutolol (Sectral), atenolol (Tenormin), and bisoprolol (Zebeta)
- Calcium-channel blockers , including diltiazem (Cardizem) and verapamil (Calan)
- digoxin (Lanoxin) (2,5)
Preventing Blood Clots Avoiding clots is a major treatment goal for people with atrial fibrillation, since a blood clot can block an artery in the brain, causing a stroke.
Anticoagulants, or blood thinners, are the most effective drugs for preventing blood clots. They include:
- warfarin (Coumadin)
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- rivaroxaban (Xarelto) (3)
- edoxaban (Savaysa)
These drugs can, however, increase your risk of bleeding and could have other side effects. (1)
Your doctor will evaluate your risk of having a stroke, and if you’re considered to be at moderate to high risk, you may be prescribed an anticoagulant. (1,5)
Nonsurgical Procedures to Restore Normal Heart Rhythm
As an alternative to medications or if medications don’t work well enough, your doctor may use one of several nonsurgical procedures to restore your normal heart rhythm:
Electrical Cardioversion Performed under deep anesthesia, electrical cardioversion involves receiving low-energy electrical shocks through your chest from a machine.
These shocks can help reset your heart rhythm, but your atrial fibrillation may return in the future.
Catheter Ablation If medications aren’t effective in preventing atrial fibrillation, your doctor may recommend a procedure in which a catheter (a thin, flexible wire) is inserted into a vein in your arm or leg and threaded to your heart.
Energy — in the form of radio waves, a laser, or cryotherapy — is then passed through the catheter to destroy areas of heart tissue that are sending abnormal electrical signals.
The most common area of the heart targeted with catheter ablation is the region where the veins from the lungs (pulmonary veins) connect to the left atrium.
Catheter ablation can also be utilized when treatments to restore a normal heart rhythm have become ineffective. In this situation, ablation of the main electrical connection between the atria and ventricles is performed to prevent the heart rate from going too fast. A pacemaker is also implanted in these situations. (1,6)
Surgery for Atrial Fibrillation
If other treatments don’t work, or if you have certain factors — such as a valvular heart disease — your doctor may recommend surgical ablation (maze procedure) in conjunction with a repair/replacement of the dysfunctional heart valve. Surgical ablation for atrial fibrillation can also be performed at the time of other heart surgeries.
In this procedure, a surgeon will create a number of small cuts or burns in the upper chambers of your heart. When these injuries heal, they’ll form scar tissue that prevents abnormal electrical signals from spreading through your heart. The resulting pattern of scar tissue on your heart resembles a maze, as there will be only a single path for electrical signals to travel to your heart’s lower chambers.
Surgical ablation may be performed as open-heart surgery (often when you’re already having surgery, such as to repair heart valves) or using a minimally invasive technique that involves small incisions and tiny cameras to guide the procedure.
Your surgeon will also generally close off or remove a tiny area of your heart, known as the left atrial appendage, where blood clots are prone to form. (1,7)
How to Keep Your Heart in Rhythm
Many of the same lifestyle changes that are often recommended to treat afib may also help prevent the condition.
Helpful steps may include:
- Being physically active
- Maintaining a healthy weight
- Following a heart-healthy diet
- Limiting alcohol and caffeine
- Managing stress
- Not smoking
- Treating or controlling conditions that may contribute to afib, such as diabetes, thyroid disease , high blood pressure, or high cholesterol (1)
Additional reporting by Quinn Phillips