AFib Treatment: Medications, Ablation, and Heart Arrhythmia Management

Medications for AFib and Atrial Fibrillation

Medications are often the first line of treatment for AFib and other atrial arrhythmias. The main goals are to control heart rate, restore normal rhythm, and reduce the risk of blood clots.

1. Rate Control Medications

These drugs help slow the heart rate, making symptoms more manageable:

Beta blockers (e.g., metoprolol, atenolol, propranolol)

Calcium channel blockers (e.g., diltiazem, verapamil)

Digoxin (especially for patients with heart failure or low blood pressure)

2. Rhythm Control Medications (Antiarrhythmics)

These medications aim to restore and maintain a normal heart rhythm:

Sodium channel blockers (e.g., flecainide, propafenone)

Potassium channel blockers (e.g., amiodarone, sotalol, dofetilide, dronedarone)

3. Anticoagulants (Blood Thinners)

AFib increases the risk of stroke due to blood clots forming in the heart. Blood thinners are prescribed to reduce this risk:

Direct-acting oral anticoagulants (DOACs): apixaban, rivaroxaban, dabigatran, edoxaban

Warfarin (requires regular blood tests)

Heparin (used during certain procedures)

Aspirin (rarely, for select patients)

How does ablation therapy compare to medication for AFib management

Ablation therapy is generally more effective than medication in managing atrial fibrillation (AFib), particularly for maintaining normal heart rhythm, reducing AFib recurrence, and improving quality of life. Multiple large-scale studies and meta-analyses have shown that catheter ablation offers significant advantages over drug therapy, especially for patients who remain symptomatic despite optimal medical management

Tests to diagnose atrial fibrillation

Blood tests. Blood tests are done to look for health conditions or substances that may affect the heart or heartbeat.

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which prints or displays the test results. An ECG can show the heart rhythm and how slow or fast the heart is beating. It's the main test for diagnosing atrial fibrillation.

Holter monitor. This small, portable ECG device records the heart's activity. It's worn for a day or two while you do your regular activities.

Event recorder. This device is like a Holter monitor, but it records only at certain times for a few minutes at a time. It's typically worn for about 30 days. You usually push a button when you feel symptoms. Some devices automatically record when an irregular heart rhythm is detected.

Implantable loop recorder. This device records the heartbeat continuously for up to three years. It's also called a cardiac event recorder. The device shows how the heart is beating while you do your daily activities. It may be used to see how often you have an AFib episode. Sometimes it's used to find rare episodes of AFib in those at high risk of the heart problem. For example, you may need one if you've had an unexplained stroke.

Echocardiogram. Sound waves are used to create images of the beating heart. This test can show how blood flows through the heart and heart valves.

Exercise stress tests. These tests often involve walking on a treadmill or pedaling a stationary bike while the heart is monitored. The tests show how the heart reacts to exercise. If you can't exercise, you may be given medicine that increases the heart rate like exercise does. Sometimes echocardiogram is done during a stress test.

Chest X-ray. A chest X-ray shows the condition of the lungs and heart.

Diagnosis to diagnose atrial fibrillation

You may not know you have atrial fibrillation (AFib). The condition may be found when a health checkup is done for another reason.

To diagnose AFib, the health care provider examines you and asks questions about your medical history and symptoms. Tests may be done to look for conditions that can cause irregular heartbeats, such as heart disease or thyroid disease