What should you not do if you have atrial fibrillation?

The treatment of atrial fibrillation (AF) varies from person to person and depends on:

• the type of atrial fibrillation 
• symptoms 
• treatment of any underlying cause
• age
• overall health

Some people may be treated by their GP, whereas others may be referred to a cardiologist.

Finding an underlying cause

The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, treatment for this may be enough.

For example, medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation.

If there is no underlying cause found

If no underlying cause of the atrial fibrillation can be found, the treatment options are:

• medicines to control atrial fibrillation
• restoring a normal heart rhythm
• medicines to reduce the risk of a stroke
• cardioversion (a controlled electrical shock to reset the heart rhythm)
• catheter ablation
• having a pacemaker fitted

You can find out more about each of these below.

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
• 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

There are a number of drugs that can be used to try to restore a normal heart. The best option for you will be decided by your cardiologist and /or GP. 

Commonly, these drugs include:

• flecainide 
• beta-blockers
• amiodarone 

Dronedarone may also be used for certain people.

It is important you know what side effects to look out for if taking such medication and seek medical advice if you experience any of them. 

To find out about side effects, read the patient information leaflet that comes with your medicine for more details. 

Medicines to reduce the risk of a stroke

The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (our complications of atrial fibrillation section has more information on this).

Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:

You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk.

Depending on your level of risk, you may be prescribed warfarin.

Anticoagulants

Anticoagulants help to reduce the risk of stroke in patients with atrial fibrillation. Newer anticoagulants like apixaban, dabigatran, edoxaban and rivoroxaban are now more commonly used than warfarin. They do not require dose changes and continuous blood test monitoring.

Warfarin may still be used in patients who can't be treated with a newer anticoagulant, or in those patients with other conditions where treatment with warfarin is preferred.

Cardioversion

Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm.

The procedure normally takes place in hospital with heavy sedation or anaesthetic and careful monitoring.

In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke.

If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke.

Catheter ablation

Catheter ablation is a procedure that very carefully interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated.

Catheters (thin, soft wires) are guided through one of your veins into your heart where they record electrical activity.

When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue.

This procedure commonly takes two to three hours, so it may be done under general anaesthetic, where you are put to sleep.

Find out more about catheter ablation for atrial fibrillation on the Arrhythmia Alliance website

Having a pacemaker fitted

A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone.

It will not cure, reverse or actively treat your atrial fibrillation. 

A pacemaker provides beats where your heart is not supplying its own. If your heart beat is very slow the pacemaker will override this and pace at a set rate. If there are significant pauses between your heart beats beats, the pacemaker will supply a beat, acting as a 'safety net'.

Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed).

Atrial fibrillation, or afib, is an abnormal rhythm of the upper chambers of the heart that causes the heart to beat much faster than normal. This creates an irregular heartbeat ( arrhythmia), and if not managed properly, can lead to a stroke and other heart-related problems. In the United States, 6 to 16 million people are projected to have this condition by 2050, according to a review published in June 2020 in Circulation Research.

The good news is that lifestyle factors can play a big role in helping you manage the afib.

“The main issue is calories and alcohol,” says Hugh Calkins, MD, a professor of cardiology at John Hopkins Medicine in Baltimore. “Many patients with afib are obese, and if you can get the weight off, that helps control the afib.”

Check out these do and don’t tips for managing afib.

Do Follow a Healthy Diet

“There really isn’t a special diet for afib patients,” says Kelly Kennedy, RDN, the resident dietitian at Everyday Health. “Instead, healthcare professionals often recommend that people follow a general healthy diet.”

A healthy diet includes foods like fruits, vegetables, lean proteins, whole grains, beans, and seeds. Nuts are also a good choice. A study published in April 2018 in the journal Heart found that people eating nuts three or more times a week lowered their chances of getting afib.

Kennedy notes there is also increasing evidence that a plant-based diet is beneficial for people with afib. A review published in November 2019 in the Journal of Arrhythmia concluded that a plant-based diet may help reduce risk factors (high blood pressure, obesity, and diabetes) associated with afib and is worth further investigation.

For those who are intimidated by a plant-based diet, Kennedy says it doesn’t have to be a monumental lifestyle shift.

“You don’t have to be vegetarian or vegan,” she says. “Just eat more plants.”

Don’t Drink Too Much Caffeine — Drink Moderately

If you have afib, you might want to cut down on the number of caffeinated drinks you chug. Drinking too much caffeine can speed up your heart and increase the frequency of premature heartbeats, which can be a problem. The good news is that you don’t have to give up your morning java or caffeinated tea entirely, just remember to drink in moderation.

In the largest study of its kind, a study published in July 2021 JAMA Internal Medicine found that caffeine didn't seem to increase a person’s risk of arrhythmia.

“It’s another study that says caffeine is not linked to afib,” says Dr. Calkins. “While there can be a patient triggered with a cup of coffee, if you ask me if I recommend that the typical afib patient has to restrict their caffeine intake, the answer is no.”

Do Watch Your Salt Intake

Eating too much salt can raise your blood pressure, putting you at greater risk for afib. Like caffeine, how much salt you eat depends on the individual. In fact, a study published May 2021 in the Journal of Internal Medicine found that salt intake did not affect afib levels to the point of having to cut down on salt in the diet.The study did have contradicting results between genders and needs further investigating.

But Calkins says that if a person has hypertension or sleep apnea along with afib, reducing salt intake can make a big difference.

Although salt is in a lot of foods we eat, there are many ways you can cut back on salt. For example, you can use salt-free seasonings to flavor your food or eat fewer processed foods. You should also avoid what the American Heart Association has deemed the "Salty Six" — foods like pizza, soups, burritos, and tacos that add the most salt to your diet.

Don’t Be a Frozen Food Snob

“In the past, frozen fruits and vegetables have gotten a bad reputation for not being as good as fresh foods,” says Kennedy. “What people don’t realize is that frozen fruits and vegetables often have a higher nutritional value than their fresh counterparts.”

That’s because frozen fruits and vegetables are often picked closer to the time when they’re ripe and then flash frozen shortly after. This helps preserve nutrients. In contrast, fresh fruits and vegetables are often picked early because they have to travel long distances to make it to grocery stores. By the time they get to the stores, some of the nutrients have been lost.

Do Stay Hydrated

Many people are unaware that being dehydrated can trigger afib, notes Kennedy. That’s why it’s important to drink enough water and fluids throughout the day. “It’s especially important for afib patients to pay attention to their potassium and magnesium intake,” says Kennedy.

Potassium and magnesium are electrolytes. When you have low levels of minerals in the blood (electrolytes), it can trigger an abnormal heart rhythm. And when you’re dehydrated, electrolytes can get depleted. Kennedy notes that the best way to get potassium and magnesium is from food (rather than supplements). Foods that are rich in potassium include fruits, vegetables, and fish. Magnesium can be found in foods like whole grains, beans, nuts, fortified breakfast cereals, and green leafy vegetables such as spinach.

Regarding water that claims to have health benefits, like alkaline water, Kennedy says to save your money. There isn’t any evidence that proves it can help with afib — a regular glass of water will do the trick.

Don’t Forget to Watch Your Calories, Especially if You Want to Shed Extra Pounds

“The data linking afib and weight is really extraordinary,” says Calkins. “The remarkable thing is, if you get the weight off, to a large degree strands of fat go away, the inflammation dies down, chambers get smaller, the pressures go down, and your afib becomes less.”

But losing weight isn’t always easy. For many people, tracking what they eat on a regular basis helps them reach their weight loss goals. This can be done by simply writing down what you eat each day. Or, if you prefer tracking what you eat on your phone or a website, check out Lose It!, Fooducate, or MyFitnessPal. All have smartphone apps that are available at the App Store and Google Play.

“The single most important trigger for afib is obesity, but it's also the thing people have the hardest time addressing,” he says.

Do See a Registered Dietitian

“Anyone can benefit from seeing a registered dietitian,” says Kennedy, noting that people who have been recently diagnosed with afib or those with multiple health conditions such as afib and diabetes may want to work with a dietitian. That’s because different health conditions have different food considerations. And that can make meal planning complicated.

Kennedy notes that another good time to consider seeing a dietitian is when your medications have been changed. For example, people who take blood thinners like warfarin need to be mindful of eating foods rich in vitamin K, like kale and spinach.

You can find a dietitian through your health insurance company or professional organizations like the Academy of Nutrition and Dietetics.

Don't Drink Too Much Booze

Alcohol has been shown to be a major trigger of afib. A study published in January 2022 in Nature Cardiovascular Research suggests that binge or excessive drinking is linked with an increased risk of an episode of afib, even in people without a previous episode.

“Over the last five years, there are more and more studies linking moderate amounts of alcohol, even a glass of wine or a beer, to increasing your risk of having afib,” says Calkins. “Some people are very sensitive to alcohol.”

Kennedy says that quitting alcohol can be difficult for some, so it’s important to strive for progress, not perfection. Monitor your symptoms, and if alcohol is a trigger, eliminating it will make a bigger difference for you than it would somebody else.