Atrial fibrillation and flutter are usually treated with medications and/or electrical shock (cardioversion). In some cases, removal of a small portion of the heart (ablation), implantation of a pacemaker or a cardioverter defibrillator, or maze surgery is needed.

If the heart rate cannot be quickly controlled, electrical cardioversion may be used. Cardioversion, the electric shock to the chest wall, is usually performed emergencies. This device briefly suspends the heart's activity and allows it to return to a normal rhythm.

Ablation destroys the heart tissue that causes the arrhythmia. The tissue can be destroyed by catheterization or surgery. Radiofrequency catheter ablation, performed in a cardiac catheterization laboratory, can cure atrial flutter and control the heart rate in atrial fibrillation. The patient is awake but sedated. A thin tube called a catheter is inserted into a vein and is threaded into the heart. At the end of the catheter, a device maps the electrical pathways of the heart. A cardiologist, a doctor specializing in the heart, uses this map to identify the pathway(s) causing the arrhythmia, and then eliminates it (them) with bursts of high-frequency radio waves. Surgical ablation is performed in an operating room under general anesthesia. Computerized mapping techniques are combined with a cold probe to destroy arrhythmia-causing tissue. Ablation is generally successful. When ablation is used for atrial fibrillation, it is usually followed by implantation of a pacemaker as well as drug therapy.

A pacemaker is a battery-powered device about the size of a matchbox that is surgically implanted near the collarbone to regulate the heart beat. Lead wires threaded to the right side of the heart supply electrical energy to pace the atria and ventricles. The implantable cardioverter defibrillator is a treatment for serious arrhythmias. The battery-powered device senses an abnormal heart rhythm and automatically provides electrical shock(s). The shock(s) suspends heart activity and then allows the heart to initiate a normal rhythm. Wire electrodes on the device are attached to the heart. Some of the electrodes are attached to the outside of the heart and some are attached to the inside of the heart through veins. The newest implantable cardioverter defibrillators can be implanted in the chest wall and do not require open chest surgery. These devices weigh less than 10 oz and generally last seven or eight years. An implantable cardioverter defibrillator is usually used with drug therapy, but the amount medication is reduced. In maze surgery, often the last resort, surgeons create a maze of stitches (sutures) that help the heart's electrical impulses travel effectively.

Most of the drugs used for treatment have potential side effects and should be carefully monitored by a doctor. The goal of treatment is to control the rate and rhythm of the heart and to prevent the formation of blood clots. If the arrhythmia is caused by heart disease, the heart disease will also be treated. The American Heart Association recommends aggressive treatment.

A digitalis drug, most commonly digoxin, is usually prescribed to control the heart rate. Digitalis drugs slow the heart's electrical impulses, helping to restore the normal rate and rhythm. These drugs also increase the ability of the heart's muscular layer to contract and pump properly. Beta-blockers and calcium channel blockers can also be used for this purpose. Beta-blockers slow the speed of electrical impulses through the heart. Some calcium channel blockers dampen the heart's response to erratic electrical impulses.

To prevent blood clots, aspirin or warfarin (Coumadin) is administered. Warfarin, however, has potential bleeding side effects, especially in older patients. Amiodarone is fairly efffective for atrial flutter. This drug is often able to maintain the heart's proper rhythm and can also help control the heart rate when the flutter occurs.