What Are the Treatments for AFib?

Medically Reviewed by James Beckerman, MD, FACC on February 03, 2023
8 min read

Atrial fibrillation is a problem with your heart's electrical activity. You and your doctor have treatment options if your symptoms become too severe.

With AFib, your heart quivers, beats irregularly, or skips beats. It can't pump blood through its chambers and out to your body as well as it should. Sometimes blood can pool in the heart and form clots, which could lead to a stroke.

Treatments such as medications, nonsurgical procedures, and surgery can slow your heartbeat and bring it back into a normal rhythm. AFib treatments can also prevent clots and help keep your heart healthy.

These can prevent clots and strokes, slow your heart rate, and control your heart rhythm.

Blood thinners. These medications prevent blood clots to lower your chance of having a stroke. But they can raise your risk of bleeding, so you might have to cut back on some activities that can lead to injuries. The most common blood thinners are:

  • Apixaban (Eliquis)
  • Aspirin
  • Dabigatran (Pradaxa)
  • Enoxaparin (Lovenox)
  • Heparin
  • Rivaroxaban (Xarelto)
  • Warfarin (Coumadin, Jantoven)

Blood thinners can make you more likely to bruise or bleed too much. Depending on which blood thinner you are taking, you might need to have an occasional blood test to make sure the medication is working and you're on the right dose.

Heart rate medicines. The most common way to treat atrial fibrillation is with drugs that control your heartbeat. These slow your rapid heart rate so your heart can pump better.

You may need other drugs. Some are called beta-blockers. They also slow your heart rate. Some examples are:

  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta, Ziac)
  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol)
  • Propranolol (Inderal, Innopran)
  • Timolol (Betimol, Istalol)

Others are known as calcium channel blockers. They slow your heart rate and tone down contractions. You might get:

  • Diltiazem (Cardizem, Dilacor)
  • Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)

Antiarrhythmic drugs. They slow the electrical signals to bring your heartbeat into what’s called a normal sinus rhythm. These treatments are sometimes called chemical cardioversion. You might get:

Sodium channel blockers, which slow your heart's ability to conduct electricity:

  • Flecainide (Tambocor)
  • Propafenone (Rythmol)
  • Quinidine

Potassium channel blockers, which slow the electrical signals that cause AFib:

  • Amiodarone (Cordarone, Nexterone, Pacerone)
  • Dofetilide (Tikosyn)
  • Sotalol (Betapace, Sorine, Sotylize)

You might get them in your doctor's office or at a hospital. Your doctor will monitor you to make sure the medicine is working.

If medicines don't work or they cause side effects, you can try cardioversion or ablation. 

Electrical cardioversion. The doctor gives your heart a shock to regulate your heartbeat. They’ll use paddles or stick patches called electrodes onto your chest.

First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.

Most people only need one. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

Your skin may be irritated where the paddles touched it. Your doctor can recommend a lotion to ease pain or itching.

Cardiac ablation. There are two major options:

1. Catheter ablation, also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s a less invasive ablation option. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then they guide it to your heart. When it reaches the area that’s causing the arrhythmia, it sends out electrical signals that destroy those cells. The treated tissue helps get your heartbeat regular again.

There are two main types of catheter ablation:

  • Radiofrequency ablation. The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that creates circular scars around each vein or group of veins.
  • Cryoablation. A single catheter sends a balloon tipped with a substance that freezes the tissues to cause a scar.

2. Surgical ablation involves cutting into your chest:

  • Maze procedure. This is usually done while you’re having open-heart surgery for another problem, like a bypass or valve replacement. The surgeon makes small cuts in the upper part of your heart. They’re stitched together to form the scar tissue that stops abnormal signals.
  • Mini maze procedure. Most people with AFib don’t need open-heart surgery. That’s where this less invasive option comes in. The doctor makes several small cuts between your ribs and uses a camera to guide catheters for either cryoablation or radiofrequency ablation. Some hospitals offer robot-assisted surgery that uses smaller cuts and allows for greater precision. 
  • Convergent procedure. This pairs catheter ablation with a mini maze procedure. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.
  • AV node ablation: You might get this procedure if:
    • You don’t respond to medications.
    • You can’t take medications because of side effects.
    • You aren’t a good candidate for a procedure that cures you.

Your doctor will insert a catheter into a vein in your groin and slide it up to the AV node, a nerve that conducts electrical impulses between the top and bottom chambers of your heart. They’ll send radiofrequency energy through the catheter to destroy the AV node. This stops the signals from reaching your ventricle. Then the doctor will implant a pacemaker into your chest. 

For some people, ablation restores a normal heart rhythm better than medicine. It’s generally safe, but it does have some risks. Some of the things that can go wrong are:

  • Bleeding around your heart or where the catheter is inserted
  • Hole in the heart
  • Stroke
  • Narrowing of the pulmonary vein
  • Damage to the esophagus, the tube that carries food from your mouth to your stomach

Also, your AFib can come back in the first few months after you have ablation. In that case, you may need to have the procedure again or take heart rhythm drugs.

  • Pacemaker

This is a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it's beating too slowly. It’s made up of a small device called a generator that holds a battery and a tiny computer. Very thin wires called leads connect the pacemaker to your heart

Getting a pacemaker may sound like a big deal, but it's a relatively minor procedure. First, your doctor inserts a needle into a large vein near your shoulder, which guides the leads into your heart. The pacemaker then goes into your chest through a small cut. Once it's in place, your doctor tests it to make sure it works.

There are some risks, such as:

  • Bleeding or bruising in the area where your doctor places the pacemaker
  • Infection
  • Damaged blood vessel
  • Collapsed lung
  • If there are problems with the device, you may need another surgery to fix it.

Sometimes the impulses your pacemaker sends to your heart can cause discomfort. You may be dizzy or feel a throbbing in your neck.

Once you have one put in, you might have to keep your distance from objects that give off a strong magnetic field because they could affect the electrical signals from your pacemaker.

Some devices that can interfere with it are:

  • Metal detectors
  • Cell phones 
  • Electric generators
  • Some medical machines such as an MRI

If problems such as high blood pressure, cholesterol, or an overactive thyroid caused your AFib, you'll need to treat the root cause. Your doctor might prescribe medications to get those conditions under control.

Your doctor may also recommend screening and treatment for sleep apnea, a disorder in which breathing starts and stops throughout the night.

Some other types of health problems can lead to AFib symptoms, too. Make sure you keep your other medical conditions under control, including:

  • Other heart problems (like heart attack and heart failure)
  • Diabetes
  • Obesity

We need more research into alternative and complementary treatments for AFib. But a few have shown some promise in early studies. They include:

  • Omega-3 fatty acids
  • Antioxidant vitamins, such as vitamins C and E
  • Herbal supplements like berberine, cinchona bark, and shenshongyanxin (a traditional Chinese mixture)

Always check with your doctor before you try a complementary treatment.

Your doctor also might recommend you take some simple steps to help keep your heart healthy:

  • Eat heart-healthy, low-salt food. Go for fruits, veggies, and whole grains.
  • Get more exercise. More physical activity strengthens your heart.

They'll probably suggest that you make other changes to lower your odds of heart disease, as well as conditions like diabetes and lung disease that can contribute to AFib:

  • Quit smoking.
  • Stay at, or try to reach, a healthy weight.
  • Control your blood pressure.
  • Manage your cholesterol.
  • If you drink alcohol, do it in moderation.

Your doctor will likely advise you to avoid stimulants, which can trigger AFib episodes. These include over-the-counter cough medicines that contain pseudoephedrine as well as recreational drugs like cocaine and amphetamines.

Don't overlook your emotional health. Stress may make atrial fibrillation worse, so find ways to manage it. You might try:

  • Yoga, tai chi, or other mind-body techniques
  • Spending time with family and friends

If you have symptoms of anxiety or depression, like long-lasting sadness or trouble concentrating, ask your doctor to refer you to a mental health specialist.

Right now, there’s no cure for it. But certain treatments can make symptoms go away for a long time for some people.

Treatments include medications, procedures such as cardioversion or ablation, and lifestyle changes such as exercising and eating a healthy diet. In some cases, AFib may resolve on its own, but it is more common for it to be a persistent issue that requires ongoing management. The most effective course of treatment depends on the underlying cause of AFib, the severity of symptoms, and the overall health of the patient.