Your medication options:
There are three primary goals in the treatment of AFib:
- Slow the heart rate
- Prevent clots and strokes
- If possible, restore the heart to its regular rhythm
Blood-thinning medications, including aspirin and warfarin, may help reduce stroke risk. In fact, long-term use of warfarin has been proven to prevent up to 80% of strokes in people suffering from AFib. Aspirin is an option when the risk of stroke is not high. To reduce heart rate, many people can be treated with medications such as digoxin, alone or in combination with beta-blockers and calcium channel blockers, as well as other medications. Your treatment will depend on your age, physical condition and history of heart disease.
Beta-blocker medications slow the heart rate and decrease how forcefully the heart contracts, reducing the amount of oxygen the heart needs to work. Beta-blockers are often used to treat heart conditions, including high blood pressure, heart failure, fast or irregular heart rates, and mitral valve prolapse, and to help decrease or prevent chest pain. Beta-blockers are also used for migraine headaches, social anxiety disorder, glaucoma, and a common type of movement disorder called essential tremor.
Examples of beta-blockers include:
- Acebutolol hydrochloride (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Bisoprolol (Zebeta)
- Carteolol (Ocupress)
- Carvedilol (Coreg)
- Esmolol (Brevibloc)
- Labetalol (such as Normodyne or Trandate)
- Metoprolol (such as Lopressor or Toprol XL)
- Nadolol (Corgard)
- Penbutolol sulfate (Levatol)
- Pindolol (Visken)
- Propranolol (Inderal)
- Sotalol (Betapace AF)
- Timolol (Blocadren)
Calcium channel blockers
Calcium channel blocker medications prevent calcium from entering muscle cells and blood vessels. As a result, blood vessels relax, slowing the heart rate and increasing blood flow to the heart muscle while reducing blood pressure.
Calcium channel blockers are used to treat heart conditions, including high blood pressure, chest pain caused by coronary artery disease, heart failure, and fast or irregular heart rhythms. They are also used to treat severe headaches.
Examples of these medications include:
- Amlodipine besylate (Norvasc)
- Diltiazem hydrochloride (Cardizem, Dilacor-XR, Tiazac)
- Felodipine (Plendil)
- Isradipine (DynaCirc)
- Nicardipine hydrochloride (Cardene)
- Nifedipine (Procardia XL)
- Verapamil (Calan SR, Isoptin SR)
- Nisoldipine (Sular)
Cardiac glycosides are medications that can help the heart beat slower and stronger, which helps the heart pump more blood with each beat. Cardiac glycosides are used to treat heart failure and may also be used to treat irregular rapid heartbeats in the upper heart chamber (AFib).
Examples of cardiac glycosides include:
- Digoxin (such as Lanoxicaps, Lanoxin)
- Digitoxin (Crystodigin)
High levels of a cardiac glycoside in the bloodstream can slow the heart rate below normal (bradycardia). This is most likely to occur in people who are receiving medication to help reduce water retention (water pills or diuretics), especially those with decreased kidney function.
Antiarrhythmic medications may be used to return an irregular heartbeat (arrhythmia) to its normal rhythm, prevent the occurrence of an arrhythmia, or control the heartbeat during an arrhythmia. These drugs work mostly by stabilizing the heart muscle tissue or slowing the heart rate.
Examples of antiarrhythmic medications are:
- Ibutilide (Corvert)
- Amiodarone (such as Cordarone or Pacerone)
- Flecainide (Tambocor)
- Sotalol (Betapace AF)
- Procainamide (Procanbid)
- Propafenone (Rythmol)
- Quinidine (such as Quinidex)
- Disopyramide (Norpace)
- Dofetilide (Tikosyn
Many of these medications have side effects and interactions with other medications. A person taking any of these medications should be in good communication with his or her health professional.
Restoring the rhythm
To help the heart maintain a normal rhythm, a procedure called cardioversion may be effective. Cardioversion delivers brief electrical shocks that stun the heart and temporarily stop all electric activity. This may allow the normal rhythm to reemerge. However, medication may be required to maintain the normal rhythm and it is not always effective. Cardioversion is used in situations and also may be done electively. Catheter ablation is a method to relieve the rapid, irregular heartbeat that accompanies AFib. This procedure involves disconnecting the atria from the ventricles electrically. Without the signals from the atria, the ventricles would beat extremely slowly, requiring a permanent pacemaker in anyone who chooses this procedure.
For some hard-to-treat AFib, a surgical procedure that is occasionally performed is the "maze" procedure in which a surgeon divides the atria into small, isolated sections. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the scars that separate the sections of the atria. It should only be used for people with severe AF that can't be controlled with medication, or for people undergoing heart surgery for other reasons.
Catheter Ablation- Pulmonary Vein Ablation (Isolation)
Current PV ablation techniques are achieving partial success rates in curing paroxysmal AF. Medications that did not work before may now control the AF. But for some there may not be any noticeable improvement at all.
During PV ablation a soft, thin, flexible tube with an electrode at the tip is inserted through a large vein or artery in your groin and moved into your heart. This catheter is directed to the precise location(s) in your heart that are producing your AF. These points are burned off or isolated from your heart.
If you are in AF during the catheter ablation procedure, it's relatively easy for the doctors to determine where the A-Fib signals are coming from and to ablate (destroy) them.
However, if you have intermittent AF (Paroxysmal AF), it's harder to pinpoint exactly the source(s) of the A-Fib signals. The challenge for doctors is how to locate and eliminate AF signals when the patient is not in AF. Since research has shown that almost all A-Fib signals come from the openings (ostia) of the four pulmonary veins in the left atrium, one technique is to make circular radiofrequency (RF) Ablation lines around each pulmonary vein opening (called "Circumferential" or "Empirical Ablation"). This isolates the pulmonary veins from the rest of the heart and prevents any pulses from these veins from getting into the heart. However, it's difficult to make circular RF lesions and they aren't always successful. This technique can achieve good success rates with for people with paroxysmal AF. For people with chronic AF, success rates may not be as good.