How can an irregular heart rhythm be treated?

Slow down the heart beat or restore the heart’s natural rhythm? This is the first question that has to be answered when treating atrial fibrillation. 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 catheter 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 atrial fibrillation or if it has only recently been diagnosed. More recent study data show that if the atrial fibrillation 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:

• If the atrial fibrillation has a treatable cause such as overactive thyroid, but has not disappeared after treatment of that cause,
• if the atrial fibrillation is causing acute, severe circulatory problems,
• if the high pulse is already damaging the heart muscle and weakening the heart,
• if there are no other medical conditions,
• in young people with atrial fibrillation,
• if people prefer rhythm control to treat their atrial fibrillation for personal reasons.

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, atrial fibrillation commonly returns in the long term.

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.