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NIH MedlinePlus the Magazine, Trusted Health Information from the National Institutes of Health

Atrial Fibrillation

Atrial Fibrillation: Treatment

Treatment for atrial fibrillation depends on how often you have symptoms, how severe they are, and whether you have other forms of heart disease. General treatment options include medicines, medical procedures, and lifestyle changes.

Blood Clot Prevention

People who have AFib are at increased risk for stroke. This is because blood can pool in the heart's upper chambers (the atria), causing a blood clot to form. If the clot breaks off and travels to the brain, it can cause a stroke.

Preventing blood clots from forming is an important part of treating AFib and preventing strokes. The benefits of this type of treatment have been proven in multiple studies.

Doctors prescribe blood-thinning medicines to prevent blood clots. These medicines include warfarin (Coumadin®), dabigatran, heparin, apixaban, rivaroxaban, and aspirin.

People taking warfarin and heparin need regular blood tests to check how well the medicines are working.

Rate Control

Doctors can prescribe medicines to slow down the rate at which the ventricles are beating in people with AFib. These medicines help bring the heart rate to a normal level.

Rate control is the recommended treatment for most patients who have AFib, even though an abnormal heart rhythm may continue and the heart doesn't work as well as it should. Most people feel better and can function well if their heart rates are well controlled.

Medicines used to control the heart rate include beta blockers (for example, esmolol, propranolol, metoprolol, and atenolol), calcium channel blockers (diltiazem and verapamil), and digitalis (digoxin). Several other medicines also are available.

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Rhythm Control

Restoring and maintaining a normal heart rhythm is a treatment approach recommended for people who aren't doing well with rate control treatment. This treatment also may be used for people who have only recently started having AFib. The long-term benefits of rhythm control have not been proven conclusively yet.

The longer you have AFib, the less likely it is that doctors can restore a normal heart rhythm. This is especially true for people who have had AFib for 6 months or more.


Medicines used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. Sometimes other medicines—such as quinidine, procainamide, and disopyramide—are used.

Your doctor will carefully tailor the dose and type of medicines he or she prescribes to treat your AFib. This is because medicines used to treat AF can cause a different kind of arrhythmia.


Doctors use several procedures to restore a normal heart rhythm. For example, they may use electrical cardioversion to treat a fast or irregular heartbeat. For this procedure, external low-energy electrical shocks are given to your heart to trigger a normal rhythm. You're temporarily put to sleep before you receive the shocks.

Catheter ablation may be used to restore a normal heart rhythm if medicines or electrical cardioversion don't work. For this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart.

Radio wave energy is then sent through the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals. An electrophysiologist usually does this procedure in a hospital. Your doctor may recommend a TEE before catheter ablation to check for blood clots in the atria.

Sometimes doctors use catheter ablation to destroy the atrioventricular (AV) node. The AV node is where the heart's electrical signals pass from the atria to the ventricles (the heart's lower chambers). This procedure requires your doctor to surgically implant a device called a pacemaker, which helps maintain a normal heart rhythm.

Winter 2015 Issue: Volume 9 Number 4 Page 25