What is the difference between afib and irregular heartbeat

The treatment of atrial fibrillation (AF) varies from person to person and depends on:

• the type of atrial fibrillation 
• symptoms 
• treatment of any underlying cause
• age
• overall health

Some people may be treated by their GP, whereas others may be referred to a cardiologist.

Finding an underlying cause

The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, treatment for this may be enough.

For example, medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation.

If there is no underlying cause found

If no underlying cause of the atrial fibrillation can be found, the treatment options are:

• medicines to control atrial fibrillation
• restoring a normal heart rhythm
• medicines to reduce the risk of a stroke
• cardioversion (a controlled electrical shock to reset the heart rhythm)
• catheter ablation
• having a pacemaker fitted

You can find out more about each of these below.

Medicines to control atrial fibrillation

Medicines called anti-arrhythmics can control atrial fibrillation by:

• restoring a normal heart rhythm
• controlling the rate at which the heart beats

The choice of anti-arrhythmic medicine depends on:

• the type of atrial fibrillation
• any other medical conditions you have
• side effects of the medicine chosen
• how well the atrial fibrillation responds.

Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.

Restoring a normal heart rhythm

There are a number of drugs that can be used to try to restore a normal heart. The best option for you will be decided by your cardiologist and /or GP. 

Commonly, these drugs include:

• flecainide 
• beta-blockers
• amiodarone 

Dronedarone may also be used for certain people.

It is important you know what side effects to look out for if taking such medication and seek medical advice if you experience any of them. 

To find out about side effects, read the patient information leaflet that comes with your medicine for more details. 

Medicines to reduce the risk of a stroke

The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (our complications of atrial fibrillation section has more information on this).

Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:

• stroke or blood clots
• heart valve problems
• heart failure 
• high blood pressure 
• diabetes 
• heart disease

You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk.

Depending on your level of risk, you may be prescribed warfarin.

Anticoagulants

Anticoagulants help to reduce the risk of stroke in patients with atrial fibrillation. Newer anticoagulants like apixaban, dabigatran, edoxaban and rivoroxaban are now more commonly used than warfarin. They do not require dose changes and continuous blood test monitoring.

Warfarin may still be used in patients who can't be treated with a newer anticoagulant, or in those patients with other conditions where treatment with warfarin is preferred.

Cardioversion

Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm.

The procedure normally takes place in hospital with heavy sedation or anaesthetic and careful monitoring.

In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke.

If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke.

Catheter ablation

Catheter ablation is a procedure that very carefully interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated.

Catheters (thin, soft wires) are guided through one of your veins into your heart where they record electrical activity.

When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue.

This procedure commonly takes two to three hours, so it may be done under general anaesthetic, where you are put to sleep.

Find out more about catheter ablation for atrial fibrillation on the Arrhythmia Alliance website

Having a pacemaker fitted

A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone.

It will not cure, reverse or actively treat your atrial fibrillation. 

A pacemaker provides beats where your heart is not supplying its own. If your heart beat is very slow the pacemaker will override this and pace at a set rate. If there are significant pauses between your heart beats beats, the pacemaker will supply a beat, acting as a 'safety net'.

Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed).

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