Atrial fibrillation, often called A-fib, is a type of irregular heartbeat (arrhythmia) that can lead to serious health problems, including blood clots, stroke, heart failure, and other complications. In a healthy heart, the upper and lower chambers beat in a steady, coordinated rhythm to pump blood efficiently. In A-fib, the upper chambers (atria) quiver or beat irregularly, disrupting this rhythm and affecting normal blood flow.

When blood isn’t pumped effectively from the atria, it can begin to pool and form clots. As a result, you might feel symptoms such as fatigue, lightheadedness, or dizziness. Your heart may also feel like it’s fluttering, pounding, skipping beats, or beating too fast or too hard.

In some cases, A-fib resolves on its own. For others, it becomes a chronic condition that worsens over time. Episodes may grow more frequent and last longer. If left untreated, restoring a normal rhythm becomes increasingly difficult. Managing this condition involves a combination of treatments designed to stabilize heart rhythm, control symptoms, and reduce the risk of complications.

Lifestyle changes

To support treatment and reduce symptoms, healthcare providers often recommend healthy lifestyle changes. A cardiologist or primary care provider may advise you to:

  • maintain a healthy weight: Obesity increases the risk and severity of A-fib. Achieving a weight that suits your health can lower your risk.

  • stay physically active: Regular physical activity, such as 30 minutes of movement daily, supports heart health.

  • manage stress: Practices like yoga, meditation, journaling, or hobbies can reduce stress and help regulate your heart rhythm.

  • eat a heart-healthy diet: Diets such as the DASH diet are recommended to reduce salt intake and support blood pressure control.

  • control blood pressure: High blood pressure raises the risk of A-fib. Managing it through lifestyle changes or medications is essential.

  • regulate cholesterol levels: Reducing saturated fats and eating more fiber can help lower your cholesterol.

  • limit alcohol use: Alcohol can trigger A-fib episodes. Cutting back may improve your symptoms.

  • quit smoking: Tobacco use damages heart function. Quitting can be difficult, so support from healthcare providers or quitlines is helpful.

If lifestyle changes alone aren’t enough, your provider may recommend medications or procedures.

Medications

Several types of medications help manage A-fib by controlling heart rate, rhythm, and reducing the risk of clots or stroke.

blood thinners

To lower the risk of strokes caused by clots, doctors often prescribe antiplatelets or anticoagulants (blood thinners). While they prevent harmful clots, they can also increase the risk of bleeding, including internal bleeding.

watch for serious symptoms such as:

  • Vomiting blood

  • Dark or bloody stools

  • Sudden severe headaches

  • Head injuries

Other bleeding signs include nosebleeds, blood in urine, or joint bleeding. If you have liver or kidney issues, a history of bleeding, or use certain medications like aspirin, your bleeding risk may increase. Alcohol use can also heighten this risk.

Over-the-counter NSAIDs like ibuprofen can interact with blood thinners, so always consult your provider before using them.

heart rate medications

To regulate heart rate, your provider may prescribe:

  • beta-blockers: Lower heart rate and blood pressure. Side effects can include fatigue, dizziness, constipation, and slow heart rate.

  • calcium channel blockers: Help reduce heart rate. Common side effects include headaches, constipation, and lightheadedness.

  • digoxin (Lanoxin): Slows the electrical signals between the atria and ventricles. It can cause nausea or vomiting, and in rare cases, lead to digoxin toxicity.

heart rhythm medications

Once heart rate is under control, the focus shifts to rhythm. Medications that help restore and maintain normal rhythm include:

  • sodium channel blockers: Slow down electrical activity in the heart.

  • potassium channel blockers: Help regulate rhythm by delaying electrical impulses.

Non-surgical procedures

If medications and lifestyle changes are not enough, your provider may recommend procedures to restore heart rhythm.

electrical cardioversion

This involves delivering an electric shock to the chest under mild anesthesia to reset the heart’s rhythm. While effective, A-fib may return, requiring ongoing anti-arrhythmia medications to maintain rhythm.

catheter ablation

This procedure targets and destroys small areas of heart tissue causing the irregular rhythm. Although effective for many, A-fib may return, especially in the weeks following the procedure. In some cases, multiple ablations or a pacemaker may be needed. Risks include bleeding, infection, or stroke.

Surgery

If other treatments fail, surgery may be an option.

pacemakers

A pacemaker is a small device implanted under the skin to help regulate heart rhythm. It's typically used when A-fib causes a slow heart rate or in cases of other arrhythmias. If a pacemaker is implanted, blood thinners are usually prescribed to reduce stroke risk.

maze heart surgery

This involves making small incisions in the upper heart chambers. As these cuts heal, they form scar tissue that blocks the irregular electrical signals causing A-fib. Maze surgery is often performed during open-heart procedures for other conditions.

left atrial appendage closure

This procedure seals or removes a small sac in the left atrium where clots often form. It's typically performed when blood thinners aren't suitable, and it can be done alongside ablation or other heart surgeries.

Living with and managing atrial fibrillation

People with A-fib often require long-term management and may face recurring hospital visits or complications related to medications, especially blood thinners. Stroke remains a serious risk, but consistent use of medication and monitoring can help reduce it.

A-fib may also lead to heart failure and other cardiovascular issues. Management involves regular follow-ups, lifestyle adjustments, and individualized care. Everyone’s experience with A-fib is unique, and treatment plans are personalized to support long-term health and quality of life.

A quick review

Atrial fibrillation (A-fib) is an irregular heart rhythm that disrupts blood flow and increases the risk of stroke and other complications. Treatment involves a combination of lifestyle changes, medications, procedures, and sometimes surgery. With the right care, many people with A-fib can manage their condition and lead a full, active life.