Treatment Options for Atrial Fibrillation: What Patients Should Know

Atrial fibrillation (AFib) is a common heart rhythm problem that causes the upper chambers of the heart to beat unevenly. When the heart doesn’t beat in a steady way, blood may not flow as it should. AFib can lead to symptoms such as a fast heartbeat, fatigue, or shortness of breath— and it raises the risk of stroke.

Medicines, procedures, and devices can all play a role in treating AFib. Finding the safest plan starts with understanding the options available to you.

Understanding Treatment Goals

There are many different treatments for AFib. Not every treatment works the same way, and your doctor may choose one or more depending on your needs. 

AFib treatments may help by:

• Lowering your risk of stroke 

• Reducing symptoms 

• Preventing complications that AFib can cause over time

• Managing other health conditions that can make AFib worse, such as high blood pressure or diabetes

Questions to ask your clinician

• What is the main goal of treatment in my case?

• How do you track whether treatment is working?

• Are there other health issues I should work on that might affect my treatment?

Medications for Atrial Fibrillation

Medications are often the first step in managing AFib. They can slow the heart rate (rate control), try to restore a normal rhythm (rhythm control), or lower stroke risk (blood thinners).

Rate control medications

Rate control drugs do not stop AFib itself. The top chambers of the heart (called atria) may still quiver, but these medicines slow down how many of those irregular signals reach the lower chambers (ventricles). By keeping the heart from beating too fast, they ease symptoms like racing heartbeat or shortness of breath.

 Common options are:

• Beta blockers (such as metoprolol)

• Calcium channel blockers (such as diltiazem or verapamil)

Rate control is often tried first, especially if symptoms are not severe, because it can improve how you feel without needing stronger medications.

Questions to ask your clinician

• What heart rate are you aiming for with this medicine?

• Which type of rate control drug is best for me?

• Are there side effects I should watch for?

Rhythm control medications

Rhythm control drugs, also called antiarrhythmics, target the atria directly. They aim to stop the quivering and restore a normal, steady rhythm to your heart.

Examples include:

• Flecainide and propafenone

• Amiodarone, sotalol, and dofetilide

• Dronedarone

These drugs are usually considered if rate control doesn’t improve symptoms. In some cases, such as when AFib is newly diagnosed and causing a lot of symptoms, or when someone has both AFib and heart failure, rhythm control may be tried earlier. Because rhythm control medicines can cause more side effects than rate control medicines, your doctor will help decide if the potential benefits outweigh the risks.

Questions to ask your clinician

• Would rhythm control medicines help me feel better than rate control?

• Which drug is safest for my heart condition?

• What should I do if I have side effects?

Blood thinners (anticoagulants)

AFib can cause blood to pool in the heart, which may lead to clots forming. Blood thinners lower this risk.

Common blood thinners include:

• Direct oral anticoagulants (DOACs): apixaban (Eliquis®), rivaroxaban (Xarelto®), dabigatran (Pradaxa®), and edoxaban (Savaysa®)

• Warfarin (Coumadin®)

Your clinician will decide which blood thinner is right for you based on your stroke risk, overall health, and other medications you take.

Questions to ask your clinician

• Do I need a blood thinner, and for how long?

• Which type is safest for me?

• How will we monitor for side effects or bleeding risks?

Procedures for Atrial Fibrillation

Cardioversion

Cardioversion is a procedure that resets the heart to a normal rhythm. It may be recommended if AFib is causing severe symptoms, if medications cannot control the heart rate, or if restoring rhythm quickly would improve your health.

Cardioversion can be done in two ways:

• Electrical cardioversion: A short, controlled shock is delivered to the heart while you are under sedation. Often used when symptoms are serious, such as very low blood pressure, chest pain, fainting, or sudden worsening of heart failure.

• Medication (chemical) cardioversion: A one-time dose or medication is given through the vein to reset the rhythm. Your doctor may choose this approach if you’re not having severe symptoms but still need help restoring a normal rhythm–or if electrical cardioversion isn’t the best option.

Timing matters. Cardioversion usually works best if your AFib episode has lasted 48 hours or less. If you’ve been in AFib for longer than that, or if the timing is unclear, blood thinners are usually given before and after the procedure to lower the risk of stroke.

Questions to ask your clinician

• Am I a candidate for cardioversion?

• How does the timing of my AFib episode affect this procedure?

• Will I need to take blood thinners before and after cardioversion?

Catheter ablation

In this procedure, a thin tube (catheter) is inserted through blood vessels in the groin, and guided to the heart. Energy, most often heat (radiofrequency) or cold (cryoablation), is delivered through the catheter to block the abnormal electrical signals that cause the irregular heartbeat.

Ablation may be considered if:

• AFib keeps coming back even with medicines

• Medications cause too many side effects or aren’t preferred

• A person has AFib that comes and goes (paroxysmal AFib) and wants a treatment to prevent more episodes

Research shows that ablation can reduce AFib episodes and improve quality of life, especially in younger people with fewer other health problems.

 Questions to ask your clinician

• Am I a candidate for catheter ablation?

• How successful is this procedure for someone like me?

• What are the possible risks or complications?

Pacemaker or other devices

In some cases, devices may also be used. A pacemaker can keep the heart from beating too slowly if AFib medicines lower the rate too much. For stroke prevention, left atrial appendage occlusion (LAAO) devices, such as the Watchman™, can seal off the area of the heart where blood clots often form. This option may be considered for people who cannot take blood thinners long term. These devices are usually considered only when standard treatments are not enough.

Questions to ask your clinician

• Why would I need a device like a pacemaker?

• What are the benefits and risks of this option?

• How will life change if I have a device?

Making the Right Choice for You

AFib can be managed in many ways. The best plan is the one that balances safety with what will help you most. By asking questions and working closely with your clinician, you can find the treatment path that best supports your health and quality of life.

References

American Heart Association. Atrial fibrillation medications. Updated 2023. Accessed September 22, 2025. https://www.heart.org/en/health-topics/atrial-fibrillation/diagnosis-and-treatment-of-afib/atrial-fibrillation-medications

American Heart Association. Cardioversion. Updated 2023. Accessed September 22, 2025. https://www.heart.org/en/health-topics/arrhythmia/prevention-and-treatment/cardioversion

Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1):e1-e157. doi:10.1161/CIR.0000000000001193

Mitchell LB. Atrial fibrillation (AFib). In: Howlett JG, ed. Merck Manual Professional Version. Updated December 2024. Accessed September 22, 2025. https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/atrial-fibrillation