Because of the risk of blood clots forming and causing a stroke, the treatment also usually includes medication to prevent blood clots (anticoagulation).
Rate control treatment
In untreated AF, the heart rate may be as fast as 180 beats per minute (bpm), although it is more commonly between 120 and 160 bpm. The aim of medication is to bring the heart rate back down to normal (ideally, to less than 90 bpm when resting). If your heart rate is brought down to normal, your heart becomes efficient again and your symptoms usually improve. Your pulse may still feel irregular but not fast.
Several medicines can slow the heart rate down. They include beta-blocker medicines (such as atenolol and propranolol), calcium-channel blocker medicines (such as diltiazem and verapamil) and digoxin. These medicines work by interfering with the electrical impulses of the heart. The medicine chosen may depend on factors such as other heart problems that you may have.
Treatment is usually successful but the dose needed can vary from person to person. Also, in some people a combination of medicines may be needed if the heart rate is not brought down low enough with a single medicine.
Rhythm control treatment
Rhythm control means reverting the erratic heartbeat back to a normal regular rhythm. This is called cardioversion.
One method of cardioversion is to give your heart an electric shock. Another method is to use a medicine that may convert the heart rhythm back to a regular beat. One medicine used for rhythm control is amiodarone. Both of these methods have only limited success. Within a year after cardioversion, the heart has reverted back to AF in about half of cases.
Cardioversion is more likely to be considered as a possible option in certain situations - for example:
- If your AF has developed recently.
- If you are younger than 65 years.
- If an underlying cause for the AF has been successfully treated.
- If you have no other heart abnormality.
- If you have acute heart failure or unstable angina which is being made worse by the irregular heartbeat of AF.
A newer technique that may be used to restore the heart rhythm is called catheter ablation. A long, thin wire (catheter) is passed into the chambers of the heart via a large blood vessel in a leg. The tip of the catheter can destroy tiny sections of heart tissue that may be the cause of the abnormal electrical impulses.
What is anticoagulation treatment?
All people with AF - except those with the lowest risk of having a stroke - should be offered anticoagulation treatment. Anticoagulation means that you take a medicine to reduce the chance of forming a blood clot and having a stroke.
Read more about preventing stroke when you have atrial fibrillation for more details.
Aspirin was used in the past for preventing strokes if you have AF but is not as effective as warfarin and is just as likely to cause problems. Aspirin is therefore no longer recommended.
Other treatments may be advised, depending on the need to treat any underlying problems such as chest pains (angina), heart valve problems, high blood pressure (hypertension) or an overactive thyroid gland (hyperthyroidism).
Further reading and references
Management of atrial fibrillation; NICE Clinical Guideline (June 2014)
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS; European Society of Cardiology (2016)
Atrial Fibrillation; NICE CKS, October 2015 (UK access only)
WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension; NICE Medical Technologies Guidance, January 2013
Thoracoscopic exclusion of the left atrial appendage in atrial fibrillation (with or without other cardiac surgery) for the prevention of thromboembolism, NICE Interventional Procedure Guideline (June 2011)
Isaew A, Adderley NJ, Ryan R, et al; The treatment of paroxysmal atrial fibrillation in UK primary care. Heart. 2017 Jun 1. pii: heartjnl-2016-310927. doi: 10.1136/heartjnl-2016-310927.
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