Treatment of atrial fibrillation varies from person to person, depending on factors including:

• the type of atrial fibrillation
• symptoms
• treatment of any underlying cause
• age
• overall health

Some people may be treated by their GP, whereas others may be referred to a heart specialist, known as a cardiologist.

The first step is to try to find the cause of the atrial fibrillation. If a cause is found, you may only need treatment for this.

For example, medication to correct hyperthyroidism (an overactive thyroid gland), if you have it, may cure atrial fibrillation.

If no underlying cause can be found, the treatment options are:

• medicines to reduce the risk of a stroke
• medicines to control atrial fibrillation
• cardioversion (electric shock treatment)
• catheter ablation
• having a pacemaker fitted

Medicines to control atrial fibrillation

Medicines called anti-arrhythmics can control atrial fibrillation by:

• restoring a normal heart rhythm
• controlling the rate at which the heart beats

The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, other medical conditions you have, side effects of the medicine chosen and how well the atrial fibrillation responds.

Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.

Restoring a normal heart rhythm

A variety of drugs are available to restore normal heart rhythm. These include:

• flecainide 
• beta-blockers, particularly sotalol
• amiodarone 
• dronedarone (only for certain people)

If a particular medicine does not work or the side effects are troublesome, another may be tried.

Newer medicines are in development but are not widely available yet.

Controlling the rate of the heartbeat

The aim is to reduce the resting heart rate to under 90 beats a minute, although in some people the target is under 110 beats a minute.

A beta-blocker (such as bisoprolol or atenolol) or a calcium channel blocker (such as verapamil or diltiazem) will be prescribed.

A medicine called digoxin may be added to help further control the heart rate. In some cases, amiodarone may be tried.

Normally just one medication will be tried before catheter ablation is considered.

Side effects

As with any medicine, anti-arrhythmics can cause side effects. Read the patient information leaflet that comes with the medicine for more details.

The most common side effects of anti-arrhythmics are:

• beta-blockers: tiredness, coldness of hands and feet, low blood pressure, nightmares and impotence
• flecainide: nausea, vomiting and heart rhythm disorders
• amiodarone: sensitivity to sunlight (high-protection sunscreen must be worn or skin covered up), lung problems, changes to liver function or thyroid function (regular blood tests can check for this) and deposits in the eye (these go away when treatment is stopped)
• verapamil: constipation, low blood pressure, ankle swelling and heart failure

Medicines to reduce the risk of a stroke

The way the heart beats in atrial fibrillation means there is a risk of blood clots forming in the heart chambers. If these enter the bloodstream, they can cause a stroke (see complications of atrial fibrillation for more information).

Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:

• stroke or blood clots
• heart valve problems
• heart failure
• high blood pressure
• diabetes
• heart disease

You may be given medication according to your risk. Depending on your level of risk, you may be prescribed warfarin or a newer type of anticoagulant, such as dabigatram, rivaroxaban or apixaban (see below).

Warfarin

People with atrial fibrillation who have a high or moderate risk of a stroke are usually prescribed warfarin, unless there is a reason they cannot take it.

Warfarin is an anticoagulant, which means it stops the blood from clotting. There is an increased risk of bleeding in people who take warfarin, but this small risk is usually outweighed by the benefits of preventing a stroke.

It's important to take warfarin as directed by the doctor. People on warfarin need to have regular blood tests and, following these, their dose may be changed.

Many medicines can interact with warfarin and cause serious problems, so check that any new medicines are safe to take with warfarin.

Whilst taking warfarin, do not drink more than three units of alcohol a day if you are a man or two units a day if you are a woman. It is also not safe to binge drink by saving up units to have on one day. Drinking cranberry juice can also affect your warfarin and is not recommended.

Read more about how warfarin interacts with other medicines.

Aspirin

Aspirin should not be prescribed as a way of preventing strokes caused by atrial fibrillation.

Newer anticoagulants

Rivaroxaban, dabigatran and apixaban are newer anticoagulants that may be used as an alternative to warfarin.

The National Institute for Health and Care Excellence (NICE) has approved these drugs for use in atrial fibrillation.

Compared to warfarin, rivaroxaban, dabigatran and apixaban do not have the same interactions with other medications, and don't require regular blood tests.

Cardioversion

Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm.

The procedure normally takes place in hospital, where the heart is carefully monitored.

In people who have had atrial fibrillation for more than two days, cardioversion can increase the risk of a clot forming. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke. In an emergency, pictures of the heart can be taken to check for blood clots and a cardioversion can be performed without going on medication first.

If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin after cardioversion if there is a high chance of their atrial fibrillation returning and they have a higher risk of a stroke (see above).

Catheter ablation

Having a pacemaker fitted

Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed).

This treatment may be used when medicines are not effective or are unsuitable. This tends to be in people aged 80 or older.

Find out more about pacemaker implantation.