Which AFib treatment is right for you?

Heart Health

by J. Brian DeVille, MD, FACC, FHRS

May 11, 2022

A diagnosis of atrial fibrillation (AFib) can be scary. But it’s a condition that affects millions of Americans and—thanks to advances in the field of electrophysiology—is manageable in the vast majority of cases. In fact, the question typically now is no longer, ‘can anything be done to manage it?’ But rather, ‘what is the best treatment approach?’

Any treatment strategy for AFib must address two factors. First, the abnormal heart rhythm and symptoms it causes (like dizziness, chest pain, fainting, etc.), and second, the increased risk of stroke. People living with AFib plus other risk factors such as high blood pressure or diabetes are at a 450-500% higher risk of stroke. 

The right treatment plan to address both factors is based on an array of individual variables: 

  • Age
  • Gender
  • Additional risk factors
  • Medical history
  • Presence of other cardiovascular conditions like heart failure

The most important consideration when determining a treatment is the type of AFib:

  • Paroxysmal – lasts a week or less and stops on its own
  • Short-lasting persistent – lasts longer than a week and less than a year
  • Longstanding persistent – lasts longer than a year


There are several medications that treat rhythm-related issues associated with AFib, with even more medications available to help manage stroke risk.

If you have short and infrequent AFib episodes (paroxysmal), you may be prescribed medication to take only on an as-needed basis—similar to a rescue inhaler for those with mild asthma. However, most people are prescribed medication to take on an ongoing basis at regular intervals to prevent an episode of AFib from occurring.

Some medications must initially be given in a hospital setting before transitioning home, while others can be prescribed in the doctor’s office. Here are some tips for working with your physician on choosing and using the best medication for your AFib:

  • Discuss the risks and benefits of each medication with your physician
  • Share both personal and family medical history, and any other potential risk factors
  • Adhere to all dosage and dose timing recommendations closely
  • Follow up with your physician’s office if you experience any side effects and for routine care

Because of the progressive nature of AFib, medications are often a starting point or used in conjunction with another therapy.

Catheter ablation

Catheter ablation is a minimally invasive procedure that uses wires and balloons threaded through tubes to isolate the tissue—usually in or around the pulmonary veins—causing AFib and cut the pathways that impact heart rhythm. An ablation procedure uses heat or extreme cold to neutralize the problematic area.

Catheter ablation is a safe procedure with a high rate of success (although success rates can vary based on the type of AFib). Because of this, unlike many medical procedures, it is not considered a “last resort” and is often a preferred method of treatment even in younger, healthier people with the goal of sparing them a lifetime of medication. 

However, ablation is not always used to attempt to cure AFib. For people with persistent or longstanding AFib, the goal of the procedure may simply be to better control it. This is referred to as a rate-control strategy rather than a rhythm-control strategy and is often used in conjunction with medication.

Surgical ablation

Rather than using access through the blood vessels in the leg, the surgeon makes small incisions between the ribs to perform the ablation from the outside of the heart. This creates scar tissue that, over time, will help normalize electrical flow in the heart and the heart’s rhythm.

While it can be used as a stand-alone procedure, it is more frequently performed in concert with another cardiovascular procedure such as bypass surgery, valve surgery or aneurysm repair.

Device therapy and beyond

People with persistent AFib that has led to a slower heart rate—or who are on medications that have slowed their heart rate—may need a pacemaker, a commonly used implant for people with AFib. Pacemakers help regulate the pace of the heart rhythm and are more likely to be used in those with congestive heart failure in addition to AFib.   

There are other therapies such as cardioversion, which uses electric shocks to restore a normal rhythm in certain people with AFib. There are also exciting new therapies currently in clinical trials that will further expand treatment options in the coming years.

Between what is already available and what is sure to come, you have more ways than ever before to keep your heart healthy—so you don’t have to skip a beat. For more ways to live well with AFib, click here.

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About the Author

J. Brian DeVille, MD, FACC, FHRS, is the co-medical director of electrophysiology for Baylor Scott & White Health. His professional interests include catheter ablation, pacemaker and ICD implantation and management, lead extraction, and clinical research in the areas of ablation and device management.

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