What are the treatment options for atrial fibrillation?

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Treatments that may be considered include:

Rate control. This means bringing the heart rate back down to normal. This is done for all people with AF who have fast heart rate (that is, most cases).
Rhythm control. This means converting the irregular rhythm back to a normal regular rhythm. This is only possible in some cases.
Anticoagulation treatment which aims to prevent a stroke.
Other treatments in certain circumstances.

Each of these are now discussed further:

Rate control treatment

If the heart rate is brought down to normal the heart becomes efficient again, and the symptoms usually improve. The pulse may still feel irregular, but not fast. Several drugs can slow the heart rate down. They include beta-blocker drugs (such as atenolol, metoprolol and propranolol), diltiazem, verapamil, and digoxin. These drugs work by interfering with the electrical impulses of the heart. The drug chosen may depend on factors such as other heart problems that you may have.

In untreated AF, the heart rate may be as fast as 180 beats per minute, although it is more commonly between 120 and 160 beats per minute. The aim of medication is to bring the heart rate back down to normal (ideally, to less than 90 beats per minute when resting). Treatment is usually successful, but the dose needed can vary from case to case. Also, in some cases a combination of drugs may be needed if the heart rate is not brought down low enough with a single drug.

Rhythm control treatment

Rhythm control means reverting the erratic heart beat back to a normal regular rhythm. This is called 'cardioversion'. This treatment is not tried in most cases as treatment to control the rate of the heart (described above) usually works well to control symptoms. However, cardioversion may be considered in certain situations. For example, if drugs to control the fast heart rate do not work very well, or if the irregular heart beat is causing unpleasant symptoms.

One method of cardioversion is to give your heart an 'electric shock'. Another method is to use drugs that may convert the heart rhythm back to a regular beat. Both of these methods have only limited success. For example, after cardioversion, within a year in about half of cases the heart has reverted back to AF.

Cardioversion is more likely to be considered in the following situations:

If your AF developed recently.
If you are younger than 65. (Age is no bar to cardioversion, but it is less likely to an option the older you become.)
If an underlying cause of the AF has been successfully treated (and so AF is unlikely to come back again once the normal heart rhythm has been restored).
If you have no other heart abnormality. (That is, if you have 'lone AF' described earlier.)
If you have acute heart failure or unstable angina which is being made worse by the irregular heart beat of AF.

Cardioversion is usually not an option in certain situations. For example:

If you have certain heart diseases that include a structural problem to the heart (for example, certain valve problems such as mitral stenosis).
If you have had AF a long time (usually more than 12 months).
If you have had several previous attempts at cardioversion which have not worked, or only worked for a short time before the heart reverted back to AF.

A newer technique to restore the heart rhythm is called catheter ablation. In this procedure a catheter (a long thin wire) 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 source or 'trigger' of the abnormal electrical impulses. This treatment is only suitable in certain cases and is not a routine treatment. It does not always work and there is a small risk of serious complications.

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