The Importance of AFib Medications
So you have been diagnosed with atrial fibrillation (AFib). You are probably a bit nervous, knowing there’s something wrong with your heart. Your physician most likely discussed treatment options, but maybe you do not remember the medication options – it is all so overwhelming!
Here, we will discuss why it is important to take medication when you have AFib, and what your medication options are.
The Danger of AFib
The most serious consequence of AFib is a stroke.
How Can a Stroke Happen?
AFib causes the atria (the upper chambers of the heart) to quiver. When they quiver, they are unable to contract regularly. When they cannot pump regularly, the contractions (the “lub-dup” that your physician listens to with a stethoscope) fail to pump blood effectively into circulation.
So – What Happens Then?
The blood that is supposed to be pumped into the lungs pools in the atria. This pooled blood can clot. This clot, if it ever gets out of the atria, can cause a stroke.
Because of the stroke risk, it is important to take medications if your doctor recommends it. Several medications can be used to treat AFib – such as heart rate control, anticoagulants, and antiarrhythmic medications.
These medications may be used singly or in conjunction, depending on what your physician recommends.
Antiarrhythmic medications may be given to convert the heart into a sinus rhythm (a normal heart rhythm), or it may be used after a procedure called a cardioversion.
Examples of these medications include:
- Dofetilide (Tikosyn)
- Propafenone (Rythmol)
- Amiodarone (Cordarone, Pacerone)
- Sotalol (Betapace, Sorine)
Side effects of these medications may include nausea and vomiting, and fatigue. They can also cause ventricular arrhythmias – arrhythmias that originate in ventricles of the heart.
Heart Rate Control
Often, if you are in AFib, your heart rate may be elevated. Medications that are used to control heart rate may not convert the heart rhythm back into a sinus rhythm, but they may restore the heart rate to a normal rate.
Examples of heart rate control medications include:
- Digoxin (Lanoxin): typically works to control the heart rate at rest, but doesn’t do a great job of controlling the heart rate during activity.
- Calcium channel blockers
- Beta blockers
Calcium channel blockers are to be avoided if you have heart failure or hypotension (low blood pressure). Beta blockers can cause hypotension.
Anticoagulants (Blood Thinners)
Anticoagulants are especially important to take if your physician prescribes them. Remember how we discussed that a huge risk of AFib is sustaining a stroke? Taking anticoagulants can keep the blood thin, meaning that the clot may not form in the first place.
The most common anticoagulant is warfarin (Coumadin, Jantoven). Coumadin is a powerful medication that is very effective. However, the downside is that the medication requires frequent monitoring – it can be difficult to get the dosing accurate.
There are also a couple of newer anticoagulants:
- Dabigatran (Pradaxa) is as effective as warfarin but does not require the frequent monitoring. However, it cannot be used if you require anticoagulation due to mechanical heart valves.
- Rivaroxaban (Xarelto) is another option that is also as effective as warfarin.
- Apixaban (Eliquis) is a third option for anticoagulation.
Your physician will weigh the pros and cons and will prescribe the correct medications to treat your AFib.