Cardiovascular

Medicines for Atrial fibrillation (AF)

A common irregular heart rhythm that raises the risk of stroke — managed by preventing clots, controlling the heart rate or rhythm, and treating the underlying cause.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Atrial fibrillation (AF)?

Atrial fibrillation is the most common sustained abnormal heart rhythm. Instead of beating in a coordinated way, the upper chambers of the heart quiver, producing an irregular and often fast pulse.

  • How it is treated: Care has three strands.
  • When to seek help: New severe palpitations with chest pain, breathlessness, fainting or signs of a stroke (face drooping, arm weakness, slurred speech) are emergencies — call 999.

What it is

Atrial fibrillation is the most common sustained abnormal heart rhythm. Instead of beating in a coordinated way, the upper chambers of the heart quiver, producing an irregular and often fast pulse. It may cause palpitations, breathlessness or tiredness, or none at all. Its greatest danger is that blood can pool and form clots in the heart, which can travel to the brain and cause a stroke — so a central part of management is assessing and reducing that stroke risk. AF can be occasional, persistent or permanent, and is often linked to high blood pressure, heart disease, thyroid problems or alcohol.

How it is treated

Care has three strands. First, stroke prevention: the stroke risk is assessed with a recognised score, balanced against bleeding risk, and anticoagulation offered when the benefit outweighs the risk. Second, rate or rhythm control: slowing a fast heart rate, or working to restore and maintain a normal rhythm, to relieve symptoms. Third, treating contributing factors such as blood pressure, thyroid disease and alcohol. The clotting and rhythm decisions are separate — many people need rate or rhythm treatment as well as an anticoagulant.

For this condition, these medicines

Medicine classes used for Atrial fibrillation (AF)

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

DOACs Cardiovascular / Haematology The usual first choice for stroke prevention in non-valvular AF; no routine monitoring needed. Warfarin Cardiovascular / Haematology Used where a DOAC is unsuitable (e.g. mechanical valves, certain valve disease); needs INR monitoring. Beta-blockers Cardiovascular A common first-line choice for controlling a fast heart rate. Calcium-channel blockers Cardiovascular Rate-limiting types (diltiazem, verapamil) are an alternative for rate control. Digoxin Cardiovascular An add-on for rate control, particularly in less active or sedentary people. Amiodarone Cardiovascular Used for rhythm control in selected people, with monitoring for its wider effects. Flecainide Cardiovascular A rhythm-control option in people without significant structural heart disease.

Symptom checker

Symptoms that can point to Atrial fibrillation (AF)

Atrial fibrillation (AF) can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

Feeling faintFeeling light-headed and as though you might pass out, or briefly losing consciousness.…PalpitationsAn unusual awareness of your own heartbeat — feeling it race, pound, flutter or skip — whi…

Clinical formulas & tools

Calculators used in Atrial fibrillation (AF)

Risk scores and formulas that inform assessment and treatment decisions in this condition:

CHA₂DS₂-VASc ScoreStroke risk in atrial fibrillation, guiding anticoagulation.CHA₂DS₂-VA ScoreStroke risk in AF (2024, sex removed).HAS-BLED ScoreMajor bleeding risk on anticoagulation in atrial fibrillation.ORBIT Bleeding ScoreBleeding risk on anticoagulation in AF.SAMe-TT₂R₂ ScorePredicts anticoagulation control on warfarin.

By active ingredient

Specific medicines used for Atrial fibrillation (AF)

Dose-free guides to individual active ingredients used in atrial fibrillation (af) — what each is, how it works, how to take it, and its advantages and disadvantages:

BisoprololA heart-selective beta-blocker used in heart failure, to control heart rate in atrial fibr…ApixabanA direct oral anticoagulant ("blood thinner") used to prevent and treat clots, including s…RivaroxabanA direct oral anticoagulant ("blood thinner") used to prevent and treat clots, including s…EdoxabanA once-daily direct oral anticoagulant ("blood thinner") used to prevent and treat clots, …AtenololA heart-selective beta-blocker used to control heart rate in atrial fibrillation and angin…MetoprololA beta-blocker used for high blood pressure, heart failure and irregular heart rhythms; ne…DiltiazemA "rate-limiting" calcium-channel blocker that relaxes vessels and slows the heart; modifi…VerapamilA "rate-limiting" calcium-channel blocker used to lower blood pressure and to slow and ste…DabigatranA direct oral anticoagulant ("blood thinner") that reduces the risk of stroke and clots, a…SotalolA beta-blocker with extra rhythm-controlling action used to treat and prevent certain abno…VernakalantA medicine given into a vein in hospital to help return a recently started irregular heart…QuinidineAn older medicine for abnormal heart rhythms, now used only rarely and under specialist su…DisopyramideAn older medicine used to control certain abnormal heart rhythms.…DofetilideA specialist medicine used to maintain a normal heart rhythm in atrial fibrillation.…ProcainamideAn older medicine used to control serious abnormal heart rhythms, given with close heart m…PropafenoneA rhythm-control medicine used to treat certain abnormal or fast heart rhythms, including …IbutilideA medicine given into a vein in hospital to convert recent-onset atrial fibrillation or fl…DronedaroneA tablet used to help maintain a normal heart rhythm in atrial fibrillation, with liver an…AcenocoumarolAn anticoagulant, or 'blood thinner', that works like warfarin to prevent and treat blood …WarfarinA long-established anticoagulant ("blood thinner") that reduces the blood's tendency to cl…AmiodaroneA powerful medicine for serious abnormal heart rhythms — very effective, but it builds up …DigoxinA long-established heart medicine that slows a fast pulse in atrial fibrillation and can h…FlecainideA medicine that restores and maintains a normal heart rhythm in atrial fibrillation and so…

When to get help

When to see a doctor

New severe palpitations with chest pain, breathlessness, fainting or signs of a stroke (face drooping, arm weakness, slurred speech) are emergencies — call 999. A newly irregular pulse without these features should still be assessed promptly.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Atrial fibrillation (AF): frequently asked questions

Why do I need a blood thinner for atrial fibrillation?

AF lets blood pool and clot in the heart; a clot can travel to the brain and cause a stroke. Anticoagulants greatly reduce that risk. Whether you need one depends on your personal stroke risk, assessed with a score such as CHA₂DS₂-VASc, balanced against your bleeding risk.

What is the difference between rate control and rhythm control?

Rate control accepts the irregular rhythm but slows the heart to a comfortable speed. Rhythm control tries to restore and maintain a normal rhythm. Both relieve symptoms; the choice depends on your symptoms, age and heart health, and is separate from the decision about anticoagulation.

Which medicines are used for AF?

For stroke prevention, DOACs (or warfarin in specific situations). For rate control, beta-blockers, rate-limiting calcium-channel blockers or digoxin. For rhythm control, drugs such as flecainide or amiodarone in selected people.

Does a blood thinner stop the palpitations?

No. An anticoagulant only reduces stroke risk — it does not change the rhythm or how it feels. Symptoms are treated separately with rate- or rhythm-control medicines.

Keep reading

Related articles

Acute breathlessness: a teaching case in clinical reasoningAn illustrative educational case showing how sudden breathlessness is assessed — the key d…Recognising a stroke: act FAST and why time is brainHow to spot a stroke using the FAST test, why every minute matters, the difference between…Understanding atrial fibrillation: symptoms, stroke risk and treatmentWhat atrial fibrillation is, why it raises stroke risk, how it is detected, and the two go…Wearables and remote monitoring: what the data can and can’t tell usHow smartwatches and health wearables measure heart rate, rhythm, oxygen and sleep, where …The Collapsed Patient: Blackouts and SyncopeA case-based guide to blackouts and fainting (syncope): common causes, red flags, what hap…Heart failure explained: symptoms, treatment and living wellA plain-English guide to heart failure — what it means, the warning signs, how it is diagn…Understanding thyroid disorders: underactive and overactiveA plain-English guide to thyroid problems — the symptoms of an underactive and overactive …Acute Limb Ischaemia: A Sudden Cold, Painful Leg CaseAn illustrative teaching case explaining acute limb ischaemia, why a suddenly cold, painfu…Blood clots: deep vein thrombosis and pulmonary embolismA UK guide to DVT and pulmonary embolism — how blood clots form in the legs and lungs, who…Palpitations: a case-based approach to a racing heartAn illustrative UK case guide to palpitations — a racing or irregular heartbeat. When it i…Acute mesenteric ischaemia: a case-based approachAn illustrative educational case on acute mesenteric ischaemia — severe sudden tummy pain …A suspected TIA (mini-stroke): a case-based approachAn illustrative case on a suspected TIA or mini-stroke — using FAST to spot it, why 999 is…Anticoagulants explained: DOACs, warfarin and bleeding riskHow blood-thinning medicines work — DOACs versus warfarin, how they differ from antiplatel…

Sources

Where this is drawn from

  • NICE NG196: Atrial fibrillation: diagnosis and management.
  • NICE CKS: Atrial fibrillation.

Related conditions

High blood pressure (hypertension)Persistently raised blood pressure that, untreated, increases the risk of stroke, heart at…

Browse by body system

Heart & circulationConditions and medicines for the heart, blood pressure, cholesterol, clotting and the bloo…

Building a patient-information or formulary resource?

We create evidence-led, dose-free clinical references and decision aids for teams.

Talk to us ☎ +44 7448 439750
☎ Call Get a Proposal