Atrial Fibrillation - Medications

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What medications have you taken to treat atrial fibrillation?

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Slowing the heart rate with medications

Having excluded or corrected the factors that cause AFib, the next step when the ventricles are beating too rapidly usually is to slow the rate at which the ventricles beat.

Available medications to slow heart rate in AFib

Patients with AFib and healthy AV nodes usually have ventricles that beat rapidly. Medications are necessary to slow down the rapid heart rate. Medications to slow the heart rate in atrial fibrillation include:

  • digitalis (Digoxin)
  • Beta blockers such as propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor), esmolol (Brevibloc)
  • Calcium channel blockers such as verapamil (Calan), diltiazem (Cardizem)

These medications slow the heart rate by retarding conduction of the electrical discharges through the AV node. These medications, however, do not usually convert AFib back into a normal rhythm. Other drugs or treatments are necessary to achieve a normal heart rhythm.

Benefits of controlling the rate: In patients with rapid ventricle contractions as a result of AFib, slowing the rate of ventricular contractions improves the heart's efficiency in delivering blood (by allowing more time between contractions for the ventricles to fill with blood) and relieves the symptoms of inadequate flow of blood -- dizziness, weakness, and shortness of breath.

With chronic, sustained AFib, doctors may decide to leave some patients in atrial fibrillation provided that their heart rates are under control, the output of blood from the ventricles is adequate, and their blood is adequately thinned to prevent strokes. This form of treatment is called rate control therapy (see below).

Limitations of medications for controlling the heart rate: In patients with diseased AV nodes, ventricular contractions may be slower than in patients who have normal AV nodes. Moreover, some elderly patients with atrial fibrillation are extremely sensitive to medications that slow the rate of ventricular contractions, usually because of a diseased AV node. In these patients, the heart rate can become dangerously slow with small doses of medications to slow the heart. This condition is referred to as tachycardia-bradycardia syndrome, or "sick sinus syndrome." Patients with tachycardia-bradycardia syndrome need medications to control the fast heart rate and a pacemaker to provide a minimum safe heart rate.

Medications used in slowing atrial fibrillation generally cannot convert atrial fibrillation to a normal rhythm. Therefore these patients are at risk for the formation of blood clots in the heart and strokes and will need prolonged blood thinning with anticoagulants like warfarin (Coumadin).

Return to Atrial Fibrillation (AFib)

See what others are saying

Comment from: geokat, 65-74 Male (Patient) Published: June 02

I have just had a heart oblation for atrial fibrillation. It has made a huge difference after 10 days of rest. I also have lost 5 more lb. but I am on weight watchers too. I feel great. If you have a fibrillation do it, it is a life changer.

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Comment from: Lime, 45-54 Male (Patient) Published: June 05

I have had high blood pressure (BP) since age of 20. I have been on medication since the age of 30. I was treated with metoprolol 50 mg twice a day for several years. I was very tired in this times. Since four years I am treated with Micardis 40 mg a day and I am feeling great. I am taking the medication every evening before go to sleep. Also, I am taking atorvastatin 10 mg for high cholesterol level. After eight hours of hard work in my back yard I was a little tired in the evening. I went to sleep around 22:00. Around 1:20 am, my hearth woke me up because I was feeling that the beating was very fast and irregular. So, I took my pulse several times and I had a certain feeling that I wouldn't accept that it was happening to me. After ten minutes of thinking I decided to go to the emergency. My BP was 180/112 and my heartbeat between 160 and 180 per minute. I was in fast atrial fibrillation. I had no pain or discomfort. Only feeling was that my hearth shaking in my body. Shortly upon my arrival at the emergency department, I was cardioverted under sedation with one shock 102 J and returned back to normal sinus rhythm. My BP went down to 126/87. After two hours in the emergency department I was back in my bed. I am feeling well and my heart has a regular rhythm. I will get my heart checked with a specialist. Considering my health status and my age, I will take it easy. For certain peoples the physical hard work is not good for the blood pressure and the heart. I think it is very important to know our physical limits and behave according to them.

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