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Treating atrial fibrillation (AF)

The treatment for atrial fibrillation (AF) varies from person to person depending on several factors. These include the severity of your symptoms, the cause and duration of your AF and whether you have any underlying health problems.

The main aims of the treatment are to:

Medication

Medication for AF has different purposes.

Blood clot prevention

Having AF puts you at a high risk of having a stroke. Preventing blood clots is one of the most important parts of treating AF, as blood clots can cause strokes.

To prevent blood clots, you may be prescribed blood-thinning medicines (anticoagulants). For example, warfarin, dabigatran or rivaroxaban.

Because anticoagulants stop blood clots, they may cause bleeding. Your doctor will consider your risk of bleeding and whether anticoagulants are suitable for you.

Health professionals no longer recommend aspirin for preventing blood clots in people with AF.

Rate control

You may be prescribed medicines to slow down the rate at which your ventricles are beating and help bring your heart rate to a normal level.

Medicines used to control your heart rate include groups of medicines called beta blockers (for example, metoprolol, bisoprolol and carvedilol) or calcium channel blockers (for example, diltiazem and verapamil).

If your heart rate is still not at a normal level with beta blockers and calcium channel blockers, your doctor may also add digoxin.

Rhythm control

If you aren't doing well on rate control medications, your doctor may prescribe medicines or recommend procedures to control your heart's rhythm.

Medicines used to control your heart's rhythm include amiodarone, sotalol, flecainide, propafenone and disopyramide. These are usually prescribed by a cardiologist.

Other types of treatment

Electrical cardioversion is sometimes recommended to treat a fast or irregular heartbeat. It uses low-energy electrical shocks to trigger your heart into a normal rhythm. It's done under a general anaesthetic.

Catheter ablation is a more invasive method that may be used to restore a normal heart rhythm. In this procedure, a catheter (a long, thin tube) is inserted into a vein in your leg or arm and threaded all the way to your heart. Radio wave energy is used to damage the small portion of tissue responsible for the abnormal electrical signals.

Pacemakers help to maintain a normal heart rhythm. They're used for people with AF that has not been effectively treated with less invasive treatments. Before inserting a pacemaker, catheter ablation is used to destroy the atrioventricular (AV) node in your heart. The AV node is a part of the electrical control system of the heart that coordinates the atrial and ventricular chambers. The pacemaker takes over the AV node's role of maintaining a normal heart rhythm.

Heart surgery is very rarely needed. The most common operation performed is known as the maze procedure. In this procedure, several small cuts are made in the atria (upper chambers) of your heart to create a pattern of scar tissue. The scar tissue doesn't carry electrical currents. So, it prevents the abnormal electrical signals that cause AF from travelling through your heart and causing an abnormal heartbeat.

Written by HealthInfo clinical advisers. Page created December 2021.

Page reference: 928694

Review key: HIAFB-25271