From the Guidelines

Atrial Fibrillation (AFib) treatment typically involves rate control therapy, rhythm control therapy, and anticoagulation.

Rate control therapy is recommended as initial therapy in the acute setting, as an adjunct to rhythm control therapies, or as a sole treatment strategy to control heart rate and reduce symptoms 1.
Beta-blockers, diltiazem, verapamil, or digoxin are recommended as first-choice drugs in patients with AF and LVEF >40% to control heart rate and reduce symptoms 1.
Rhythm control therapy is indicated for symptom improvement in patients with AF, and entails electrical or pharmacological cardioversion of AF in symptomatic patients with persistent or longstanding-persistent AF, long-term antiarrhythmic drug therapy, catheter ablation, AF surgery, ablation, and pacing 1.
Anticoagulation is recommended in all patients with documented AF/atrial flutter who have an increased risk of stroke, with the CHADS-VASc score used to evaluate stroke risk 1.

Atrioventricular node ablation combined with cardiac resynchronization therapy should be considered in severely symptomatic patients with permanent AF and at least one hospitalization for HF to reduce symptoms, physical limitations, recurrent HF hospitalization, and mortality 1.
Catheter ablation is a reasonable alternative to long-term antiarrhythmic drug therapy for maintaining sinus rhythm 1.
Antiarrhythmic drugs such as dronedarone, flecainide, propafenone, sotalol, or amiodarone are recommended for long-term antiarrhythmic drug therapy, with selection guided by safety and individual patient characteristics 1.

From the Research

The treatment for Atrial Fibrillation (AFib) can be categorized into two main strategies: rate control and rhythm control.

Rate control aims to modulate ventricular heart rate and prevent tachymyopathy, while rhythm control aims to restore and sustain sinus rhythm 2, 3.
Rate control can be achieved through drugs, such as atrioventricular nodal blocking agents, or ablation of the atrioventricular node, rendering the patient pacemaker-dependent 2, 3.
Rhythm control can be achieved through electrical cardioversion, pharmacological cardioversion, or catheter ablation of pulmonary veins 2, 3, 4.

Antiarrhythmic drugs, such as class I and III drugs (e.g., flecainide, propafenone, amiodarone, and sotalol), can be used to maintain sinus rhythm after cardioversion 2.
However, these drugs have limitations, including pro-arrhythmic effects and contraindications in patients with structural heart diseases 3.
New treatment options, such as TASK-1 inhibition, are currently under investigation and may provide alternative therapies for AFib 3.

Catheter ablation is a non-pharmacological alternative for treating AFib and can be used as a first-line therapy in patients with symptomatic paroxysmal AFib 5, 4.
Catheter ablation has been shown to improve arrhythmia outcomes, patient-reported outcomes, and quality of life, while reducing healthcare resource usage 4.
However, catheter ablation also carries risks of intraprocedural complications and varying success rates 3.

Lifestyle and risk factor modification, including weight loss and exercise, can help prevent AFib onset, recurrence, and complications 5, 6.
Risk factor modification, such as treatment of hypertension, diabetes, and obstructive sleep apnea, can also reduce AFib episodes 6.

Anticoagulation therapy is necessary for patients at substantial stroke risk, regardless of rate or rhythm treatment strategy 2, 5, 6.
Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are recommended over warfarin due to lower bleeding risks 5.