What causes and treats atrial fibrillation (AFib)?

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Last updated: June 2, 2025 • View editorial policy

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From the Guidelines

Atrial fibrillation (AFib) is primarily caused by a combination of factors including heart disease, high blood pressure, age, obesity, sleep apnea, thyroid problems, excessive alcohol consumption, and family history, with the most recent evidence suggesting that altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress also play a significant role 1.

Causes of AFib

The causes of AFib can be divided into several categories, including:

  • Heart disease, such as coronary artery disease, heart failure, and valvular heart disease
  • High blood pressure
  • Age, with the risk increasing significantly after the age of 65
  • Obesity
  • Sleep apnea
  • Thyroid problems, such as hyperthyroidism
  • Excessive alcohol consumption
  • Family history of AFib

Treatment of AFib

Treatment of AFib typically involves a dual approach of rate control and rhythm control.

  • Rate control medications include beta blockers (metoprolol 25-200mg daily, carvedilol 3.125-25mg twice daily), calcium channel blockers (diltiazem 120-360mg daily, verapamil 120-360mg daily), and digoxin (0.125-0.25mg daily) 1.
  • Rhythm control may involve antiarrhythmic drugs like amiodarone (200mg daily after loading), flecainide (50-200mg twice daily), propafenone (150-300mg three times daily), or sotalol (80-160mg twice daily) 1.

Prevention of Stroke

Blood thinners are crucial to prevent stroke, with options including warfarin (dose adjusted to INR 2-3), apixaban (5mg twice daily), rivaroxaban (20mg daily), dabigatran (150mg twice daily), or edoxaban (60mg daily) 1.

Procedures and Lifestyle Modifications

Procedures like cardioversion (electrical shock to reset rhythm), catheter ablation (scarring problematic heart tissue), or the Maze procedure (surgical creation of scar tissue) may be necessary for persistent cases. Lifestyle modifications are also important, including reducing alcohol, managing stress, treating sleep apnea, and maintaining healthy weight. AFib occurs when disorganized electrical signals cause the heart's upper chambers to quiver instead of contracting effectively, leading to poor blood flow and potential clot formation. The most recent evidence suggests that drug-induced atrial fibrillation is a significant concern, with many cardiovascular, non-cardiovascular, and anticancer drugs potentially causing or exacerbating the risk of developing AFib 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Causes of Atrial Fibrillation (AFib)

  • Atrial fibrillation is the most common arrhythmia in the general population and is frequently associated with organic heart disease 2.
  • The condition can be caused by various pathophysiological processes, including electrical, structural, and autonomic remodeling of the atria 3.
  • AFib is associated with a twofold increase in premature mortality, and major adverse cardiovascular events such as heart failure, severe stroke, and myocardial infarction 4.

Treatment of Atrial Fibrillation (AFib)

  • Beta-blockers, such as metoprolol, are effective in maintaining sinus rhythm and controlling the ventricular rate during atrial fibrillation 2.
  • The combination of flecainide and metoprolol has been shown to reduce AFib clinical recurrences and improve tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation 5.
  • For rate control in patients with AFib and rapid ventricular response, calcium channel blockers and β-blockers are effective options, with diltiazem likely achieving rate control faster than metoprolol 6.
  • AV-nodal conduction-slowing drugs, such as calcium channel antagonists and beta-blockers, are used to control the ventricular rate during atrial fibrillation 2.

Mechanisms of Atrial Fibrillation (AFib)

  • The mechanisms of AFib involve complex electrophysiological and structural changes within the left atrium, as well as genetic and environmental factors 4.
  • Remodeling in AFib can be grouped into three categories: electrical remodeling, structural remodeling, and autonomic remodeling 3.
  • These changes contribute to creating an AFib-prone substrate that can produce AFib-associated electrical phenomena, including a rapidly firing focus, complex multiple reentrant circuit, or rotors 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Use of beta-blockers in atrial fibrillation.

American journal of cardiovascular drugs : drugs, devices, and other interventions, 2002

4
Research

Mechanisms of atrial fibrillation.

Heart (British Cardiac Society), 2019

5
Research

Flecainide-metoprolol combination reduces atrial fibrillation clinical recurrences and improves tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2016

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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