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.

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, a chest X-ray, 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.

If you have mild symptoms, or if atrial fibrillation returns after cardioversion, your doctor may prescribe medicines to control your heart rate and help prevent stroke. These may include:

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

Many people with atrial fibrillation need to take blood-thinning (anticoagulant) medicine to help prevent strokes. People at low risk for stroke may take daily aspirin instead. 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?

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. Afterward, you may need a pacemaker to keep your heart beating regularly.

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 anticoagulants to prevent stroke?
  Atrial fibrillation: Should I try electrical cardioversion?
  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 develop immediately. More serious problems may develop 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.

Serious complications such as a stroke or heart failure may occur before atrial fibrillation is discovered.

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.

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 upon the severity of your symptoms and the complexity of your individual case. 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 determine 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 determine 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 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 develops when the thyroid gland makes too much thyroid hormone.

You may get an X-ray if your exams show that you might have heart failure or a problem in your lungs, such as pneumonia.

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

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.

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 developing 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 live 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, medicines to slow heart rate, or possibly rhythm-control medicines.

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 forless 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 the anticoagulant medicine 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, episodes of paroxysmal atrial fibrillation come on more often and last longer over time.

Having paroxysmal 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 the anticoagulant medicine warfarin to reduce this risk. 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 at low risk of having a stroke or you cannot take warfarin, you may need to take aspirin daily.

You may also need to take rhythm-control medicines (antiarrhythmics) to try to prevent paroxysmal atrial fibrillation from recurring.

Doctors may recommend the "pill in the pocket" approach for people with paroxysmal atrial fibrillation. With this approach, you can take a single dose of an antiarrhythmic drug when you feel palpitations instead of taking the medicine every day. For some people, this stops atrial fibrillation episodes. It may also reduce medicine side effects and the need to be seen in the emergency room or be hospitalized. But not everyone can use this treatment. Before you can take the "pill in the pocket" approach, your doctor will want to make sure that you do not have any other heart disease and that your heart's electrical system is normal.

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.

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. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.

Rhythm-control medicines. Rhythm-control medicines (antiarrhythmics) are still considered valuable for the treatment of atrial fibrillation. If symptoms persist despite rate-control medicines and in certain other cases, rhythm-control medicines are often prescribed. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning.

Research studies have changed the way persistent atrial fibrillation is treated in many cases. The studies found that traditionally prescribed rhythm-control medicines were expensive, often had side effects, and did not produce better results than rate-control medicines. Still, rate-control and rhythm-control medicines are both effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.

Anticoagulant medicines. Most people with atrial fibrillation should take warfarin, an anticoagulant medicine, to prevent blood clots that can lead to a stroke. Warfarin can prevent stroke and save lives in people who have an average to high risk of stroke. If you have high blood pressure, diabetes, heart failure, or a history of transient ischemic attack (TIA) or stroke, you may be at average to high risk of stroke. Talk to your doctor about whether you should take warfarin.

For people with a low risk of stroke or those who cannot take warfarin, daily aspirin may be recommended.

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?

For information about whether to take anticoagulants, see:

Click here to view a Decision Point. Atrial fibrillation: Should I take anticoagulants to prevent stroke?

If you take warfarin, you need to take extra steps to avoid bleeding problems. For more information, see:

Click here to view an Actionset. Warfarin: Taking your medicine safely.

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 performed in a medical center where the staff has experience with the procedures.

Catheter ablation

Catheter ablation for atrial fibrillation is relatively new and is still being studied. Catheter ablation destroys the heart tissue that causes atrial fibrillation and keeps atrial fibrillation going after it starts. Thin wires are inserted into a vein in the groin and guided into the heart. The wires have an attachment at the tip. The attachment sends out very hot or very cold temperatures. This heat or cold destroys the tissue that causes atrial fibrillation or the tissue that keeps it happening.

Catheter ablation is most successful at treating paroxysmal atrial fibrillation. In people with persistent or chronic atrial fibrillation, the success rate is lower. Catheter ablation is an invasive procedure and has some serious risks. Catheter ablation should only be done in people who have tried other treatments but continue to have serious symptoms. As the procedure becomes more effective and safe, doctors may use it as one of the first treatments for atrial fibrillation.

Ablation procedures either try to cure atrial fibrillation (focal ablation, circumferential ablation, or pulmonary vein ablation) or try to control your symptoms (nodal ablation).

Ablation to cure atrial fibrillation. Focal, circumferential, and pulmonary vein catheter ablation are used to try to cure atrial fibrillation. Focal ablation, also known as targeted ablation, is used to destroy the specific areas that are firing off abnormal electrical impulses and causing atrial fibrillation. Circumferential ablation is used to destroy the tissue that lets atrial fibrillation continue. Sometimes a doctor uses both focal and circumferential ablation.

Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in the pulmonary vein can block these impulses and prevent atrial fibrillation from happening.

A pacemaker device is usually not needed when only specific areas are destroyed.

Ablation to control symptoms of atrial fibrillation. Nodal catheter ablation may be used to control symptoms of atrial fibrillation when the cause cannot be stopped. Nodal catheter ablation destroys your atrioventricular (AV) node and blocks electrical signals to your lower heart chambers (ventricles). After nodal catheter ablation, you will need a permanent pacemaker to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. So you will probably need to take the anticoagulant medicine warfarin.

Click here to view a Decision Point. Heart problems: Should I have catheter ablation?
Click here to view an Actionset. Heart problems: Living with a pacemaker or ICD

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.

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. Adults older than age 75 with lone atrial fibrillation are at risk for stroke and require treatment with the anticoagulant medicine warfarin (such as Coumadin).

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.

People with atrial fibrillation and no damage to the heart valves are 6 times more likely to have a stroke than people without atrial fibrillation. The risk of stroke is significantly higher if heart valve damage is present. This risk of stroke also increases with age and with high blood pressure, diabetes, heart failure, or a previous stroke or transient ischemic attack (TIA). Taking anticoagulant medicines, such as warfarin, greatly reduces your risk of blood clots and 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: Are You at Risk for a Stroke if You Have Atrial Fibrillation?

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.

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.

Experts also recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, one study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation.1 For more information, see the topic Coronary Artery Disease.

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.

Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older and those who have other stroke risk factors, check his or her heartbeat once a month. 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.

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:

  • Quitting smoking and avoiding secondhand smoke. Quitting smoking may be the most important step you can take to prevent coronary artery disease. For more information, see the topic Quitting Smoking.
  • Controlling your cholesterol. This can be accomplished 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.
  • Trying a balanced, low-fat and low-sodium diet, such as one based on the American Heart Association's healthy diet guidelines.2 For more information, see:
    Click here to view an Actionset.Heart disease: Eating a heart-healthy diet.
  • Eating more fish. Experts recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, a recent study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation.1
  • 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.
  • Avoid getting sick from the flu. Get a flu shot every year.
  • Being on the alert for signs of obstructive sleep apnea because many people with atrial fibrillation also have obstructive sleep apnea.
  • Using complementary options to help control your stress. Examples include:

Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older, check his or her heartbeat once a month. 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.

Safety and warfarin

If you take an anticoagulant medicine, such as warfarin, you need to take extra steps to avoid bleeding problems. If you take warfarin:

  • Get regular blood tests.
  • Prevent falls and injuries.
  • Eat a steady diet, and pay attention to foods that contain vitamin K.
  • Tell your doctors about all other medicines and vitamins that you take.

For more information, 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.

Treatment with medicine is often needed for many years when heart disease is the cause of atrial fibrillation.

Rate-control medicines are used if your heart rate is too fast. Your doctor may give them to you to see if your atrial fibrillation symptoms are present when your heart rate is under control. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. Rate-control medicines may not be an option if you have a lot of symptoms with atrial fibrillation.

In a study called the AFFIRM trial, rate-control medicines were found to be preferable to antiarrhythmic medicines as a first treatment for certain people with atrial fibrillation, specifically older people at risk for stroke who did not have severe symptoms. The study found that antiarrhythmic medicines were expensive, often had side effects, and did not produce better results in this group of people.3

Unlike antiarrhythmic medicines, rate-control medicines usually do not return your heart to a normal rhythm. In other words, your heart rhythm will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.

Rhythm-control medicines are sometimes used to try to convert atrial fibrillation to a normal sinus rhythm. Rhythm-control medicines, also called antiarrhythmic medicines, are also used to try to maintain normal sinus rhythm when symptoms persist despite rate-control medications and in certain other cases.

Warfarin, an anticoagulant medicine, is 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?

For more information about whether you should take an anticoagulant medicine, see:

Click here to view a Decision Point. Atrial fibrillation: Should I take anticoagulants to prevent stroke?

If you take an anticoagulant medicine, such as warfarin, you need to take extra steps to avoid bleeding problems. You need to:

  • Get regular blood tests.
  • Prevent falls and injuries.
  • Eat a steady diet, and pay attention to foods that contain vitamin K.
  • Tell your doctors about all other medicines and vitamins that you take.

For more information, see:

Click here to view an Actionset. Warfarin: Taking your medicine safely.

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. You may 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.

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

Electrical cardioversion is frequently used for atrial fibrillation to restore a normal sinus rhythm if the heart rhythm does not convert on its own. You may also elect to have cardioversion if you find your symptoms bothersome.

If your atrial fibrillation has recently started and it has been continuously present for less than 48 hours, your doctor may consider using electrical cardioversion or antiarrhythmic medicines to convert your heart to a normal rhythm. If your atrial fibrillation has lasted for more than 48 hours, it is possible that the blood that is pooling in the quivering upper heart chambers (atria) has led to the formation of blood clots. Cardioversion could cause a blood clot to be pumped into the bloodstream, travel to the brain, and cause a stroke.

If you've had atrial fibrillation for more than 48 hours, your doctor will probably prescribe anticoagulants for several weeks to reduce the risk of stroke before attempting cardioversion.

But if you have severe symptoms, such as very low blood pressure, you may have cardioversion immediately. In this case, your doctor may use a transesophageal echocardiogram to assess whether you have any clots in your heart that could cause a stroke. If the transesophageal echocardiogram shows that your heart is clear of clots, you may have cardioversion. Anticoagulant medicine is taken for at least 3 weeks after cardioversion.

If medicines do not keep you in normal rhythm and you continue to be bothered by your symptoms, catheter ablation might help you. Catheter ablation is used to try to cure atrial fibrillation or to control the heart rate. The procedure destroys small areas in the heart that might be causing atrial fibrillation or keep it going. You may need a permanent pacemaker along with catheter ablation.

Click here to view a Decision Point. Heart problems: Should I have catheter ablation?
Click here to view a Decision Point. Atrial fibrillation: Should I try electrical cardioversion?
Do I need a pacemaker?

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.americanheart.org
 

Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide 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. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.


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 Web site 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 Web site 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
E-mail: 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

Citations

  1. Mozaffarian D, et al. (2004). Fish intake and risk of incident atrial fibrillation. Circulation, 110(4): 368–373.
  2. American Heart Association (2006). Diet and lifestyle recommendations revision 2006. Circulation, 114(1): 82–96. [Erratum in Circulation, 114(1): e27.]
  3. Wyse DG (2002). Rate Versus Rhythm Control in the Management of Atrial Fibrillation. Available online: http://www.americanheart.org/presenter.jhtml?identifier=3005618.

Other Works Consulted

  • ACTIVE Investigators (2009). Effect of clopidogrel added to aspirin in patients with atrial fibrillation. New England Journal of Medicine, 360(120): 2066–2078.
  • American Heart Association and American College of Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]
  • Boos CJ, et al. (2007). Atrial fibrillation (chronic), search date August 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Calkins H, et al. (2007). HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures, and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm, 4(6): 816–861.
  • Hirsch J, et al. (2008). Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed.). Chest, 133(6): 71S–109S.
  • Lip GYH, Watson T (2007). Atrial fibrillation (acute onset), search date October 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Mozaffarian D, et al. (2008). Physical activity and incidence of atrial fibrillation in older adults. The Cardiovascular Health Study. Circulation. Published online August 4, 2008 (doi:10.1161/circulationaha.108.785626).
  • Prystowsky EN, Waldo AL (2008). Atrial fibrillation, atrial flutter, and atrial tachycardia. In V Fuster et al., eds., Hurst's the Heart, 12th ed., pp.953–982. New York: McGraw-Hill Medical.
  • Shea JB, Sears SF (2008). A patient's guide to living with atrial fibrillation. Circulation, 117(20): e340–e343.
  • Sherman DG, et al. (2005). Occurrence and characteristics of stroke events in the atrial fibrillation follow-up investigation of sinus rhythm management (AFFIRM) study. Archives of Internal Medicine, 165(10): 1185–1191.
  • Snow V, et al. (2003). Management of newly detected atrial fibrillation: A clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Annals of Internal Medicine, 139(12): 1009–1018.

Credits

Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer John M. Miller, MD - Electrophysiology
Last Updated December 18, 2008

related physicians

related services

Bon Secours International| Sisters of Bon Secours USA| Bon Secours Health System

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Privacy Policy. How this information was developed to help you make better health decisions.

© 1995-2010 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.