Patient information from BMJ

Atrial fibrillation: what treatments work?

Last published:Aug 16, 2021

Atrial fibrillation can be alarming, especially the first time it happens. Your heart beats very fast. It may go away on its own, or you may need treatment to make your heart beat smoothly again. You can use it to talk to your doctor and decide which treatments are right for you.

To learn more about what happens in atrial fibrillation and what the symptoms are, see the leaflet Atrial fibrillation: what is it?

What treatments work?

The treatment you get for atrial fibrillation will depend on how long you have had the condition, how much it affects you, and what other illnesses you have.

• If you've started getting it recently, you may have treatments to try to get your heart rhythm back to normal.

• If you've had it for a long time, or if you are older, you may also need treatments to slow down your heart.

• If you get it only occasionally, you may not need treatment.

• Sometimes, simply cutting down on or avoiding coffee or alcohol might reduce how many attacks you have.

Some people need emergency treatment in hospital to get their rhythm back to normal quickly. If this happens you'll be given medicines, usually by injections, and possibly electrical treatment to calm and stabilise your heart.

Treatments to prevent you getting blood clots

Atrial fibrillation can increase your risk of getting blood clots. That's because it stops blood flowing smoothly through your heart. If you get a blood clot there's a chance it could cause a stroke.

Unless you have a very low risk of having a stroke (apart from your atrial fibrillation), you will probably be offered medicines to thin your blood and prevent blood clots.

These drugs, called anticoagulants, can reduce your risk of having a stroke by about two-thirds.

If you take a medicine called warfarin to thin your blood, you will need regular blood tests to check you're taking the right dose. If the dose is too high you might bleed too easily.

You might be prescribed a type of anticoagulant called a direct oral anticoagulant (DOAC). These work in the same way as warfarin, but you don't need to have regular blood tests as they are more predictable.

The medication you are offered will partly depend on what your doctor thinks will help you most.

If you're having treatment to get your heart rhythm back to normal, doctors may recommend treatment to prevent blood clots at the same time. You might be given a drug called heparin.

Treatments to slow down your heart

There are three main types of medicine for slowing down your heart. You're likely to be offered a beta-blocker or a calcium channel blocker. Both work well to slow your heartbeat.

But these drugs can cause side effects in some people. For example, beta-blockers can make you feel dizzy or tired. If you have asthma you shouldn't take a beta-blocker. It can make your breathing worse.

Calcium channel blockers can make your blood pressure too low, which can cause dizziness.

If beta-blockers or calcium channel blockers are not suitable for you, or if they don't work, your doctor may suggest you take digoxin instead or as well. Digoxin is another drug that can help to slow down your heart.

Treatments to get your heart rhythm back to normal

There are two things that doctors may try to get your heart rhythm back to normal: medicines and electrical treatment.

Most people who take one of these medicines get a normal heart rhythm within one hour to 24 hours. But it may not last.

Some of these medicines can also make your blood pressure drop too low, causing dizziness. And some of them can make your heart rhythm worse, especially if you have heart disease. So doctors are careful about which drugs they use, depending on your medical history.

Giving your heart electrical treatment, in the form of a mild electric shock, may get its normal rhythm back. This is done in hospital, and you'll have a general anaesthetic first.

Another type of electrical treatment that can restore a normal heart rhythm is called catheter ablation. A thin wire is inserted into a vein, usually in your neck or groin. The wire is then gently pushed through the vein until it reaches the heart. Radio waves are then passed through the wire, and they create heat that destroys the heart tissue that's causing the increased heart rate.