Atrial fibrillation (AFib) is a type of arrhythmia, or abnormal heart rhythm. According to the American Heart Association, it affects about 2.7 million Americans.
People with AFib have an irregular beating of the heart’s upper chambers, called the atria. The atria beat out of synch with the lower chambers, called the ventricles. When this happens, not all blood gets pumped out of the heart. This can cause the blood to pool within the atria. Clots can form when the blood pools. If one of these clots breaks free and travels toward the brain, it can restrict blood flow to the brain. This can cause a stroke.
People with AFib may have an abnormal heart rhythm on a continuous basis. Or they may only have episodes when their heart beats irregularly. Fortunately, there are many treatments for AFib. These include medications as well as surgical or catheter procedures to help stop the arrhythmia.
If you’ve been diagnosed with AFib, your treatment will likely start with drugs. Medications can help control your heart rhythm and rate. They can also help manage high blood pressure, which is common in people with AFib. Additionally, these drugs can help prevent blood clots from forming.
If your heart rate is too fast, this means that your heart doesn’t work as efficiently as it should. Over time, a heart that beats too fast can become weak. This can lead to heart failure. In treating AFib, your doctor will want to make sure your heart rate is under control. This will make it easier to get your heart’s rhythm under control as well.
There are a few major types of drugs designed to control your heart rate.
These drugs help lower your heart rate. They do this by blocking the effects of epinephrine, also known as adrenaline. Beta-blockers are often given to people with AFib. These drugs can also treat high blood pressure, anxiety, migraines, and other issues.
Examples of beta-blockers include:
- acebutolol (Sectral)
- atenolol (Tenormin)
- betaxolol (Kerlone)
- labetolol (Trandate)
- bisoprolol (Zebeta)
- carvedilol (Coreg)
- metoprolol tartrate (Lopressor)
- metoprolol succinate (Toprol-KL)
- nebivolol (Bystolic)
- penbutolol (Levatol)
- sotalol hydrochloride (Betapace)
- nadolol (Corgard)
- pindolol (Visken)
Calcium channel blockers
Calcium channel blockers also slow down your heart rate. These drugs help relax the smooth muscle lining of the arteries. They also keep the heart from absorbing calcium. Calcium can strengthen the heart’s contractions. These actions mean that these drugs help relax the heart muscle and widen the arteries.
Only two calcium channel blockers are centrally acting. This means that they help lower your heart rate. They’re often used to treat AFib. These drugs include:
- verapamil hydrochloride (Calan SR, Verelan)
- diltiazem hydrochloride (Cardizem CD, Dilacor XR)
Other calcium channel blockers are peripherally acting. They also relax blood vessels, but they aren’t helpful for AFib heart rate problems.
The main digitalis drug is digoxin (Digitek, Lanoxin). This drug helps strengthen heart contractions. Doctors often prescribe it as a regular part of heart failure treatment. Digoxin also helps slow the speed of electrical activity from the atria to the ventricles. This action helps control heart rate.
AFib is an electrical problem. Your heart’s rhythm is controlled by electrical currents that follow a set path throughout the heart. In AFib, electrical currents no longer follow that pattern. Instead, chaotic electrical signals run throughout the atria. This makes the heart quiver and beat erratically.
Drugs that are specifically used to treat problems with heart rhythm are called antiarrhythmic drugs. There are two basic types: sodium channel blockers and potassium channel blockers. Antiarrhythmic drugs help prevent recurring AFib episodes.
Sodium channel blockers
These drugs help control heart rhythm. They do this by reducing how fast the heart muscle conducts electricity. They focus on electrical activity in the sodium channels of the heart cells.
Examples of these drugs include:
- propafenone (Rythmol)
- flecainide (Tambocor)
Potassium channel blockers
Like sodium channel blockers, potassium channel blockers also help control heart rhythm. They slow down electrical conduction in the heart. They do so by interfering with conduction that occurs through the potassium channels in the cells.
Examples of these drugs include:
- amiodarone (Cordarone, Pacerone)
- dronedarone (Multaq)
- sotalol (Betapace)
Dronedarone (Multaq) is a new drug that is only used to prevent AFib in people who’ve had it in the past. People with permanent AFib should not use this drug. Sotalol (Betapace) is both a beta-blocker and a potassium channel blocker. That means it controls both heart rate and heart rhythm.
There are different types of blood thinners. These drugs help prevent dangerous blood clots from forming. They include antiplatelet drugs and anticoagulant drugs. Blood thinners raise your risk of bleeding. If your doctor gives you one of these drugs, they’ll watch you closely for side effects during treatment.
These drugs work by interfering with the action of platelets in your bloodstream. Platelets are blood cells that help stop bleeding by bunching together and forming a clot.
Antiplatelet drugs include:
- anagrelide (Agrylin)
- clopidogrel (Plavix)
- prasugrel (Effient)
- ticagrelor (Brilinta)
- tirofiban (Aggrestat)
- vorapaxar (Zontivity)
- dipyridamole (Persantine)
These drugs work by extending the time it takes for your blood to clot. If your doctor gives you this drug, they’ll monitor you closely to make sure the dosage is right for you. It can be tricky to keep your blood at the correct thinning level, so your doctor needs to check often that your dosage is accurate.
Examples of these drugs include:
- warfarin (Coumadin)
- dabigatran (Pradaxa)
- edoxaban (Savaysa)
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
Anticoagulants come as oral or injectable drugs. The injectable forms are often given in the hospital by a healthcare provider. You may eventually be able to give the injections to yourself and continue to take them at home. In some cases, you may only take them at home. These injectable drugs are given subcutaneously (under the skin).
Injectable anticoagulants include:
- enoxaparin (Lovenox)
- dalteparin (Fragmin)
- fondaparinux (Arixtra)
Different medications for AFib have different potential side effects. For example, antiarrhythmic drugs that treat irregular heart rhythms can actually cause those symptoms to happen more often. Calcium channel blockers can cause tachycardia, headaches, and dizziness, among other side effects. Beta-blockers can lead to side effects such as tiredness, cold hands, and digestive upset, as well as more serious issues.
If you believe you’re having side effects from one of your medications, talk to your doctor. Don’t stop taking a medication without consulting your healthcare provider. Your doctor can discuss other options with you. You might not have the same side effects with a different drug, even if it serves a similar purpose.
You can ask your doctor if you may be at higher risk for any particular side effects based on your health history and the other medications you take.
Your doctor should have a complete list of all of the medications you take to ensure that there aren’t any negative interactions between the different drugs. Be sure to tell your physician about any vitamins, supplements, or natural remedies you take, too, since these substances may also interact with medications for your AFib.
There are many medications used to treat AFib. They each work in different ways. Your choices will depend on your medical history, the side effects you can tolerate, what other drugs you’re taking, and other factors. Talk with your doctor to find the drug that works best to control your symptoms.