The next step in restoring the heart’s normal rhythm is medication. There are several medications used to treat atrial fibrillation. For a patient who is in AFib all of the time, doctors may combine medications with cardioversion. For someone who is in and out of atrial fibrillation, they usually use medication alone.
There are two main categories of drugs used in people with atrial fibrillation: rate control drugs and anti-arrhythmic drugs.
Rate control drugs control your heart rate. In a lot of people with atrial fibrillation, the problem isn’t so much the off-kilter rhythm; it’s that it’s simply beating too fast. “When the heart rate is over 100 beats per minute for very long, over time the ventricles, the bottom pumping chambers, can become weak,” says Whang. “So it’s important to try to control the heart rate.
To do that, doctors usually prescribe beta-blockers or calcium channel blockers, medications that are commonly used to treat high blood pressure and heart disease.
To correct the arrhythmia itself, there are no "magic pills." "In general, most of the anti-arrhythmic medications we have today are effective between 45% and 55% of the time,” says Wylie. Some are more effective than others, and they all come with their own side effects. The most effective, amiodarone, also carries a side-effect burden, including potential thyroid, lung, and liver damage. “It requires frequent monitoring, just to be sure the person is tolerating it,” says Whang.
If you’ve tried multiple anti-arrhythmic drugs but still can’t seem to get control of your AFib symptoms, doctors may recommend catheter ablation, a nonsurgical but invasive procedure.
During a catheter ablation, doctors make small incisions in the groin and thread long, thin tubes called catheters through a vein up to your heart. The catheters can deliver either radiofrequency (heating energy) or cryoablation (freezing energy) to treat areas in the atrium that are triggering and sustaining the atrial fibrillation. Basically, it creates scar tissue in certain areas of the heart that cause AFib, disconnecting them electrically from the rest of the heart.
How well does it work? For patients who are in persistent atrial fibrillation and have had multiple cardioversions, Wylie says, the success rate is about 50%-60%. For “paroxysmal” patients -- those in and out of AFib -- success is higher, about 70%-75%.
“There are dramatic cases of people in AFib who have had their quality of life ruined by symptoms, and afterward, their frequency of AFib goes down to essentially zero,” says Whang. "We don’t yet know, though, if ablation for AFib improves actual stroke risk and survival, as opposed to just quality of life.”
And those success figures are based on 1.5 procedures per patient, Wylie adds. “That means that there’s a 50-50 chance you’ll need a second procedure to get results.”