What are atrial fibrillation medications?

Atrial fibrillation (AFib, Afib) medications are drugs that are prescribed to treat atrial fibrillation, a heart condition which causes irregular heartbeat. Atrial fibrillation medications help restore the heart's normal rhythm and rate, which is within the range of 60 to 100 beats per minute in healthy individuals.
Atrial fibrillation (AFib, Afib) medications are drugs that are prescribed to treat atrial fibrillation, a heart condition which causes irregular heartbeat. Atrial fibrillation medications help restore the heart’s normal rhythm and rate, which is within the range of 60 to 100 beats per minute in healthy individuals.

Atrial fibrillation (AFib, Afib) medications are drugs that are prescribed to treat atrial fibrillation, a heart condition which causes irregular heartbeat. Atrial fibrillation medications help restore the heart’s normal rhythm and rate, which is within the range of 60 to 100 beats per minute in healthy individuals.

Atrial medications also reduce the symptoms of atrial fibrillation, and prevent complications that can arise from the condition. The main components of drug therapy, known as pharmacologic cardioversion, for atrial fibrillation include:

  • Rate control: Medications such as calcium channel blockers, beta blockers and cardiac glycosides (digitalis) to control the heart rate.
  • Rhythm control: Antiarrhythmic medications that reset and maintain a normal heart rhythm.
  • Anticoagulation: Medications such as blood thinners (anticoagulants) and antiplatelet agents, to prevent blood clots that atrial fibrillation can cause, particularly in a small pouch-like structure attached to the left atrium, known as left atrial appendage.
  • Treatment of underlying disorder: Medications or procedures as needed to treat the underlying cause of atrial fibrillation.

In addition to medications for long-term management of the condition, patients with atrial fibrillation may require other procedures depending on the severity of the condition and symptoms. Procedural treatments for atrial fibrillation include:

  • Electrical cardioversion: A procedure that uses electrical current to reset the heart rhythm to its normal pattern.
  • Cardiac ablation: A procedure to scar the heart tissues which generate abnormal electrical signals leading to atrial fibrillation. Cardiac ablation may be performed surgically or with a thin tube (catheter) threaded through a vein into the heart.
  • Pacemaker: An implanted electrical device that produces rhythmic electric pulses to keep the heartbeat steady and within the normal range.
  • Surgical procedures: Surgical procedures may include:
    • Maze procedure, which involves making small incisions in the atria to stop the occurrence of atrial fibrillation
    • Closure of the left atrial appendage to prevent clot formation
    • Other surgeries for underlying cardiovascular diseases

Medications and other treatments cannot permanently cure atrial fibrillation, and the risk for recurrence remains. Atrial fibrillation, however, can be managed with appropriate therapy and lifestyle changes.

What is the drug of choice for atrial fibrillation?

The critical first-line treatment for atrial fibrillation is to control the heart rate and prevent formation of blood clots.

  • Calcium channel blockers diltiazem and verapamil are the initial choice of medication to reduce the heart rate and ventricular contraction.
  • Aspirin or warfarin is typically the first choice of medication for anticoagulation.
  • Amiodarone is a commonly prescribed antiarrhythmic medication for atrial fibrillation.

What is atrial fibrillation?

Atrial fibrillation is a condition in which the heartbeat becomes irregular, and often accelerated. The electrical pulses that pace the contractions of the heart become erratic and chaotic, resulting in an abnormal heart rhythm (arrhythmia) and heart rate (usually greater than 100 beats per minute).

The heart’s upper chambers (atria) contract in response to steady rhythmic electric pulses discharged from a cluster of cells in the upper wall of the right atrium, known as sinoatrial (SA) or sinus node. The electric pulses are transmitted to the lower chambers (ventricles) through the atrioventricular (AV) node, making the ventricles contract in rhythm with the atria.

Atrial fibrillation is caused by abnormal electrical discharge by the sinus node, which makes the atria quiver instead of contracting effectively. This affects the flow of blood from the atria to the ventricles, and consequently, to the rest of the body.

Inefficient pumping by the atria can cause blood flow to slow down in the atria, and lead to formation of blood clots, particularly in the left atrial appendage. The blood clots (embolisms) can travel and block the brain’s or heart’s blood vessels and cause a stroke or heart failure.

Symptoms of atrial fibrillation

Some people may have no symptoms of atrial fibrillation, but most people have one or more of the following symptoms:

Classification of atrial fibrillation

The published guidelines of the American College of Cardiology/American Heart Association/Heart Rhythm Society classify atrial fibrillation into the following types, based on severity and persistence:

  • Paroxysmal AFib: Episodes of AFib that happen for a few minutes at a time and last less than a week. Treatment may not be required, but it is important to see a doctor.
  • Persistent AFib: Episodes of AFib that last longer than 7 days and require treatment with medication or electric cardioversion.
  • Long-standing persistent AFib: AFib that persists for more than a year, and does not respond to medication or electric cardioversion. Treatment with an ablation or pacemaker may be required.
  • Permanent AFib: AFib that doesn’t respond to treatment and has to be managed with long-term medications to reduce risks of complications from AFib such as stroke and heart failure.

QUESTION

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What is the main cause of atrial fibrillation?

Atrial fibrillation most often occurs due to underlying cardiovascular or other conditions. The risk factors for atrial fibrillation include:

What are the types of atrial fibrillation medications?

Medications for atrial fibrillation control heart rate, prevent clot formation and reset the heart rhythm. The choice of medication depends on the symptoms, severity of the condition, and other co-existing conditions. Patients may also require other medications to treat the underlying cause of atrial fibrillation.

Atrial medications may be taken as tablets, or administered as injections or intravenous infusions in emergency situations. The types of atrial fibrillation medications include the following:

Heart rate control

  • Calcium channel blockers
  • Beta blockers
  • Cardiac glycosides

Heart rhythm control

  • Antiarrhythmic agents

Blood clot prevention

  • Anticoagulants
  • Antiplatelet agents

How do atrial fibrillation medications work?

Each type of atrial fibrillation medication works in a unique way to control atrial fibrillation and prevent its complications. Medications are typically individualized depending on the patient’s condition.

Heart rate control

Calcium channel blockers

Calcium channel blockers bring down the heart rate by inhibiting the flow of calcium ions into the cells of voltage-sensitive heart muscles. This slows down the conduction rate of electric pulses and contraction of the ventricles, relaxing the muscles of the heart and arteries.

Calcium channel blockers prescribed for atrial fibrillation include:

Beta blockers

Beta blockers are usually a second-line treatment for atrial fibrillation, and are more useful for atrial fibrillation patients who also have high blood pressure. Beta blockers relax the smooth muscles of the heart and arteries and bring down blood pressure and the heart rate.

Beta blockers slow or prevent the hormones epinephrine and norepinephrine, produced by the adrenal gland, from stimulating beta-1 receptors on the heart muscle cells. When stimulated by the hormones, beta-1 receptors raise the heart rate and the strength of its contraction.

Beta blockers prescribed to treat atrial fibrillation include:

Cardiac glycosides

Cardiac glycosides reduce the heart rate by stimulating the vagus nerve which regulates the electrical conduction in the sinus node. Glycosides are primarily used for atrial fibrillation with congestive heart failure. A glycoside often prescribed for atrial fibrillation is:

Heart rhythm control

Antiarrhythmic medications

Antiarrhythmic medications regulate the heart rhythm by slowing down the electrical impulses. Antiarrhythmic drugs reduce the frequency and duration of atrial fibrillation episodes. Following are some of the antiarrhythmic medications used to treat atrial fibrillation:

Clot prevention

Anticoagulants

Anticoagulants stop the formation of blood clots by preventing conversion of fibrinogen into fibrin. Fibrin is an insoluble protein molecule that combines with other fibrin molecules to form a mesh to trap platelets and help form clots. Commonly prescribed anticoagulants include:

Antiplatelet agents

Antiplatelet agents prevent the platelets in the blood from clumping together to form clots. Antiplatelet agents are usually taken by patients who cannot take anticoagulants for some reason. Commonly prescribed antiplatelet agents include:

Additional information

  • Please visit our medication section of each drug within its class for more detailed information.
  • If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
  • It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
  • Never stop taking your medication and never change your dose or frequency without consulting with your doctor.

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Heart Disease: Causes of a Heart Attack See Slideshow

QUESTION

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Medically Reviewed on 4/5/2021
References
https://emedicine.medscape.com/article/151066-medication

https://www.medicinenet.com/atrial_fibrillation/article.htm

https://www.medicinenet.com/atrial_fibrillation_afib_treatment_drugs/article.htm

https://pubmed.ncbi.nlm.nih.gov/10822036/