Medications for AFib
The medications prescribed for AFib treatment fall into three categories: drugs to manage the heart rate, drugs that regulate the rhythm, and drugs that reduce the risk of clot formation.
Heart Rate Control
The three types of medications used to regulate heart rate are beta-blockers, calcium channel blockers, and digoxin.
- Beta-blockers slow the heart rate and keep it in the normal. They also decrease the heart’s workload, which helps reduce the strain on the heart muscle over time.
Beta-blockers also reduce blood pumped by the heart, which lowers blood pressure.
Some examples of beta-blockers include atenolol, sotalol, metoprolol, nadolol, and propranolol.
- Calcium channel blockers decrease heart rate and help to limit the strength of muscle contraction. Diltiazem and verapamil are both examples of calcium channel blockers currently in use.
- Digoxin slows the electrical conduction rate of the impulses that move from the atria to the ventricles. Digoxin is sometimes the second option after calcium channel blockers or beta-blockers.
Antiarrhythmic drugs convert AFib back into the normal rhythm. The particular antiarrhythmic drug of choice depends on the type of AFib you have (paroxysmal, persistent, long-standing, permanent, or non-valvular).
- The antiarrhythmic medications prescribed for AFib include flecainide, amiodarone, dronedarone, propafenone, quinidine, and dofetilide.
- Some people need more than one antiarrhythmic medication to achieve rhythm control.
Blood Clot Prevention
Blood-thinning medications help reduce the blood’s thickness so that it is less likely to form clots. If you have had blood clots or have a high risk of developing them in the future, your physician will prescribe either an anticoagulant or antiplatelet drug.
- Anticoagulants reduce the risk of stroke by decreasing the formation of blood clots. Your doctor will assess whether you are a candidate for the medication in this category based on your medical history, which will take into account if you have had any previous problems with blood clots, diabetes high blood pressure, stroke, heart failure or other types of heart disease.
The anticoagulants most often used in conjunction with AFib are warfarin, apixaban, dabigatran, edoxaban, and rivaroxaban.
The American Heart Association has a scale called the CHA2DS2--VASc risk calculator to help your physician determine if anticoagulant therapy is right for you. The tool evaluates your risk in the following areas:
- Congestive heart failure
- Age (75 or greater)
- Stroke (previous history)
- Vascular disease (history of aortic plaque, heart attack, or peripheral artery disease
- Age 65 to 74
- Sex (female)
Your total score will give your doctor the information needed to decide on whether you need to start on an anticoagulant regimen.
- Antiplatelets reduce the ability of the platelets in your bloodstream to stick together and form clots. Platelets act as one of your body’s mechanisms to stop bleeding, such as when you cut your finger.
The antiplatelet medications often prescribed for treating AFib are aspirin and clopidogrel.
Nonsurgical Intervention Options
Cardioversion is a therapy used to treat AFib episodes, but it isn’t always effective in returning the heart to its regular rate. Web MD’s information on AFib treatment reports that roughly 50% of individuals who have cardioversion revert to AFib.
Cardioversion takes place in a hospital or outpatient clinic office for close supervision of the heart’s response to the procedure. Cardioversion uses a low-level electrical shock, delivered with a device called a cardiac defibrillator, to jolt the heart back into a normal rhythm.
Cardioversion is not an option if your AFib episode has lasted longer than two days because it can elevate the risk of blood clot formation.
An electrophysiologist, who is a physician specializing in heart rhythms will assess your AFib and determine the type of ablation that is appropriate for you.
Catheter ablation is a procedure that will help to stop the extra electrical impulses that other areas of the heart send to the atria. The technique is often the treatment of choice if medication or cardioversion has not converted AFib back to a consistent regular rhythm.
Then electrophysiologist performs the procedure, which usually takes 2 to 3 hours and requires administration of a general anesthetic to help you fall asleep. The electrophysiologist threads a small thin wire called a catheter into an area of the groin and advances it toward the heart.
The catheter uses an energy source like high-frequency radio waves to emit a quick surge of heat or cold that destroys the tissue causing the irregular electrical activity. The electrophysiologist will create these injuries in several areas of the heart.
When healing occurs, scar tissue will form, and it will block transmission of the unwanted electrical signals.
AV Node Ablation
An AV node ablation involves sending a dose of radiofrequency energy to the area of the heart that links the atria and ventricles. This kind of ablation is like a catheter ablation as the small wire inserted into the groin and transferred up to the heart delivers the energy.
AV node ablation results in a blockage of signals from the atria to the ventricles and requires pacemaker placement to keep the ventricles beating at the correct rate. Unlike a catheter ablation, the atria continue to fibrillate after AV node ablation.