Atrial fibrillation (or AFib) is a condition that causes an irregular, fast heart rate and rhythm. It also causes issues with blood circulation.
Afib can range in severity. It may cause you occasional problems, or you may have persistent and permanent heart rhythm issues. This condition can lead to blood clots, heart failure, stroke, and dementia. If you have a more severe form of AFib, you’ll need medication. Drugs can control your heart rate and prevent blood clots.
Each type of AFib drug has a specific purpose. Like all medications, AFib drugs can cause side effects. Talk with your doctor about the risks and benefits of your medication before you start treatment.
Many people with AFib have heart palpitations. These can feel like flutters in your chest or a pounding in your heart.
In a healthy heart, the electrical activity is regulated and organized well. It causes a steady, consistent heart rate. But in AFib, one of the main problems is that the heart’s right atrium (or chamber) fires off electrical signals randomly and quickly. This activity can be so chaotic that the atrium can’t contract at all. Instead, it trembles or fibrillates.
The fibrillating chamber sends electrical signals to other areas of the heart. The signals can overwhelm the control structures in your ventricles. (Your ventricles are the lower chambers of your heart.) This can cause a fast, irregular heart rate.
Your doctor may give you heart rate control medications. This can help make your heart rate more consistent. It may also restore normal beats.
Drugs that work this way include:
- beta blockers
- calcium channel blockers
Digoxin works by helping to control electrical currents between the upper and lower chambers of the heart. This action helps control heart rate.
Digoxin is often used with other medications. It may not work as well when you exercise or are under a lot of physical or emotional stress. Other AFib drugs may work better during these times.
The more common side effects of this drug can include:
- breast enlargement
- mental health issues, such as depression, anxiety, and hallucinations (seeing or hearing things that aren’t there)
- fast, irregular heart rate
- stomach problems, such as nausea, vomiting, or diarrhea
- unusual weakness or tiredness
- unexplained bruising or bleeding
- changes in vision
These drugs work by slowing your heart rate down. They can reduce how often you have palpitations. However, in some people, beta blockers may actually cause palpitations.
Examples of these drugs include:
- carvedilol (Coreg)
- nadolol (Corgard)
- metoprolol (Lopressor)
- propranolol (Inderal, InnoPran)
- atenolol (Tenormin)
- bisoprolol (Zebeta)
These drugs work very well at controlling heart rate. They’re also effective in lowering the risk of heart attacks in people whose AFib is due to coronary artery disease.
Still, these drugs may cause side effects. These can include:
- low blood pressure
- heart failure
- mental health issues, including depression
Your doctor will monitor you closely for side effects during treatment with these drugs.
Calcium channel blockers
These drugs work like beta blockers. They decrease heart rate. Calcium channel blockers for AFib are centrally acting. This means that they help lower heart rate. Other calcium channel blockers are peripherally acting. They may lower blood pressure, but they aren’t helpful for AFib heart rate problems.
Centrally-acting calcium channel blockers work by weakening your heart contractions. These drugs include:
- diltiazem (Cardizem)
- verapamil (Calan, Isoptin)
The more common side effects of these drugs include:
- heart failure
- low blood pressure
If you have heart failure or low blood pressure, you should not use calcium channel blockers. Your doctor will give you a different medication to treat your AFib.
AFib affects both heart rate and heart rhythm. Your doctor may give you medications for each of these issues.
The first step is to control your heart rate. Once your heart rate is better controlled, your doctor may focus on treating your heart rhythm. You may need to have an electrical cardioversion done to control your heart rhythm. But drugs are also an option in some cases. These drugs are called anti-arrhythmic drugs. They include:
Sodium channel blockers
These drugs work by controlling the electricity in your heart. They include:
- propafenone (Rythmol)
- quinidine (Quinalan, Quinatime)
The more common side effects of these drugs can include:
- trouble breathing
- chest pain
Potassium channel blockers
These drugs work by reducing the electrical signals in your heart that cause symptoms of AFib. Potassium channel blockers include:
- amiodarone (Pacerone)
- Dronedarone (Multaq)
- sotalol (Betapace)
Dronedarone (Multaq) is a new drug is only used to prevent AFib in people who have had the condition in the past. You should not take this drug if you have permanent AFib.
The more common side effects of potassium channel blockers can include:
- slow heart rate
- chest pain
- trouble breathing
These drugs are used to prevent blood clots. In AFib, the chaotic atrial electrical activity in your heart stops the atria from contracting well. This causes blood to move sluggishly through the atria. It can even pool in some areas. If this happens, blood clots can form easily.
When one of these blood clots breaks off, it can travel to the lungs. There, it could cause a pulmonary embolism. The clot can travel to other parts of your body, too. A clot may cause a stroke, ischemia (reduced blood flow to your heart), or blocked blood flow. These conditions can all be fatal (cause death).
There are two main types of drugs that help prevent dangerous blood clots. These include anticoagulants and antiplatelet agents. These drugs are sometimes called blood thinners. However, this is misleading because they don’t affect the thickness of your blood. Instead, these drugs work by preventing the formation of clots.
- warfarin (Coumadin)
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- edoxaban (Savaysa)
- rivaroxaban (Xarelto)
Due to their strong effects, these drugs are also used to prevent strokes.
Antiplatelet agents include:
- anagrelide (Agrylin)
- clopidogrel (Plavix)
- dipyridamole (Persantine)
- prasugrel (Effient)
- ticagrelor (Brilinta)
- tirofiban (Aggrestat)
- vorapaxar (Zontivity)
While blood thinners can help prevent clots from AFib, they can’t cure existing blood clots. However, there are other drugs or treatments that can if your clot is significant. The greatest risk with blood thinners is bleeding. Your doctor may have you temporarily stop your medication if you plan to have surgery.
Side effects from blood thinners can be life-threatening. Tell your doctor right away if you have any side effects. They can include the following:
- stomach pain
- bad headache
- dark or bloody urine
- dark or bloody stools
- bleeding gums
Over-the-counter pain relievers and cold medications can interact with blood thinners. Vitamins, green tea, and ginger can also cause interactions. Interactions can increase your risk of side effects. Tell your doctor about all medications you take before starting treatment with any AFib drugs.
AFib is an ongoing health problem. Most people need long-term treatment to keep their heart working well. These drugs are the common drugs doctors use to treat Afib. Never stop taking your medications without talking with your doctor first. If your drug is causing bothersome side effects, talk with your doctor. There are other drugs to treat Afib. Together, you and your doctor can find a medication that works well for you.