Restoring a normal heart rhythm: the pros and cons

This treatment approach reduces the high pulse using medication. The aim is to reduce the heart’s workload and relieve symptoms such as palpitations (a pounding and racing heart). The resting heart rate is reduced to less than 110 beats per minute at first. This is typically done using beta blockers. If that isn’t enough to relieve the symptoms, doctors can try to lower the heart rate further, either by using a higher dose of the same medication or using additional medications. The aim of treatment isn't to reset the heart rhythm at first.

Reducing the pulse can already be enough to relieve the symptoms. If you still have symptoms despite a reduction in pulse, it can be a good idea to try to reset the rhythm of your heart.

The aim of this treatment is to try to restore the normal rhythm of the heart (the “sinus” rhythm), either with medication or by delivering controlled electric shocks to the heart. After cardioversion, people sometimes take medication to stabilize their heart rate (anti-arrhythmics) and ultimately prevent atrial fibrillation from recurring. A procedure known as catheter ablation may be considered too in certain situations, with the aim of further stabilizing the heartbeat.

But it isn’t always possible to prevent atrial fibrillation from returning. In about 50 to 70 out of 100 people, this irregular heart rate returns within three years despite having stabilizing treatment.

If treatment to reduce the pulse relieves the symptoms enough, that can be the treatment of first choice. Research has shown that treatment to reset the heart rhythm doesn't have any advantages in that case: It doesn't increase life expectancy or offer better protection from strokes.

It is important to know that neither of the two treatment approaches can completely prevent atrial fibrillation. If this irregular heart rate comes back, blood clots can form. Because of this, most people have to take anticoagulant medication as well (to prevent strokes), regardless of which of the two treatment approaches they choose.

There are two main reasons for only having treatment to reduce the heart rate:

• There are fewer check-up appointments because you take fewer medications.
• The risk of side effects is lower.

Resetting the heart rhythm (cardioversion) can relieve the symptoms a little better. So it's a treatment option for people who still have bothersome symptoms despite having had treatment to reduce their pulse. But cardioversion is more likely to cause side effects.

For this reason, many medical societies only recommend cardioversion if other treatments aren’t effective enough.

The decision about whether or not to have cardioversion treatment isn't a final decision: Your situation may change over time, leading to a change in treatment strategy.