Atrial Fibrillation medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Atrial fibrillation (AFib or AF) is the most common type of heart arrhythmia that affects over 2.7 million people in the United States. It’s estimated that over by 2030, the number of Americans will increase to over 12 million cases. AFib is more common among older adults. According to the CDC, approximately 2 percent of people younger than 65 have AFib, while around 9 percent of those 65 and older have it. People of European descent are more likely to be diagnosed with AFib than African Americans.

What is atrial fibrillation?

Atrial fibrillation (AFib or AF) is one of the most common types of irregular heart rhythms (arrhythmia). During AFib, the heart’s upper chambers (atria) beat irregularly, which causes poor blood flow to the lower chambers (ventricles). With poor blood flow, your ventricles do not fill completely or pump enough blood to your lungs and body. This can lead to an increased risk of stroke, heart failure, blood clots, and other complications.

There are three main types of atrial fibrillation:

• Paroxysmal atrial fibrillation. This type occurs periodically and usually stops on its own within one week.
• Persistent atrial fibrillation. This type of AFib lasts longer than one week and requires treatment.
• Long-standing persistent atrial fibrillation. This type lasts more than a year and can be difficult to treat.

Atrial fibrillation causes

Problems with the heart’s structure or electrical signaling usually cause AFib. Medical conditions or other risk factors that can cause this damage include:

• Advanced age, especially after age 65
• Hypertension (high blood pressure)
• Ischemic heart disease
• Obesity
• Thyroid disease
• Diabetes
• Coronary artery disease (CAD)
• History of heart attack
• Heart valve disease
• Chronic kidney disease
• Heavy alcohol use or binge drinking
• Family history of AFib
• Sleep apnea
• Lung disease
• Smoking
• Illegal drugs such as cocaine

How is atrial fibrillation diagnosed?

To properly diagnose atrial fibrillation, your doctor or healthcare professional will look at your symptoms, review your medical and family history, perform a physical exam, and run some labs and imaging tests.

Atrial fibrillation symptoms

People with AFib sometimes have no noticeable signs or symptoms. Those who do may have the following symptoms of atrial fibrillation:

• Rapid, fluttering, pounding, irregular heartbeat (palpitations)
• Fatigue
• Dizziness
• Chest pain
• Lightheadedness
• Shortness of breath
• Weakness
• Fainting
• Confusion
• Anxiousness

If your doctor suspects you have AFib, they will perform a physical exam and listen to your heart rate and rhythm with a stethoscope. They may also order other tests to rule out other conditions and help confirm their diagnosis. These tests can include:

• Electrocardiogram (ECG or EKG). This quick and painless test is usually the first one your doctor will order. ECG uses sensors (electrodes) placed on the chest, and sometimes the arms and legs. Wires connect the sensors to a computer that measures and records your heart’s rhythm and electrical signals.
• Holter monitor. This portable ECG monitor is typically worn during normal daily activities for 24 hours or longer to assess symptoms that might not have been captured with a traditional ECG.
• Event monitor. This monitor is similar to a Holter monitor but is typically worn for up to 30 days. It only records when it detects symptoms or you press a button.
• Echocardiogram. This test uses ultrasounds to detect poor blood flow in your heart. It can also reveal any muscle contraction problems, injury to the heart, and blood clots.
• Blood tests. This can help rule out causes such as an overactive thyroid (hyperthyroidism) and check for other causes of your AFib.

What are some atrial fibrillation treatment options?

The treatment will depend on the severity of your condition and any underlying cause of your symptoms. The goals will be to restore your normal heart rhythm (sinus rhythm), control your heart rate, and reduce your risk of stroke and other complications. Your treatment may include a combination of medications, cardioversion therapy, lifestyle changes, and surgery.

Medications

• Beta-blockers. Medications such as Lopressor (metoprolol) and Coreg (carvedilol) are used to slow down your heart rate.
• Calcium channel blockers. These medications also help with heart rate control, including Calan SR (verapamil) and Cardizem CD (diltiazem).
• Lanoxin (digoxin). If you have failed other therapies, your doctor may prescribe this medication to help lower your heart rate.
• Anti-arrhythmic drugs. Anti-arrhythmic medications such as Tambocor (flecainide) and Cordarone (amiodarone) are used to treat your abnormal heart rhythm.
• Blood thinners. These oral anticoagulants are used to reduce the risk of blood clots and stroke. Examples include Jantoven (warfarin), Eliquis (apixaban), and Xarelto (rivaroxaban).

Cardioversion and other procedures

• Electrical cardioversion. This procedure uses low-energy electrical shocks directly to your heart to reset the rhythm. This is not always a permanent solution and you can have further episodes of AFib.
• Catheter ablation. This procedure uses a catheter inserted into your heart through a blood vessel (usually in your groin). They then deliver heat (radiofrequency ablation) or cold (cryoablation) energy to block abnormal electrical signals and restore your normal heartbeat.
• Pacemaker. This small battery-powered device is implanted into your chest to reduce AFib when it is triggered by a slow heartbeat. It is usually only used if you have another arrhythmia in addition to Afib.
• MAZE procedure. This procedure creates a pattern of scar tissue to help your heart’s electrical impulses travel on the right path. It is typically used in severe cases or in those who already need another heart surgery.

What is the best medication for atrial fibrillation?

The best medication for the treatment of atrial fibrillation will depend on the individual’s specific medical atrial fibrillation, medical history, medications that the individual is already taking that may potentially interact with atrial fibrillation medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter atrial fibrillation medications approved by the Food and Drug Administration (FDA).

Your healthcare provider will determine the right dosage based on your response to the treatment, medical atrial fibrillation, weight, and age. Other possible side effects may exist; this is not a complete list.

Best medications for atrial fibrillation

What are the most common side effects of atrial fibrillation medications?

As with all medicines, those used for atrial fibrillation will have some side effects, depending on the class you are taking:

• Anticoagulants can cause serious side effects such as major or fatal bleeding. Some common side effects include bruising, nausea, stomach pain, and dizziness.
• Medications used to control your heart rate like Lopressor (metoprolol) and Cardizem CD (diltiazem) can cause low blood pressure, slow heart rate, headache, dizziness, nausea, and fatigue.
• Anti-arrhythmics commonly cause shortness of breath, headache, dizziness, fatigue, nausea, vomiting, and chest pain.

What are some home remedies for atrial fibrillation?

Along with medications, some healthy lifestyle changes can improve your heart health and lower your risk of AFib.

Atrial fibrillation prevention

• Eat a heart-healthy diet. Try foods such as vegetables, fruits, fiber-rich foods, and low-fat meat. Try to avoid foods high in sugar, salt, or saturated fats.
• Get regular exercise. Increase your physical activity to at least 150 minutes each week. Make sure to discuss any potential exercise plan with your doctor before starting.
• Maintain a healthy weight. Losing excess weight can help decrease your risk of AFib and other heart conditions.
• Stop smoking. Smoking cigarettes can double your risk of AFib.
• Limit or avoid alcohol. Heavy alcohol use or binge drinking can increase your risk of developing AFib.
• Manage your stress. Stress is a major trigger for a lot of people with AFib. Try to reduce your stress through mediation, therapy, or exercise.

Frequently asked questions about atrial fibrillation

Can you die from AFib?

Generally, no. AFib episodes are not usually deadly, but complications from AFib such as a stroke and heart failure caused by AFib can be.

Can you exercise with AFib?

Being physically active can improve your heart health and may decrease your risk of AFib. Always consult your doctor before starting any exercise plan.

What is your life expectancy with AFib?

If managed correctly with medications and lifestyle changes, you can live a long and active life with AFib.

What foods should you avoid with AFib?

You should try to eat a heart-healthy diet with plenty of vegetables, fruits, and fiber-rich foods. You should try to avoid foods high in salt, sugar, or saturated fats. You should also limit your caffeine and alcohol consumption.

What are some complications of AFib?

Blood clots are a major complication of AFib that can lead to stroke. If not managed correctly, AFib can weaken your heart muscle over time which can lead to heart failure.

Related resources for atrial fibrillation

• Atrial fibrillation overview. MayoClinic
• What is atrial fibrillation? Heart.org
• What is atrial fibrillation? Centers for Disease Control and Prevention
• Atrial fibrillation overview. NHS
• What is atrial fibrillation? National Heart, Lung, and Blood Institute
• Atrial fibrillation practice essentials. Medscape
• Atrial fibrillation symptoms and signs. MedicineNet