Written and medically reviewed by Dorcas Morak, Pharm.D
September is Atrial Fibrillation Awareness Month, a fitting time to talk about a heart rhythm condition that affects millions of Americans and is expected to affect approximately 12 million people by 2030. AFib often goes unnoticed until it causes serious complications like a stroke. The good news is that atrial fibrillation is highly treatable, and understanding your symptoms, risk factors, and treatment options can help protect your heart and overall health.
What Is Atrial Fibrillation (AFib)?
Atrial fibrillation (AFib) is an irregular, often rapid heart rhythm caused by disorganized electrical signals in the heart's upper chambers (the atria). Instead of contracting normally, the atria quiver or fibrillate, allowing blood to pool and potentially form blood clots. If a clot travels to the brain, it can cause a stroke.
What Causes Atrial Fibrillation?
AFib develops when the heart's electrical system doesn't function normally. While the exact cause isn't always known, several conditions and lifestyle factors can increase the risk, including:
- High blood pressure
- Coronary artery disease
- Heart valve disease
- Heart failure
- Diabetes
- Thyroid disorders, particularly an overactive thyroid (hyperthyroidism)
- Obesity
- Obstructive sleep apnea
- Heavy alcohol consumption
- Smoking
- Increasing age
- Family history of atrial fibrillation
Managing these underlying conditions may help reduce the frequency of AFib episodes.
Common Symptoms of Atrial Fibrillation
Some people experience noticeable symptoms, while others have no symptoms at all and only discover they have AFib during a routine exam.
Common symptoms include:
- Heart palpitations or a racing, fluttering heartbeat
- Fatigue
- Shortness of breath
- Dizziness or lightheadedness
- Chest discomfort
- Weakness
- Reduced ability to exercise
Because AFib can occur without symptoms, regular checkups and pulse checks become increasingly important as you get older, especially after age 65.
Seek emergency medical attention immediately if you experience chest pain, fainting, severe shortness of breath, or signs of a stroke such as sudden facial drooping, arm weakness, difficulty speaking, or sudden vision changes.
Why Atrial Fibrillation Increases Stroke Risk
When blood pools inside the quivering atria, it can form clots that may travel to the brain and cause a stroke. People with AFib have approximately a fivefold higher risk of stroke than those without the condition, making stroke prevention one of the primary goals of treatment.
How Is Atrial Fibrillation Diagnosed?
Doctors commonly diagnose AFib using an electrocardiogram (ECG or EKG), which records the heart's electrical activity. Because AFib may come and go, additional testing may include:
- Holter monitor (continuous heart rhythm monitoring)
- Event monitor for intermittent symptoms
- Echocardiogram to evaluate heart structure and function
- Blood tests to identify conditions such as thyroid disorders that may contribute to abnormal heart rhythms
Who Needs Blood Thinners for AFib?
Doctors commonly use the CHA2DS2-VASc score, which considers factors such as age, high blood pressure, diabetes, heart failure, vascular disease, and previous stroke, to estimate an individual's stroke risk. Patients with higher scores are generally more likely to benefit from anticoagulant (blood thinner) therapy.
Best Blood Thinners for Atrial Fibrillation
Direct oral anticoagulants (DOACs) are the preferred treatment for most people with non-valvular AFib because they are effective and typically do not require routine blood monitoring. Examples include:
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Edoxaban (Savaysa)
Some patients, including those with mechanical heart valves or certain types of valve disease, may still require warfarin (Coumadin), which requires regular blood testing to ensure the dose remains safe and effective.
Medications That Control Heart Rate and Heart Rhythm
In addition to preventing stroke, treatment often focuses on controlling how fast the heart beats or restoring a normal heart rhythm.
Rate-control medications help slow the heart rate and may include:
- Metoprolol (Lopressor)
- Atenolol (Tenormin)
- Diltiazem (Cardizem)
- Verapamil (Calan)
Rhythm-control medications help restore and maintain a normal heart rhythm and may include:
- Amiodarone (Pacerone)
- Flecainide
- Propafenone (Rythmol)
- Sotalol (Betapace)
- Dofetilide (Tikosyn)
Your healthcare provider will recommend the most appropriate medication based on your symptoms, overall health, and other medical conditions.
Procedures That Treat Atrial Fibrillation
When medications do not adequately control symptoms, other treatments may be recommended.
Catheter ablation uses heat or cold energy to destroy the areas of heart tissue responsible for abnormal electrical signals. It can significantly reduce AFib episodes and improve quality of life for many patients.
For people who cannot safely take long-term blood thinners because of bleeding risk, left atrial appendage closure devices, such as the Watchman™ device, may reduce stroke risk by preventing blood clots from forming in the part of the heart where they most commonly develop.
Lifestyle Changes That Can Help Manage AFib
Healthy lifestyle habits play an important role in managing atrial fibrillation and reducing future episodes. Helpful strategies include:
- Maintaining a healthy weight
- Keeping blood pressure under control
- Managing diabetes
- Limiting alcohol consumption
- Avoiding tobacco products
- Treating obstructive sleep apnea
- Staying physically active with your healthcare provider's guidance
- Managing stress and getting adequate sleep
These changes may improve symptoms and complement your medical treatment plan.
Can Atrial Fibrillation Be Cured?
While some people remain free of AFib after catheter ablation, atrial fibrillation is often considered a chronic condition that requires ongoing management. Treatment focuses on controlling symptoms, lowering stroke risk, and improving quality of life. Regular follow-up appointments help ensure your treatment plan continues to meet your needs.
How Much Do AFib Medications Cost?
Medication costs vary considerably depending on the drug and whether a generic version is available.
Brand-name anticoagulants such as Eliquis and Xarelto may cost several hundred dollars per month without insurance. In contrast, generic medications such as metoprolol, diltiazem, warfarin, or atenolol are often available at much lower prices.
Because prices can vary significantly between pharmacies, comparing prescription costs on the RxLess® app before filling your medication may help reduce out-of-pocket expenses.
Save Money on AFib Medications
Managing atrial fibrillation often involves taking an anticoagulant along with one or more medications to control heart rate or heart rhythm, making prescription costs an ongoing expense.
Before filling your prescription, compare prices with the RxLess® Assurance Plan to see if another nearby pharmacy offers a lower cost. Simply download the free RxLess® app from the Apple App Store or Google Play to automatically become a member.
Important: Always take AFib medications exactly as prescribed. Never stop taking a blood thinner or heart medication without first speaking with your healthcare provider, as doing so may significantly increase your risk of stroke or other serious complications.
