Atrial Fibrillation

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Atrial Fibrillation

Overview

What is atrial fibrillation?

Atrial fibrillation (say “A-tree-uhl fih-bruh-LAY-shun") is an irregular heart rhythm (arrhythmia) that starts in the upper parts (atria) of the heart. Atrial fibrillation is a common type of arrhythmia in people older than age 60.

Atrial fibrillation is the most common type of persistent irregular heartbeat (arrhythmia).

Normally, the heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with the heart’s electrical system causes the atria to quiver, or fibrillate. The quivering upsets the normal rhythm between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm.

Atrial fibrillation is dangerous because it greatly increases the risk of stroke. If the heart doesn't beat strongly, blood can collect, or pool, in the atria. Pooled blood is more likely to form clots. If the heart pumps a clot into the bloodstream, the clot can travel to the brain and block blood flow, causing a stroke. Atrial fibrillation can also lead to heart failure.

What causes atrial fibrillation?

Conditions that damage or strain the heart commonly cause atrial fibrillation. These include:

Atrial fibrillation may also be caused by:

  • Other medical problems, such as lung disease, pneumonia, or a high thyroid level (hyperthyroidism).
  • Heart surgery.
  • Heavy alcohol use. Having more than 3 drinks a day over many years can cause long-lasting atrial fibrillation. Drinking a large amount of alcohol at one time (binge drinking) may also cause a spell (episode) of atrial fibrillation.
  • Use of stimulants. These include caffeine, nicotine, medicines such as decongestants, and illegal drugs such as cocaine.
  • Use of some prescription medicines, such as albuterol or theophylline.

Sometimes doctors can't find the cause. Doctors call this lone atrial fibrillation.

What are the symptoms?

Symptoms may include:

  • Feeling dizzy or lightheaded.
  • Feeling out of breath.
  • Feeling weak and tired.
  • A feeling that the heart is fluttering, racing, or pounding (palpitations).
  • A feeling that the heart is beating unevenly.
  • Chest pain (angina).
  • Fainting.

Atrial fibrillation is common, especially in older adults, and it may not cause obvious symptoms. If you have any of the symptoms listed, see your doctor. Finding and treating atrial fibrillation right away can help you avoid serious problems.

How is atrial fibrillation diagnosed?

The doctor will ask questions about your past health, do a physical exam, and order tests. The best way to find out if you have atrial fibrillation is to have an electrocardiogram (EKG or ECG). An EKG is a test that checks for problems with the heart’s electrical activity.

You might also have lab tests and an echocardiogram. An echocardiogram can show how well your heart is pumping and whether your heart valves are damaged.

How is it treated?

A number of treatments may be used for atrial fibrillation. Which treatments are best for you depend on the cause, your symptoms, and your risk of stroke.

Doctors sometimes use a procedure called cardioversion to try to get the heartbeat back to a normal rhythm. This can be done using either medicine or a low-voltage electrical shock (electrical cardioversion). Atrial fibrillation often comes back after cardioversion.

Medicines are used to help prevent stroke. Most people who have atrial fibrillation need to take a blood-thinning medicine to help prevent strokes. You might take an anticoagulant, such as warfarin, or an antiplatelet, such as aspirin. If you are age 55 or older and have atrial fibrillation, you can find your risk of stroke using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

Medicines might be used to control your heart rate or heart rhythm.

  • Rate-control medicines keep the heart from beating too fast during atrial fibrillation.
  • Rhythm-control medicines (antiarrhythmics) help return the heart to its normal rhythm and keep it there.

Cardioversion and medicines don't work for some people who continue to have bothersome symptoms. In these cases, doctors sometimes recommend a procedure called ablation. Ablation destroys small areas of the heart. This creates scar tissue, which blocks or destroys areas that cause or maintain the irregular heart rhythm.

What can you do at home for atrial fibrillation?

Atrial fibrillation is often the result of heart disease or damage. So making changes that improve the condition of your heart may also improve your overall health.

  • Don't smoke. Avoid secondhand smoke, too. Quitting smoking can quickly reduce your risk of stroke and heart attack.
  • Eat a heart-healthy diet with plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
  • Get regular exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
  • Control your cholesterol and blood pressure. If you have diabetes, keep your blood sugar in your target range.
  • Manage your stress level. Stress can damage your heart.
  • Avoid caffeine, alcohol, and stimulants.
  • Avoid getting sick from the flu. Get a flu shot every year.

More information

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
  Atrial Fibrillation: Should I Try Electrical Cardioversion?
  Atrial Fibrillation: Which Anticoagulant Should I Take To Prevent Stroke?
  Heart Problems: Should I Have Catheter Ablation?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Heart Disease: Eating a Heart-Healthy Diet
  Heart Disease: Walking for a Healthy Heart
  Heart Problems: Living With a Pacemaker or ICD
  Warfarin: Taking Your Medicine Safely

Interactive tools help people determine health risks, ideal weight, target heart rate, and more. Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
  Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

Cause

Atrial fibrillation is caused by a problem with the electrical activity of the heart.

Conditions that damage the heart muscle or strain the heart may cause atrial fibrillation. These include:

  • High blood pressure, a condition in which the force of blood against artery walls is too strong. Normal blood pressure is 119 millimeters of mercury (mm Hg) systolic over 79 mm Hg diastolic or below.
  • Coronary artery disease and heart attack. Coronary artery disease is caused by the buildup of plaque on the inside of the coronary arteries. These blood vessels supply oxygen-rich blood to the heart muscle.
  • Heart failure. Heart failure occurs when the heart is not able to pump blood effectively.
  • Heart valve disease, most often mitral valve disease. Heart valve disease occurs when a heart valve is damaged or narrowed and does not properly control the flow of blood through and out of the heart.
  • Cardiomyopathy. Cardiomyopathy damages the heart muscle and decreases the amount of blood it can pump.
  • Myocarditis, which is inflammation of the heart muscle. Myocarditis may occur after a viral, fungal, or bacterial infection or another illness, such as diphtheria, rheumatic fever, or tuberculosis.
  • Rheumatic heart disease. Rheumatic heart disease is damage to the heart muscle and heart valves that results from rheumatic fever.
  • Congenital heart disease. Congenital heart defects are structural heart problems or abnormalities that have been present since birth.
  • Endocarditis. Endocarditis can damage the heart muscle and heart valves.
  • Wolff-Parkinson-White syndrome, which causes rapid or irregular rhythms (arrhythmias) in the heart.

Heart surgery, such as coronary artery bypass or valve surgery, can trigger atrial fibrillation. In people older than 65, any surgery can trigger atrial fibrillation and raise the risk of complications, such as a stroke. In these cases, atrial fibrillation may be short-lasting. Treatment can return the heart to a normal rhythm.

Other conditions that cause atrial fibrillation include:

  • Chronic obstructive pulmonary disease (COPD), a group of diseases that make it difficult to breathe because air does not flow easily out of the lungs.
  • Pneumonia, which is an inflammation of the lungs that is most often caused by infection with bacteria or a virus.
  • Pulmonary embolism. Pulmonary embolism is the sudden blockage of blood flow in an artery in the lungs.
  • Hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone.
  • Use of alcohol. Long-term, heavy alcohol use seems to be linked to atrial fibrillation. Besides long-term use, drinking a large amount of alcohol at one time (binge drinking) may also cause an episode of atrial fibrillation.
  • Use of stimulants. These include medicines, such as theophylline, amphetamines, and decongestants that contain stimulants (such as pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank; and excessive nicotine or caffeine.
  • Use of some prescription medicines, such as albuterol or theophylline.
  • Pericarditis, which is an inflammation of the sac around the heart. Pericarditis can temporarily irritate the heart muscle.

Atrial fibrillation caused by a condition that is treatable, such as pneumonia or hyperthyroidism, often goes away when that condition is treated.

Atrial fibrillation can sometimes develop in people who do not have heart disease or other health conditions. This is called lone atrial fibrillation.

Symptoms

Symptoms of atrial fibrillation include:

  • Heart palpitations.
  • Irregular pulse.
  • Shortness of breath, especially during physical activity or emotional stress.
  • Weakness, fatigue.
  • Dizziness, confusion.
  • Lightheadedness or fainting (syncope).
  • Chest pain (angina).

Atrial fibrillation is often discovered during routine medical checkups because many people do not have symptoms. Others may notice an irregular pulse but do not have other symptoms.

Mild symptoms may occur immediately. More serious problems may occur after the start of atrial fibrillation and over the course of several days. So it is important to identify and treat atrial fibrillation as soon as possible to avoid serious problems.

What Increases Your Risk

Risk factors for atrial fibrillation include:

When to Call a Doctor

Some symptoms of atrial fibrillation need urgent medical evaluation.

Call 911 or other emergency services immediately if you:

If you see someone pass out, call 911 or other emergency services immediately.

Call your doctor if you have:

  • An irregular heart rate.
  • Heart palpitations.
  • Periods of unexplained lightheadedness, dizziness, or confusion.
  • An episode of fainting or you come close to fainting for no apparent reason.
  • Shortness of breath that gets worse with exercise.

Anticoagulants

If you take an anticoagulant, such as warfarin (Coumadin), watch for signs of bleeding.

Call 911 if:

  • You cough up blood.
  • You vomit blood or what looks like coffee grounds.
  • You pass maroon or very bloody stools.
  • You have a sudden, severe headache that is different from past headaches. (It may be a sign of bleeding in the brain.)

Call your doctor right away if:

  • You have new bruises or blood spots under your skin.
  • You have a nosebleed that doesn't stop quickly.
  • Your gums bleed when you brush your teeth.
  • You have blood in your urine.
  • Your stools are black and look like tar or have streaks of blood.
  • You have heavy period bleeding or vaginal bleeding when you are not having your period.

If you are injured, apply pressure to stop the bleeding. Realize that it will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.

Who to See

The following health professionals can detect, diagnose and, in some cases, treat atrial fibrillation:

In general, the extent to which you will need specialized care will depend on how bad your symptoms are and how complex your case is. Many people who have only mild symptoms or whose arrhythmia is not causing other problems may continue to see their primary care doctors for the ongoing management of the condition.

But some people with atrial fibrillation have severe symptoms and may benefit from regular monitoring and treatment by a more specialized physician, such as a:

Exams and Tests

An electrocardiogram (EKG, ECG) is the best and simplest way to find out whether you have atrial fibrillation. An electrocardiogram is a recording of the electrical activity of your heart. It is usually done along with a medical history and physical exam. During your exam, your doctor will take your blood pressure to find out whether you have high blood pressure. Your doctor will also listen to your heart to see if you have a heart murmur.

If your doctor suspects that you have atrial fibrillation that comes and goes, he or she may ask you to use a device to record your heart rhythm on a continuous basis. This is referred to by several names, including ambulatory electrocardiogram, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.

Your doctor may also recommend an electrophysiology (EP) study. An EP study can help your doctor see if there is a problem with your heartbeat (heart rhythm) and find out how to fix it.

Your doctor may do more tests to see whether you have damage to your heart or heart valves. An exercise electrocardiogram, also called a stress test, will help your doctor see whether you have coronary artery disease. An echocardiogram gives your doctor a lot of information about your heart. It can show whether your heart valves are damaged, how well your heart is pumping, and whether you have heart failure or have had a heart attack.

You may also have a blood test to check for hyperthyroidism. Hyperthyroidism occurs when the thyroid gland makes too much thyroid hormone.

If you take warfarin (such as Coumadin) for atrial fibrillation, you will need to have frequent blood tests to monitor how long it takes for your blood to clot (prothrombin time).

Treatment Overview

Treating atrial fibrillation is important for several reasons. An irregular, rapidly beating heart can weaken the heart muscle and cause it to dilate or stretch out. This can increase your risk of having heart failure or having chest pain or even a heart attack. Also, atrial fibrillation can greatly increase your risk of having a stroke. Atrial fibrillation can also cause symptoms that are hard to deal with.

Many people are able to live full and active lives while being treated for atrial fibrillation. To stay healthy, you will probably need to take medicines, including an anticoagulant or aspirin, a medicine to slow heart rate, or possibly a rhythm-control medicine.

Initial treatment

If atrial fibrillation is causing your heart to pump dangerously fast or your blood pressure to drop dramatically, you will probably be taken to the hospital for treatment to restore your blood pressure and heart rate to normal. If atrial fibrillation is not causing severe symptoms, you may be treated on an outpatient basis. Treatment for people who have just started having episodes of atrial fibrillation usually includes trying to convert the heart to a normal rhythm. Sometimes anticoagulant medicines are used to prevent clots and stroke.

  • If you have had atrial fibrillation for less than 48 hours, your doctor may perform a procedure called cardioversion, using either medicine or a low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm).
  • If atrial fibrillation has lasted for more than 48 hours, attempting cardioversion could cause a stroke. In this case, you may need to take an anticoagulant medicine, such as warfarin, for several weeks before your doctor tries cardioversion. Taking anticoagulants reduces the chance that a clot might travel from the heart to the brain after cardioversion.
  • If you are not sure how long you have had atrial fibrillation, you are also at risk of having a clot in your heart. If you are not having severe symptoms, such as fainting, your doctor will probably also recommend that you take anticoagulants for several weeks before cardioversion to prevent a stroke.
  • If you have severe symptoms and you are not sure how long you have had atrial fibrillation, your doctor may try to restore your heart to a normal rhythm immediately. In this case, your doctor will use a transesophageal echocardiogram to determine whether you have a clot in your heart that could cause a stroke. The results of this test will determine what your doctor does next:
    • If the heart is clear of clots, cardioversion can be attempted. Anticoagulants are used after to prevent strokes.
    • If there is a clot in the heart, your doctor will prescribe anticoagulants before trying cardioversion.

Cardioversion usually works to restore a normal sinus rhythm. But in many cases the heart rhythm goes back to atrial fibrillation.

Click here to view a Decision Point. Atrial Fibrillation: Should I Try Electrical Cardioversion?

Ongoing treatment

When atrial fibrillation comes on suddenly, lasts a short time, and goes away on its own, it is called paroxysmal atrial fibrillation. Typically, over time, episodes of paroxysmal atrial fibrillation come on more often and last longer.

Over time, episodes of atrial fibrillation typically last longer and often do not go away on their own. This is called persistent atrial fibrillation. When you have had atrial fibrillation for a long time, it is more difficult to return your heart to a normal rhythm (also called a normal sinus rhythm). When cardioversion is not an option or does not work, medicines are usually given to control the heart rate and prevent stroke.

Prevent a stroke

Having atrial fibrillation can raise your risk of stroke.

If you are at an average to high risk of having a stroke, your doctor may prescribe long-term use of an anticoagulant medicine, such as warfarin, to lower this risk. Anticoagulants, also called blood thinners, can prevent blood clots that can lead to a stroke. You may be at average to high risk of stroke if you are older than 75 or have a history of heart disease, high blood pressure, diabetes, or stroke.

If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

If you are at low risk of having a stroke or you cannot take an anticoagulant, you may choose to take aspirin daily.

Talk to your doctor about whether you should take warfarin. For help deciding whether to take warfarin, see:

Click here to view a Decision Point. Atrial Fibrillation: Should I Take Warfarin to Prevent Stroke?

If you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:

Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.

Control your heart rate or rhythm

You may also need to take rate-control medicines or rhythm-control medicines (antiarrhythmics). Both of these types of medicines are effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.

Rate-control medicines. Rate-control medicines are used if your heart rate is too fast. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. They usually do not return your heart to a normal rhythm—in other words, your heartbeat will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. You might not have symptoms from an irregular heart rhythm if your heart rate is lower than 110 beats per minute. Rate-control medicines may relieve symptoms caused by the fast heart rate. But these medicines may not be an option if you have severe symptoms with atrial fibrillation.

Rhythm-control medicines. Rhythm-control medicines (also known as antiarrhythmics) may be used for some people who have atrial fibrillation. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning. These medicines might help relieve symptoms caused by an irregular heart rate.

Treatment if the condition gets worse

For some people with atrial fibrillation, medicines to slow the heart rate or control its rhythm do not work. These people continue to have a rapid, irregular heart rate. In these cases, doctors sometimes recommend a nonsurgical procedure called catheter ablation or a surgical procedure called the maze procedure. Experts suggest that these procedures should be done in a medical center where the staff has experience with the procedures.

Catheter ablation

Catheter ablation for atrial fibrillation is a relatively new procedure. Catheter ablation destroys the heart tissue that causes atrial fibrillation and that keeps atrial fibrillation going after it starts. Ablation might be done if you have symptoms of atrial fibrillation that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with. To help decide whether catheter ablation is a good choice for you, see:

Click here to view a Decision Point. Heart Problems: Should I Have Catheter Ablation?

Maze procedure

A surgical procedure to cure atrial fibrillation is called the maze procedure. The maze procedure is usually done during open-heart surgery. The procedure creates scar tissue that blocks excess electrical impulses from traveling through your heart. Because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and are having heart surgery for other reasons. Doctors are developing less invasive surgical maze techniques. These may be less painful and easier to recover from.

Ongoing Concerns

Atrial fibrillation with heart disease

Heart disease—including high blood pressure, heart valve disease, and coronary artery disease—is the most common cause of atrial fibrillation. Seen mostly in people older than 65, this type of atrial fibrillation is often the most complicated to manage.

At first, people usually have paroxysmal atrial fibrillation. Paroxysmal episodes go away on their own. They may last anywhere from a few seconds to a few weeks and may not cause symptoms.

Paroxysmal atrial fibrillation episodes may recur for weeks or years, although usually the disease progresses, and atrial fibrillation becomes persistent, meaning that it no longer goes away on its own. Your doctor may try a procedure called cardioversion, using either medicine or low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm). The decision to try cardioversion is based upon how bothersome you find the symptoms and how long the episode of atrial fibrillation has persisted.

If the heart cannot be converted to a normal rhythm or does not stay in a normal rhythm, medicines are used to control the heart rate and prevent it from becoming dangerously fast. Many people are able to live full and active lives while being treated for atrial fibrillation. Others may need further treatment because they develop shortness of breath, weakness, fainting, or other significant symptoms.

If atrial fibrillation is not treated, it can further damage the heart and cause serious complications, such as heart failure.

You can lower your risk of complications by controlling high blood pressure.

Lone atrial fibrillation

In rare cases, doctors cannot find the cause of atrial fibrillation. These cases are called lone atrial fibrillation. Lone atrial fibrillation occurs more often in people younger than 65. It often stops on its own, or it may need to be treated.

Treatment may be needed if a rapid heartbeat causes discomfort, decreased energy, or other unacceptable symptoms.

Stroke risk

Atrial fibrillation increases your chance of having a stroke. When blood does not completely empty out of the rapidly beating atria, a clot can develop in the blood that pools in the atria. The clot may travel from the heart to the brain, causing a stroke.

The risk of stroke increases with age and with high blood pressure, diabetes, heart valve disease, heart failure, or a previous stroke or transient ischemic attack (TIA). You can lower your risk of stroke by taking medicines that help prevent blood clots, such as warfarin or aspirin.

If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: Are You at Risk for a Stroke if You Have Atrial Fibrillation?

Prevention

A healthy lifestyle, proper nutrition, treatment for high blood pressure, and other measures can prevent atrial fibrillation by protecting you from heart disease. Manage your stress, exercise regularly, control your blood pressure, and do not smoke.

For tips on starting a walking program, see:

Click here to view an Actionset. Heart Disease: Walking for a Healthy Heart.

Eat a heart-healthy diet. This includes eating at least two servings of fish each week, particularly oily fish such as salmon, trout, and tuna. For more information, see Click here to view an Actionset. Heart Disease: Eating a Heart-Healthy Diet.

Avoid medicines, alcohol, and stimulants—such as caffeine or nicotine—that may contribute to the development of atrial fibrillation.

Take antibiotics when directed to do so by your doctor to lower your chance of getting a heart infection (endocarditis). Infection in the heart may lead to atrial fibrillation. For more information, see the topic Endocarditis.

Check your heartbeat regularly. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor. Checking your heartbeat is important, because many people do not have symptoms of atrial fibrillation. Ask your doctor how often you should check your heartbeat. Once a month might be right for you.

Living With Atrial Fibrillation

Because atrial fibrillation is often the result of a heart condition, making changes to improve your heart condition will usually improve your overall health. Some of these changes include:

  • Not smoking. If you smoke, try to quit. Medicines and counseling can help you quit for good.
  • Controlling your cholesterol. This can be done by diet and exercise, and medicines if needed.
  • Controlling your blood pressure. Follow a low-sodium, low-fat, and low-saturated fat diet; increase your exercise; decrease alcohol intake; and take medicines, if needed, to control your blood pressure.
  • Eating a heart-healthy diet. This includes eating a variety of fruits, vegetables, and whole grains. Limit sodium and saturated fat. Eat fish, especially oily fish like salmon and tuna, at least twice each week. For more information, see:
    Click here to view an Actionset. Heart Disease: Eating a Heart-Healthy Diet.
  • Not using alcohol, caffeine, or stimulants, such as methamphetamines or cocaine. Be aware that some nonprescription medicines, especially cold and herbal remedies, contain stimulants that can trigger atrial fibrillation. Talk to your doctor or pharmacist before taking any new medicine.
  • Trying an exercise program. Exercise has many positive effects: weight management, cholesterol reduction, blood pressure control, blood sugar leveling in diabetes, triglyceride reduction, mood elevation, and increased strength. Try to exercise on most, preferably all, days of the week. Talk to your doctor before starting an exercise program. For more information, see the topic Cardiac Rehabilitation.
  • Avoiding illness from the flu. Get a flu shot every year.
  • Being on the alert for signs of obstructive sleep apnea. Many people with atrial fibrillation also have obstructive sleep apnea.
  • Using complementary options to help control your stress. Examples include:

Check your heartbeat regularly. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor. Checking your heartbeat is important, because many people do not have symptoms of atrial fibrillation. Ask your doctor how often you should check your heartbeat. Once a month might be right for you.

Safety and anticoagulants

When you take an anticoagulant (also called a blood thinner), you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:

Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.

Medications

Medicine treatment decisions are based on the cause of your atrial fibrillation, your symptoms, and your risk for complications. You will likely take a medicine to help prevent a stroke. You may also take a medicine that controls your heart rate or your heart rhythm.

Prevent a stroke

Anticoagulants

Anticoagulant medicines, also called blood thinners, are recommended for most people with atrial fibrillation who are at average to high risk of stroke.

If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

Anticoagulants used for atrial fibrillation include:

For help deciding if you should take an anticoagulant to prevent a stroke, or for help deciding which anticoagulant to take, see:

Click here to view a Decision Point. Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
Click here to view a Decision Point. Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?

Aspirin and other antiplatelet medicines

If you are at low risk of stroke or cannot take anticoagulants, your doctor may recommend that you take aspirin. It is not as effective as anticoagulant medicines in preventing clots, but it does not have as many side effects.

Your doctor may have you take other antiplatelet medicines, such as clopidogrel (Plavix), along with aspirin or instead of aspirin. When aspirin and clopidogrel are used together, they may reduce the risk for stroke more than aspirin alone. But this combination is also more likely to cause bleeding than aspirin alone.

Safety and medicine

If you take an anticoagulant (also called a blood thinner), you need to take extra steps to avoid bleeding problems. These steps include the following:

  • Prevent falls and injuries.
  • Tell your doctors about all other medicines and vitamins that you take.

If you take warfarin, you also:

  • Get regular blood tests.
  • Eat a steady diet. And you pay attention to foods that contain vitamin K.

For more information about safety with warfarin, see:

Click here to view an Actionset. Warfarin: Taking Your Medicine Safely.

Control your heart rate or rhythm

You may also need to take rate-control medicines or rhythm-control medicines (antiarrhythmics). Both of these types of medicines are effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.

Control heart rate. Rate-control medicines are used if your heart rate is too fast. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. They usually do not return your heart to a normal rhythm—in other words, your heartbeat will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. You might not have symptoms from an irregular heart rhythm if your heart rate is lower than 110 beats per minute. Rate-control medicines may relieve symptoms caused by the fast heart rate. But these medicines may not be an option if you have severe symptoms with atrial fibrillation.

Control heart rhythm. Rhythm-control medicines (also known as antiarrhythmics) may be used for some people with atrial fibrillation. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning. These medicines may help relieve symptoms caused by an irregular heart rate.

What to Think About

Some of these medicines may also be used to treat coronary artery disease, heart failure, and high blood pressure.

Surgery

The maze procedure, a surgery to correct atrial fibrillation, may be an option. Usually medicines and catheter ablation are tried before surgery is considered. But you may be a candidate for this surgery, especially if you are already having heart surgery for another reason, such as mitral valve replacement or coronary artery bypass surgery. If this is the case, the maze procedure can be done at the same time.

The maze procedure involves creating scar tissue that blocks excess electrical impulses from traveling through your heart. It usually requires open-heart surgery, but less invasive surgical methods are being developed.

Other Treatment

Pacemakers are sometimes needed by people who have atrial fibrillation. If you have a pacemaker, see Click here to view an Actionset. Heart Problems: Living with a Pacemaker or ICD.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


Heart Rhythm Society
1400 K Street NW
Suite 500
Washington, DC  20005
Phone: (202) 464-3400
Fax: (202) 464-3401
Web Address: www.hrsonline.org
 

The Heart Rhythm Society provides information for patients and the public about heart rhythm problems. The website includes a section that focuses on patient information. This information includes causes, prevention, tests, treatment, and patient stories about heart rhythm problems. You can use the Find a Specialist section of the website to search for a heart rhythm specialist practicing in your area.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Other Works Consulted

  • ACTIVE Investigators (2009). Effect of clopidogrel added to aspirin in patients with atrial fibrillation. New England Journal of Medicine, 360(20): 2066–2078.
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Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer John M. Miller, MD - Electrophysiology
Last Revised February 18, 2011

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