Treatments for atrial fibrillation include medicines to control heart rate and reduce the risk of stroke, and procedures to restore normal heart rhythm. It may be possible for you to be treated by a GP, or you may be referred to a heart specialist (a cardiologist).

Some cardiologists, known as electrophysiologists, specialise in the management of abnormalities of heart rhythm. You'll have a treatment plan and work closely with your healthcare team to decide the most suitable and appropriate treatment for you. Factors that will be taken into consideration include:

• your age
• your overall health
• the type of atrial fibrillation you have
• your symptoms
• whether you have an underlying cause that needs to be treated

The first step is to try to find the cause of the atrial fibrillation. If a cause can be identified, you may only need treatment for this. For example, if you have an overactive thyroid gland (hyperthyroidism), medicine to treat it may also 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

You'll be quickly referred to your specialist treatment team if one type of treatment fails to control your symptoms of atrial fibrillation and more specialised management is needed.

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, any 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 medicines are available to restore normal heart rhythm, including:

• flecainide
• beta blockers, particularly sotalol

An alternative medicine may be recommended if a particular medicine does not work or the side effects are troublesome.

Controlling the rate of the heartbeat

The aim is to reduce your heart rate to less than 90 beats per minute when you are resting. A beta blocker, such as bisoprolol or atenolol, or a calcium channel blocker, such as verapamil or diltiazem, will be prescribed. The medicine you'll be offered will depend on what symptoms you're having and your general health.

A medicine called digoxin may be offered if other drugs are not suitable. If one medicine is not controlling your symptoms, you may be offered another alongside it.

Side effects

As with any medicine, anti-arrhythmics can cause side effects. The most common side effects of anti-arrhythmics are:

• beta blockers – tiredness, cold hands and feet, low blood pressure, nightmares and impotence
• flecainide – feeling sick, being sick and heart rhythm disorders
• 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's a risk of blood clots forming in the heart chambers. If these enter the bloodstream, they can cause a stroke. Your doctor will assess and discuss your risk with you, and try to minimise your chance of having a stroke.  They'll 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 (hypertension)
• diabetes
• heart disease

If you're prescribed an anticoagulant, your doctor will assess and discuss your risk of bleeding with you both before you start the medicine and while you're taking it.

Cardioversion

Cardioversion may be recommended for some people with atrial fibrillation. It involves giving the heart a controlled electric shock to try to restore a normal rhythm. Cardioversion is usually carried out in hospital so the heart can be carefully monitored. If you have had atrial fibrillation for more than 2 days, cardioversion can increase the risk of a clot forming.