How can atrial fibrillation (AF) be controlled?

Medication

If you have been diagnosed with atrial fibrillation, then it is likely that you will be advised to start medication. The aims of medication are:

Treat the AF by either controlling the heart rate or restoring the heart to a normal rhythm
Reduce the risk of complications by thinning the blood

There are a number of medications that can act in different ways. Some people need more than one medication and finding what’s right for you can take time. All medication can have side effects. Your healthcare team will work with you to find the right combination that balances potential side effects with the benefits of particular treatments.

Rate Limiting Drugs

These drugs are used to control how fast the heart is beating. Beta-blockers, calcium channel blockers, and digoxin are the most commonly used. Most people get on well with these drugs. Occasionally, they can cause breathlessness or tiredness. There are a number of options within these families of drugs. Talk to your healthcare team if you are noticing side effects as it is often possible to try different alternatives.

Rhythm control drugs

These drugs are used to get the heart back into a normal rhythm and keep it there. You either take them every day or, if you know when your heart flips into AF, they can be taken “as needed” to get the heart to flip back out of AF. Fleicanide and amiodarone are the commonest rhythm control drugs. There are some risks associated with taking these medications; the doctor will discuss this in detail with you before starting any treatment.

Summary of some of the medications used to treat AF

Type of medicine	How do they work?
Beta-blockers (eg Bispoprolol, Atenolol)	Slow the heart
Calcium channel blockers (eg Diltiazem, Verapamil)	Slow the heart
Digoxin	Slow the heart
Fleicanide	Restores / maintains normal rhythm
Amiodarone	Restores / maintains normal rhythm
Dronedarone	Restores / maintains normal rhythm

Blood thinning drugs (anticoagulation)

When you are diagnosed with AF, your doctor will work out your risk of blood clots. If you are at risk, your doctor will talk to you about the risks and benefits of blood thinning medication (anticoagulants). Anticoagulant drugs slow down but do not totally stop your blood from clotting. The main risk of anticoagulation is bleeding. For the majority of people the benefit of reducing the risk of clots is much greater than the small risk of bleeding.

There are two types of blood thinning tablets used:

“Novel” or “New” anticoagulants (also known as “NOACs”)

e.g Dabigatran, rivaroxaban, apixaban, edoxaban

Most commonly used
Must be taken at the same time each day
No need for monitoring with blood tests

Warfarin

Less commonly used
Needs monitoring with blood tests
Can affect and be affected by many other drugs

Non-drug treatments

For some people, drug treatment either doesn’t work or causes problematic side effects. If this is the case, there are other possible treatments. These treatments are provided by specialist cardiology teams who advise on which treatment is appropriate for whom.

Cardioversion

Cardioversion is when an electric shock is given to the heart through special sticky pads placed on the front of the chest. People having cardioversion are either given a general anaesthetic (i.e. completely asleep) or sedated, so it is entirely pain-free.

Catheter ablation

Catheter ablation is when a long electrical wire is put into a vein via a plastic tube. The wire is then pushed through to the heart itself and used to eliminate the abnormal electrical activity within the heart that causes AF.

Healthy Living

In addition to medication, there are also things that you can do with your diet and lifestyle which can help reduce the symptoms and complications associated with AF.

Healthy Eating

Eating a healthy diet will lower your risk of all cardiovascular diseases, reducing your risk of AF. In addition, some particular things are worth thinking about if you have AF, including paroxysmal AF:

	Vitamin K – if you take Warfarin, it is important to be aware of the amount of Vitamin K in your diet. Vitamin K can have an effect on blood clotting, affecting the dose of warfarin that you need. Your healthcare team can advise you on which foods contain Vitamin K.
	Meal size – large meals can trigger episodes of AF. In addition, being mindful of portion size can help achieve and maintain a healthy weight.
	Tea and coffee – caffeine in tea and coffee can increase the heart rate or set off AF in some people. Try not to drink more than 3 cups a day or consider swapping to decaffeinated tea and coffee.
	Salt – reducing your salt intake helps with blood pressure, meaning less strain on the heart. You should have less than 1 teaspoon of salt a day.
	Chocolate – some people find that chocolate can set off AF.
	Blood fats – eating a diet that helps reduce blood fats, especially cholesterol, protects against coronary heart disease which can cause AF.
	Triggers in you – if you have AF that comes and goes, it is worth having a think about whether there are particular foods that will start your AF. Cheese, processed meats and pickles are all examples of foods that can trigger AF.

Physical Activity

All forms of physical activity and exercise help to keep your heart and you healthy. Having atrial fibrillation should not be a barrier to doing physical activity. Your doctor will be able to advise on any limitations or changes that you may need to make. It is important to speak to your doctor if you are thinking of taking up exercise that is new or more strenuous than you are used to.

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