As with any arrhythmia, treatment of atrial fibrillation (AF) depends on the nature and severity of the abnormal rhythm, as well as the nature of any underlying condition(s). Treating AF frequently includes treating the underlying condition, such as high blood pressure or heart failure. Not all patients with AF need to be converted to a normal rhythm.

In general, there are two approaches to treating AF. They include:

• Rhythm control, which includes restoring the heart’s sinus rhythm.
  
  
• Rate control, which includes controlling the heart’s ventricular rate in patients with persistent or permanent atrial fibrillation.

In addition, physicians will attempt to prevent blood clots from forming and/or breaking off and traveling through the blood stream (embolizing), where they may cause stroke.

The choice of therapy depends on the patient’s condition and the nature of the atrial fibrillation. Medications that may be used include:

• Beta blockers, calcium channel blockers and digoxin (a type of inotrope). These are commonly used in rate control of atrial fibrillation. These medications slow transmission of electrical impulses from the atria to the ventricles. Though these medications slow the overall heart rate during atrial fibrillation, they will not restore the heart to its normal rhythm. Beta blockers have shown to be useful in preventing arrhythmias following heart surgery.
  
  
• Antiarrhythmics. These are commonly used in rhythm control of atrial fibrillation. These medications stabilize the heart rhythm, helping to maintain a normal rhythm. There is a wide variety of antiarrhythmics that may be used, depending on the patient’s condition, mostly their heart, lung and kidney function. Antiarrhythmics can also cause undesirable side effects so patients on these medications need to see their physician regularly.
  
  
• Anticoagulants. Medications that inhibit the formation of blood clots. Anticoagulants are often administered before rhythm control in initiated to prevent existing blood clots from breaking loose or new ones from forming. It is usually also continued for several weeks after therapy has begun. Anticoagulants must be monitored carefully to avoid side effects such as bleeding.
  
  
• Aspirin. Aspirin acts as an antiplatelet and may be given in conjunction with anticoagulants to prevent further cardiovascular complications.

More invasive treatments include:

• Cardioversion. Returns AF to a normal heart rhythm through either an electric shock or drugs. While most patients can be electrically cardioverted to a normal rhythm, only 60 percent can be maintained in a normal rhythm long term. Once again, anticoagulant therapy is frequently administered in conjunction with cardioversion. In patients who have atrial fibrillation for more than 48 hours, cardioversion should not be performed unless the presence of a clot inside the heart is excluded by a transesophageal echocardiogram and/or after three to four weeks of therapeutic treatment with warfarin (an anticoagulant).
  
  
• Radiofrequency ablation. Destroying (ablating) the tissues and pathways that are causing faulty signals. Recent research has identified the pulmonary veins in the left atrium as the trigger for AF in some patients. New techniques to isolate the pulmonary veins are being developed. This technique has some risks and is reserved for patients whose symptoms persist despite medical therapy.  
  
  
• Pacemaker. A device that is usually implanted to keep the heart from beating too slowly. In patients with AF, a pacemaker may be used in conjunction with medication to help control the heart rate. Some types of pacemakers have special features to help suppress AF. In addition, in patients whose AF cannot be controlled with medications, the physician may perform a procedure to interrupt the electrical connection between the atrium and ventricles. This is called an AV node ablation. Afterward, the physician would implant a pacemaker to keep the heart from beating too slowly. The patient would still be in AF but not feel it.
  
  
• Maze procedure. Making small, careful cuts in the atrial wall, thus designing a maze of new pathways through which electrical signals can travel. Signals will travel through this newly created maze rather than randomly leaping from various parts of the heart, therefore reducing AF. The maze procedure is highly successful. Significant research is ongoing, including the use of minimally invasive techniques and robotic procedures. The procedure is usually done in conjunction with valve surgery. The left atrial appendage, which is a structure within the left atrium that commonly harbors thrombi, is usually obliterated or excised during this surgery.