When and why you need drugs for atrial fibrillation
Medications are often part of the treatment plan for people with atrial fibrillation — a fast, irregular heartbeat.
- Reviewed by Sunil Kapur, MD, Contributor
A rapid or irregular heartbeat (arrhythmia) can make you feel like your heart is racing or fluttering. Some people don’t notice a change in rate or pattern, but they may feel breathless or fatigued. Atrial fibrillation (afib), the most common heart arrythmia, can also raise your risk of stroke. For many people with afib, medications are a mainstay of treatment. Increasingly, cardiologists recommend starting treatment soon after a diagnosis rather than waiting until the condition worsens.
“More and more, we’re realizing that the earlier we start treatment for afib, the more successful we are,” says Dr. Sunil Kapur, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital. With afib, episodes can last anywhere from a few seconds to hours, days, or even longer. “For example, a person may have an episode that lasts half an hour but that doesn’t recur for six months,” says Dr. Kapur. But over time, the condition tends to progress and bouts become longer and more frequent. Here’s what you need to know about medications to treat afib (see “What is a heart arrhythmia?”).
What is a heart arrhythmia?Normally, your heart beats in a steady, stable rhythm at about 60 to 100 beats per minute (bpm). But if the electrical signals that tell your heart to beat don’t work properly, your heartbeat may become too slow, too fast, or irregular. Known as arrhythmias, these abnormalities generally fall into two categories: bradycardia is a slow heart rate (less than 60 bpm), and tachycardia is a fast heart rate (greater than 100 bpm). Tachycardia is further divided into two main forms: a rapid but regular heart rhythm called supraventricular tachycardia (SVT) and a fast, irregular heart rhythm known as atrial fibrillation (afib). While bradycardia is not unusual in older adults, treatment may require a pacemaker rather than relying on medications. SVT is less common, affecting fewer than three in 1,000 people. Afib becomes more prevalent with age and affects about one in 11 people over age 65. |
When do you need medication for afib?
For people with bothersome symptoms, medications that slow the heartbeat may help. Known as rate-controlling drugs, they include beta blockers and calcium-channel blockers. Common beta blockers include
- atenolol (Tenormin)
- bisoprolol
- carvedilol (Coreg)
- metoprolol (Lopressor, Toprol)
- nadolol
- propranolol (Inderal LA, Innopran XL).
Calcium-channel blockers for afib include diltiazem (Cardizem, Cartia, Tiazac) and verapamil (Verelan). An older drug, digoxin (Lanoxin), also slows down the heart. It may be less effective and riskier than beta blockers and calcium-channel blockers, but it can still be an option for people who can’t take those drugs.
In addition to rate-controlling drugs, people with afib may also take anti-arrhythmics (see below). “We also prescribe both types of medications to people without symptoms to try to prevent weakening of the heart muscle or heart failure from a long-term elevated heart rate,” says Dr. Kapur.
Anti-arrhythmic drugs
Rate-controlling drugs aren’t always effective for people with afib symptoms, so doctors may prescribe a drug that helps restore the heart’s regular rhythm. These medications have more side effects than rate-controlling drugs, including possibly worsening existing rhythm disturbances or causing new ones. As a result, some require careful monitoring at first, which may require a short hospital stay. Anti-arrhythmic drugs include
- amiodarone (Nexterone)
- disopyramide (Norpace)
- dofetilide (Tikosyn)
- dronedarone (Multaq)
- flecainide
- propafenone (Rythmol SR)
- sotalol (Betapace).
When these medications are ineffective or cause too many side effects, electrical cardioversion (the application of electrical current over the heart to restore normal rhythm) or a procedure called catheter ablation are other options.
Stroke prevention: Anti-clotting drugs
During a bout of afib, blood tends to pool inside the heart’s upper chambers (atria). This increases the likelihood of clot formation, and these clots can then travel to the brain and cause a stroke. As a result, most people with afib take medications (commonly known as blood thinners) to help prevent clots. This usually means one of the novel oral anticoagulants, or NOACs, which include
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- edoxaban (Savaysa)
- rivaroxaban (Xarelto).
An older drug, warfarin, also helps prevent clots but requires frequent monitoring and can have harmful interactions with a number of foods and other medications. Because NOACs are easier to use, they’re recommended over warfarin with some exceptions, including people with a mechanical heart valve and people with moderate to severe mitral stenosis (a narrowing of the mitral valve). For them, warfarin remains the better choice.
Image: © narvo vexar/Getty Images
About the Author
Julie Corliss, Executive Editor, Harvard Heart Letter
About the Reviewer
Sunil Kapur, MD, Contributor
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