Afib’s Big Three: Rate Control, Rhythm Control, and Stroke Prevention

Chances are, if you have afib, your treatments will include one or more of the following: rate control, rhythm control, and stroke prevention. Of course, each individual is unique, and medical treatments vary depending on the recommendations of their physician. Nevertheless, in general, the management of these three conditions is a typical part of any afib treatment regimen. For each of these concerns, there are specific medications, procedures, tools, and techniques which may be applied to achieve the best possible outcome for each patient. Certainly, there is significant overlap, and any given patient may receive treatment for any or all of these areas. Nevertheless, to help understand the underlying mechanisms of afib, each of these factors is briefly discussed below.

Rate Control

One problem many afib patients must deal with is a racing heart. Normal heart rates generally fall in the range of 60 to 100 beats per minute. With afib, sudden bursts of heart rate frequencies may range as high as from 100 to 175 beats per minute. Paradoxically, when this happens blood pressures may be normal or, even, low. This is because blood flow with afib is impaired due to ineffective pumping, even though there is a rapid heart rate.

Certain groups of medications are generally used to control heart rates. These include beta-blockers, calcium channel blockers, and cardiac glycocides. Based on the specific medication, these drugs slow the heart, relax the blood vessels, reduce the effort required from the heart, or improve cardiac output.

Medication treatment for rate control with afib is not a cure but may help control the condition. Over the long term, these treatments may either lose their effectiveness or result in undesirable side effects. In these cases, longer-term therapies may be necessary.

Rate control is often the initial treatment option for afib sufferers. In some cases, however, rate control either is not applicable, produces undesirable side effects, or loses its effectiveness over time. In these cases, rhythm control is undertaken to manage the heart’s sinus rhythm. This approach, referred to as drug or chemical cardioversion, results in a more normal heart rhythm but may come at the expense of side effects. There are many excellent medications available from which your physician will select the one(s) most appropriate.

When taking these medications, anticoagulants are often also given to reduce stroke risks. Over time, however, these medications, as is the case with rate control drugs, have been shown to lose their effectiveness. In these cases, other approaches may be needed. If these medications are not effective or lose their effectiveness over time, then minimally invasive radiofrequency ablation or catheter/surgical ablation may be considered. These surgical procedures interrupt the erratic electrical signals within the heart that cause the irregular rate and rhythm issues. In some cases, a pacemaker is needed to monitor and regulate heart rates following these procedures.

Stroke Prevention

One of the main objectives for those with afib is the prevention of blood clotting and reduction of stroke risks. When heart rates and rhythms are irregular, the heart muscles do not contract properly causing blood to ‘pool’ in certain areas. When, blood pools, clots can form which may break free and cause a stroke. Blood thinners and anticoagulants are prescribed to reduce the tendency of blood to clot, thus reducing stroke risks. Whether afib is causing rate problems (a too-fast heartbeat) or rhythm problems (an erratic heartbeat), preventing blood clots and strokes is paramount within most afib medical treatment plans. Slowing the heart rate and restoring a normal heart rhythm helps return the patient to a healthier lifestyle, but long term treatment with blood thinners may be necessary.

If you have afib or believe you have afib, it is essential to see a physician as soon as possible. Dr. Shanti Bansal, Houston’s top electrophysiologist at Atrial Fibrillation Centers of America is available to visit with you and to evaluate your situation. To control your heart rate and rhythm and to reduce your chances for a stroke, it is important to be assessed and, if necessary to begin a treatment program. Dr. Bansal can answer all your questions and guide you to your best possible health. Give our office a call and speak to one of our professional staff. Call for an appointment today, 832-478-5067.


Atrial Fibrillation Centers of America