Medications to control heart rate and heart rhythm in atrial fibrillation

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Treatment for atrial fibrillation, a common heart rhythm disorder, will depend on how long you've had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the treatment goals for atrial fibrillation are to:

• Reset the rhythm or control the rate
• Prevent blood clots

The strategy you and your doctor choose depends on many factors, including whether you have other problems with your heart and if you're able to take medications that can control your heart rhythm.

Doctors may prescribe medications to control your heart rate or to help maintain a normal heart rhythm. In some cases, if medications aren't effective, you may need a more invasive procedure to control your heart rate.

Heart rate control

You may be prescribed medications to control your heart rate and restore it to a normal rate. Heart rate control can be achieved through several medications.

The medication digoxin (Lanoxin) may control heart rate at rest, but not as well during activity. Most people require additional or alternative medications, such as calcium channel blockers or beta blockers.

Beta blockers may cause side effects such as worsening of heart failure and low blood pressure (hypotension). Calcium channel blockers also can cause side effects and may need to be avoided if you have heart failure or low blood pressure.

Maintaining a normal heart rhythm

Your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include:

• Dofetilide (Tikosyn)
• Flecainide
• Propafenone (Rythmol)
• Amiodarone (Cordarone, Pacerone)

Although these drugs may help maintain a normal heart rhythm, they can cause side effects, including:

• Nausea
• Dizziness
• Fatigue

Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart's lower chambers. These medications may be needed indefinitely. Even with medications, the chance of another episode of atrial fibrillation is high.

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May. 14, 2014

References

1. What is atrial fibrillation? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/af/. Accessed Feb. 17, 2014.
2. Cheng A, et al. Overview of atrial fibrillation. http://www.uptodate.com/home. Accessed Feb. 17, 2014.
3. Verdecchia P, et al. Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE intolerant subjects with cardiovascular disease studies. Journal of Hypertension. 2012;30:1004.
4. Furie KL, et al. Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: A science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:3442.
5. What is cardioversion? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/crv/. Accessed Feb. 10, 2014.
6. Naccarelli G, et al. Restoration of sinus rhythm in atrial fibrillation. http://www.uptodate.com/home. Accessed Feb. 13, 2014.
7. Wann LS, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2011;57:223.
8. Kumar K. Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Recommendations. http://www.uptodate.com/home. Accessed Feb. 13, 2014.
9. Ganz LI. Control of ventricular rate in atrial fibrillation: Pharmacologic therapy. http://www.uptodate.com/home. Accessed Feb. 13, 2014.
10. Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. April 7, 2014.

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Lifestyle changes for people with atrial fibrillation

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Tests used to diagnose atrial fibrillation

Atrial fibrillation is a common heart rhythm disorder.

To diagnose atrial fibrillation, your doctor may review your signs and symptoms, review your medical history, and conduct a physical examination. Your doctor may order several tests to diagnose your condition, including:

• Electrocardiogram (ECG). An ECG uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart. This test is a primary tool for diagnosing atrial fibrillation.


• Holter monitor. This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart's activity for 24 hours or longer, which provides your doctor with a prolonged look at your heart rhythms.


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  Event recorder. This portable ECG device is intended to monitor your heart activity over a few weeks to a few months. You activate it only when you experience symptoms of a fast heart rate.

  
  

  When you feel symptoms, you push a button, and an ECG strip of the preceding few minutes and following few minutes is recorded. This permits your doctor to determine your heart rhythm at the time of your symptoms.

  
  


• 
  

  Echocardiogram. In this noninvasive test, sound waves are used to produce a sonar video image of your heart. Sound waves are directed at your heart from a wand-like device (transducer) that's held on your chest (transthoracic echocardiogram). The sound waves that bounce off your heart are reflected through your chest wall and processed electronically to provide video images of your heart in motion, to detect underlying structural heart disease.

  
  

  Doctors may conduct a type of echocardiogram in which they guide a flexible tube with a transducer attached down your throat into your esophagus (transesophageal echocardiogram). In this test, sound waves are used to produce images of your heart, which may be seen more clearly with this type of echocardiogram. Doctors may also use this test to detect blood clots that may have formed in your heart.

  
  


• Blood tests. These help your doctor rule out thyroid problems or other substances in your blood that may lead to atrial fibrillation.


• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor can also use an X-ray to diagnose conditions other than atrial fibrillation that may explain your signs and symptoms.

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Apr. 19, 2014

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Preventing atrial fibrillation

To prevent atrial fibrillation, a common heart rhythm disorder, it's important to live a heart-healthy lifestyle to reduce your risk of heart disease. A healthy lifestyle may include:

• Eating a heart-healthy diet


• Increasing your physical activity


• Avoiding smoking


• Keeping a healthy weight


• Limiting or avoiding caffeine and alcohol


• Reducing stress, as intense stress and anger can cause heart rhythm problems


• Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat

If you currently have atrial fibrillation, in addition to these lifestyle changes, work with your doctor to manage your heart rhythm condition.

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