Atrial fibrillation, a condition in which the heart does not beat at regular intervals, is the most common cardiac arrhythmia. Treatments depend on the frequency and severity of your symptoms and the presence of heart disease. Standard treatments include medications, surgical procedures, and lifestyle changes.
Repeat episodes of atrial fibrillation can alter the heart's electrical system, leading to persistent or permanent AFib. In this case, doctors will use a treatment approach that controls your heart rate and prevents further complications, such as blood clots, which increase risks for stroke.
Heart-rate control medications
Doctors can prescribe medicines to slow the heart rate to a normal level, between 60 to 100 beats per minute (rate control).
Heart-rate control medications include:
- Beta blockers. Targets cells on heart muscles. Examples: Metoprolol and Atenolol.
- Calcium channel blockers. Increases the blood and oxygen supply to the heart. Examples: Diltiazem and Verapamil.
- Digitalis. Strengthens the force of the heart beat. Example: Digoxin.
Heart-rhythm control medications
If you aren't doing well with a rate-control treatment, a physician might recommend a procedure called cardioversion (low-energy shocks) to restore and maintain a normal heart rhythm (sinus rhythm). This can be done as a medical procedure using low-energy shocks or in the form of anti-arrhythmic medications that help restore normal sinus rhythm.
Some anti-arrhythmic medications can cause proarrhythmia. Proarrhythmia simply means causing cardiac arrhythmias. That is, instead of eliminating arrhythmias, these drugs can produce them.
Anti-arrhythmic medications include:
Amiodarone (Cordarone, Pacerone). Available in oral and intravenous doses, Amiodarone is more effective than any other drug in treating atrial fibrillation. However, it is also most likely to cause life-threatening side effects, including pulmonary toxicity and thyroid abnormalities.
Dronedarone (Multaq). Dronedarone comes as a tablet to take by mouth. It is usually taken twice a day, with the morning meal and the evening meal. Side effects generally include diarrhea, heartburn, and rash.
Propafenone (Rythmol). Propafenone comes as a tablet and an extended-release (long-acting) capsule taken by mouth. Patients who take propafenone can experience dry mouth, headache, anxiety, and blurred vision.
Sotalol (Betapace). Sotalol comes as a tablet to take by mouth on an empty stomach. Common side effects include lightheadedness, excessive tiredness, and muscle aches. In some cases, sotalol has been known to cause proarrhythmia.
Dofetilide (Tikosyn). Dofetilide comes as a twice-daily capsule. Like Sotalol, it can cause proarrhythmia, and the FDA has required doctors to take special training before they can prescribe it. Other side effects can include chest pain, flu-like symptoms, and difficulty sleeping.
Flecainide (Tambocor). There is a chance that flecainide may cause or worsen heart rhythm problems. Studies have found that people who take flecainide are more likely to have a heart attack than people who don’t. Other common side effects include difficulty breathing, wheezing, and dizziness. Flecainide is available as an extended-release capsule or a twice-daily tablet.
Blood clot prevention medications
Atrial fibrillation can lead to blood pooling in the heart's upper chambers (the atria), which can produce blood clots. If a clot breaks off and travels to the brain, you could suffer a stroke. Your risks for a stroke increase if you also have heart disease.
To help reduce your stroke risk, a doctor may prescribe one of the blood-thinning medications (anticoagulants) listed below. Ask your doctor about the possible side effects of each drug.
Blood clot prevention medications include:
Warfarin. A tablet taken by mouth, warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. While on warfarin, your doctor will perform regular blood tests to monitor how your blood is clotting.
Dabigatran. Dabigatran is in a class of anticoagulant (''blood thinner'') medications that helps prevent blood clots from forming in the body.
Rivaroxaban Rivaroxaban works by decreasing the clotting ability of the blood to prevent deep vein thrombosis (a blood clot, usually in the leg).
Your doctor might also recommend treatments for an underlying cause of AFib (such as a thyroid disorder) to reduce your AFib risk.
Remember: certain lifestyle changes can help too, such as following a healthy diet, cutting back on salt intake (to help lower blood pressure), quitting smoking, and reducing stress.