Atrial fibrillation (AFib) is the most common type of arrhythmia, or abnormal heart rhythm. According to the Centers for Disease Control and Prevention (CDC), it’s estimated that AFib will affect
AFib means that the heart’s upper chambers (known as the atria), beat out of synch with the lower chambers (known as the ventricles). When this happens, not all blood gets pumped out of the heart.
This can cause blood to pool within the atria, which raises the risk of blood clots forming. If one of these clots breaks free and travels toward the brain, it can restrict blood flow to the brain, causing a stroke.
A person with AFib may have brief, sporadic episodes of an abnormal heart rhythm or experience it on a continuous basis.
Fortunately, there are many treatments for AFib. Some cases of AFib may require medication and surgery or other procedures to help stop the arrhythmia, while others can be managed with medication and a heart-healthy lifestyle.
Certain AFib medications can help restore a normal heart rhythm and rate. They don’t cure AFib, but they can help control symptoms and reduce the frequency and severity of future AFib episodes. Some of these drugs also treat high blood pressure, which is common in people with AFib.
If you have AFib, you may be prescribed medications known as blood thinners. These medications can help prevent blood clots and may lower your risk of a stroke.
The severity of your condition and other measures of heart health will determine which medications your doctor prescribes.
If your heart rate is too fast or too chaotic, this means that your heart doesn’t work as efficiently as it should. Over time, an abnormal heart rate can weaken your heart. This can increase your risk of heart failure.
When treating AFib, your doctor will want to make sure your heart rate is under control. This will make it easier to manage your heart’s rhythm, too.
There are a few major types of drugs designed to control your heart rate, including:
- calcium channel blockers
- digitalis glycosides
Let’s look at each one in more detail.
Beta-blockers are a class of medication that can 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, migraine, and other issues.
Examples of beta-blockers include:
- acebutolol (Sectral)
- atenolol (Tenormin)
- betaxolol (Kerlone)
- labetalol (Trandate)
- bisoprolol (Zebeta)
- carvedilol (Coreg)
- metoprolol tartrate (Lopressor)
- metoprolol succinate (Toprol-XL)
- nebivolol (Bystolic)
- penbutolol (Levatol)
- sotalol hydrochloride (Betapace)
- nadolol (Corgard)
- pindolol (Visken)
Calcium channel blockers
Calcium channel blockers can also slow down your heart rate. These drugs help relax the smooth muscle lining of the arteries and can also keep the heart from absorbing calcium. Calcium can strengthen the heart’s contractions.
As a result of these actions, calcium channel blockers 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 issues.
A drug known as digoxin (Digitek, Lanoxin) belongs to a class of medications called digitalis glycosides.
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 your heart rate.
AFib is an electrical problem. Your heart’s rhythm is controlled by electrical currents that follow a set path throughout the heart.
With AFib, the 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. They help prevent recurring AFib episodes. There are two basic types:
- sodium channel blockers
- potassium channel blockers
Sodium channel blockers
Sodium channel blockers help control heart rhythm by reducing how fast your 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 heart 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.
AFib can interfere with the normal, healthy flow of blood throughout your heart. The irregular beat of the atria allows blood to pool rather than move into the ventricles and out to the lungs or the rest of the body.
Blood that pools can easily become a blood clot. Once that clot leaves the heart it can become lodged in an artery supplying blood to the brain. If it blocks circulation, that clot can cause a stroke—the disruption of blood flow to brain tissue.
There are two main types of blood thinners — medications that either slow down or interfere with the blood clotting process. They include:
Blood thinners raise your risk of bleeding complications. 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 binding 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.
Anticoagulants known as non-vitamin K oral anticoagulants (NOACs) are now recommended over warfarin for most people. Examples of these drugs include:
- dabigatran (Pradaxa)
- edoxaban (Savaysa)
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
Warfarin (Coumadin) is still recommended for people who have moderate to severe mitral stenosis or have an artificial heart valve.
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.
Some possible side effects of calcium channel blockers include:
- tachycardia (fast resting heart rate)
- swelling of your feet and/or legs
Some of the most common side effects of beta-blockers include:
- feeling tired
- feeling dizzy or lightheaded
- cold hands and feet
- difficulty sleeping
The most common side effects from blood thinners are episodes of excessive bleeding. This may include:
- prolonged bleeding from a cut or scrape
- heavy periods
- bleeding gums
- blood in urine or stool
- nosebleeds without an obvious cause
Blood thinners may also cause excessive bruising just under the skin and internal bleeding complications. If you suffer an injury, such as a fall, be aware that weakness or numbness on one side of the body or a sudden headache or change in vision or hearing may indicate internal bleeding.
Treat these symptoms as an emergency and get to a hospital. People who take blood thinners are advised to wear a medical alert bracelet detailing their heart condition and the medications they take.
Don’t stop taking a medication without consulting your healthcare professional. 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 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 healthcare professional about any vitamins, supplements, or natural remedies you take, too, since these substances may also interact with your AFib medications.
Having AFib means working closely with your doctor to manage your condition. You may have a cardiologist or a specialist in abnormal heart rhythms known as an electrophysiologist.
Your particular condition and overall health will determine how often you need to see your doctor for scheduled checkups. However, there may be times, between your regular visits, that you may need medical attention.
For example, if you start to experience noticeable AFib symptoms, it could mean that your condition is becoming more serious or that your current medication is no longer working as effectively as it should.
Make an appointment with your doctor if you start to experience medication side effects, have symptoms that bother you, or have symptoms that last for more than a few days.
More severe symptoms and side effects include:
- a racing heart
- an erratic heart rate
- chest pain
- shortness of breath or trouble breathing
- weakness on one side of the body
If you experience any of these symptoms, be sure to call 911 or get to a hospital right away.
There are many medications used to treat AFib. They each work in different ways. Your doctor will recommend a particular medication based on your:
- overall health
- medical history
- other drugs you’re taking
- the side effects you’re able to tolerate
- other conditions you may have
You may need to try more than one kind of drug or various doses to find the medication and the dosage best suited to control your AFib safely and effectively. If a drug isn’t working or is causing intolerable side effects, your doctor can prescribe a different medication or change your dosage.
It’s important to work with your physician and to take your medications exactly as prescribed. If you have any questions about your medications, be sure to talk with your doctor to get the answers you need.
To maximize the effectiveness of your medications, your doctor may also recommend lifestyle changes that include:
- a heart-healthy eating plan, such as the Mediterranean diet or the DASH diet
- safe, regular exercise that’s well suited to your strength and abilities
- healthy options for stress management
- getting sufficient sleep every night
- managing your weight or losing weight if you’re overweight
- keeping your blood pressure, cholesterol, and blood sugar under control
Medications are a cornerstone of AFib treatment. Some of the most common AFib medications include drugs that can:
- control your heart rate
- control your heart rhythm
- prevent blood clots
It’s important to work with your doctor to find the medication that works best for you. It may take some time to find the drugs and dosages that work most effectively, with the fewest side effects.
Let your doctor know if you have concerning side effects so they can work to find a different, more suitable option for you.