How can an irregular heart rhythm be treated?

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Atrial fibrillation causes the heart to beat irregularly and too quickly. Some people only have to take medication to slow their heart rate down. But it can also be a good idea to restore the heart’s steady rhythm.

Atrial fibrillation causes two problems with the heart rhythm: Because the upper heart chambers (atria) beat uncontrollably (“fibrillate”), they send electrical signals to the lower heart chambers (ventricles) in irregular intervals. The ventricles are then not able to contract rhythmically and the heart beat is irregular. And many more signals reach the ventricles per minute than with a usual heart rhythm. The heart rate is then also too fast.

That can cause symptoms like a racing heart (palpitations), dizziness and weakness, and put long-term strain on the heart. These symptoms can be relieved by getting the heart back to its normal rhythm. There are two treatment approaches because there are two problems:

  • Rate control – the heart rate is slowed down: For some people, it can be enough to take medication to slow their heart down. Suitable medications for rate control include beta blockers. The heart then still beats irregularly, but no longer as quickly.
  • Rhythm control – the heart beats regularly again: The atrial fibrillations are stopped. The heart beats in its usual rhythm again (sinus rhythm), and more slowly. Restoring the sinus rhythm is called cardioversion. It can be done using bursts of electrical energy (electrical cardioversion), or with medications known as antiarrhythmic agents. There are a number of ways to stop the atrial fibrillations from coming back, including heart surgery known as catheter ablation.
Illustration: Ways of influencing the heart rhythm to treat atrial fibrillation

Rate control or rhythm control?

Slow down the heart beat or restore the heart’s natural rhythm? This is the first question that has to be answered when treating . Generally both approaches reduce symptoms such as palpitations, dizziness and weakness, improving quality of life. Rate control only involves taking medication, whereas special procedures like ablation are usually needed for rhythm control. The first step is often to try to slow the heart down, and this usually works. The heart may jump back to its normal rhythm by itself within 24 hours anyway. But if the symptoms don't get better after rate control, doctors recommend using rhythm control.

Doctors sometimes try to get the heart back into its normal sinus rhythm right away, especially if this is the first time someone has had or if it has only recently been diagnosed. More recent study data show that if the was diagnosed within the last twelve months, rhythm control can offer better protection from complications such as stroke and death than rate control.

Doctors also try rhythm control straight away if one or more of the following apply:

The main potential disadvantages of resetting the normal heart rhythm are the risks associated with the procedures and the generally limited chances of success: Although it is often possible to restore the normal heart rhythm through cardioversion, commonly returns in the long term.

What can help to make a decision?

Deciding which treatment is best depends on a number of factors. If you still have doubts after talking to your doctor and thinking things over, you can seek a second medical opinion.

Before doing so, it is important to be aware of the specific decision to be made, and then get detailed information about the advantages and disadvantages of the treatment options, that is to say rate control and the various rhythm control procedures.

Our decision aid “Atrial fibrillation: How can an irregular heart rhythm be treated?” briefly summarizes the key points. There you can make a note of what's especially important to you.

Atrial fibrillation: How can an irregular heart rhythm be treated?

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Virk SA, Bennett RG, Chow C et al. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients With Heart Failure: A Meta-Analysis of Randomised Controlled Trials. Heart Lung Circ 2019; 28(5): 707-718.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on March 30, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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