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Determining Treatment for Afib

Your irregular heartbeat means blood doesn't flow as well as it should, and clots may form inside your heart. If one of those travels to your brain, it can cause a stroke. Your doctor may recommend medications but your course of treatment depends on you age, your symptoms and how often they occur, how long you  have been in afib, any other health problems, and if you have already had a stroke.

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Blood Thinners

To help lower the chances of clots, your doctor may prescribe a more powerful blood thinner called an anticoagulant, especially if you have high blood pressure, diabetes, or heart failure. The most common is warfarin (Coumadin). It can cut your risk of stroke, but you'll have to get your blood tested often, and you'll have to be careful to avoid cuts or other injuries. Some foods can make warfarin less effective, too.

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Other Blood Thinners

Newer anticoagulants including apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana, Savaysa), and rivaroxaban (Xarelto) also reduce the risk of stroke. You don't have to have regular blood tests when you take them. Plus, food doesn't affect how well they work. But you still could have problems with bleeding.

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Slow Down Your Racing Heart

When your heart is beating too fast, medicine can slow it down and lessen the strain on your heart muscle. Getting the rate below 100 beats per minute can help you feel stronger. To do that, doctors often prescribe either beta-blockers or calcium channel blockers, depending on your health.

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Reset an Irregular Heart Rhythm

Some people with AFib need electrical cardioversion to "reset" their heart's rhythm. While you're under mild anesthesia, a doctor uses patches or paddles to gently shock your heart.

Your doctor might want to do an ultrasound first to check for clots in your heart. If you have one, you'll need to take blood thinners for a few weeks before your procedure.

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Heart Reset With Anti-arrhythmics

About half of people who have electrical cardioversion get AFib again. So doctors sometimes prescribe medications called anti-arrhythmics to help keep your heartbeat regular. You'll need to check in with your doctor often, because they can cause side effects including heart rhythm problems.

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Ablation

When drugs and electrical treatments aren't working, your doctor may suggest a procedure called ablation. While you're sedated, a surgeon will insert a thin, flexible tube into a large blood vessel and guide it to the spot in your heart that's misfiring. He'll destroy the tissue there by heating or freezing it. Depending on what kind of ablation you have, you may need a pacemaker, too.

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Pacemaker for a Steady Beat

This small, battery-powered device goes under your skin near your collarbone. It has wires that attach to your heart to keep it going when it gets too slow. 

After surgery, you'll need to avoid pulling on the area, but you'll soon be able to get back to your usual activities. Most electronics like microwaves or phones won't bother your pacemaker, but some security systems and headphones can. You'll learn what to avoid and how to check your own pulse.

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Heart Surgery

If medication and simpler procedures haven't helped, or if you have certain other heart problems, your doctor may recommend an operation called a Maze procedure. The surgeon makes precise cuts to scar the surface of the heart's upper chambers and interrupt the electrical signals that throw off your heart rhythm. Sometimes it can be done with only a tiny "keyhole" incision. If the surgery works, you should have fewer symptoms and be able to live normally.

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Lifestyle Changes

No matter how you treat your AFib, your daily habits can help your heart. Eat a heart-healthy diet. Cut back on the caffeine you drink. (Some people find that coffee, sodas, and tea make their symptoms worse.) Read medicine labels to check for decongestants -- especially in cold and cough medicines. Limit alcohol to no more than 1 drink a day if you're a woman and 2 if you're a man. Get regular exercise. And if you smoke, quit.

Talk to your doctor if your symptoms get worse.

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Sources | Medically Reviewed on 02/11/2016 Reviewed by James Beckerman, MD, FACC on February 11, 2016

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SOURCES:

Agency for Healthcare Research and Quality: "Blood Thinner Pills."
American Heart Association Scientific Sessions, Orlando, Nov. 12-16, 2011.
American Heart Association: "Atrial Fibrillation Medications," "Living with Your Pacemaker," "Medications for Arrhythmia," "Non-surgical Procedures for Atrial Fibrillation," "Surgical Procedures for Atrial Fibrillation," "Types of Blood Pressure Medications."
Cleveland Clinic: "What Is Atrial Fibrillation?"
Connolly, S. New England Journal of Medicine, Sept. 17, 2009.
De Caterina, R. Journal of the American College of Cardiology, April 2012.
Ebell, M. American Family Physician, June 15, 2005.
King, D. American Family Physician, July 15, 2002.
Razavi, M. Texas Heart Institute Journal, 2005.
Stopafib.org, American Foundation for Women's Health: "Anticoagulant Medication for Atrial Fibrillation," "New Stroke Risk Factors for Those with Atrial Fibrillation (AF): Female Gender, Heart Disease, and Age," "Rate Control Medication for Atrial Fibrillation."
U.S. Preventive Services Task Force: "Aspirin for Prevention of Cardiovascular Disease."
University of Michigan Electrophysiology Service: "The Treatment of Atrial Fibrillation."

Reviewed by James Beckerman, MD, FACC on February 11, 2016

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.