Atrial fibrillation (A-fib) is a medical condition that disrupts the rhythm of the heart, causing irregular and rapid beating in its upper chambers. However, a person can manage the condition using medications and by making lifestyle changes.
People with A-fib have a higher risk of heart failure and stroke. In fact, their risk of stroke is around five times higher than that of people who do not have A-fib. However, several medications can help reduce these risks.
This article lists the medications available for A-fib and explains when to use them. It also discusses their potential side effects.
People take medications for A-fib to address specific health concerns. These include:
- preventing clots
- controlling heart rate
- managing the heart’s rhythm
The sections below describe the different medications that can help a person achieve each of these positive health outcomes.
Preventing blood clots is one of the main reasons that people with A-fib take medications.
People might use the following medications to treat clots that have already developed or to thin the blood and keep clots from forming in the first place.
Three different kinds of anticlotting medications are available for people with A-fib:
- “traditional” anticoagulants, such as warfarin (Coumadin)
- novel oral anticoagulants (NOACs)
- antiplatelets, such as aspirin or clopidogrel (Plavix)
NOACs are the preferred route of drug treatment for preventing blood clots. According to the European Society of Cardiology, NOACs are more effective than antiplatelets at preventing blood clots.
NOACs are usually more expensive than warfarin. However, unlike warfarin, NOACs do not require regular blood tests.
The Food and Drug Administration (FDA) have approved the following NOACs for managing A-fib:
- dabigatran (Pradaxa)
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
- edoxaban (Savaysa)
However, antiplatelet therapy is available for people who may not be able to take NOACs, such as those with chronic kidney disease or anemia.
Controlling heart rate
Controlling the heart rate can improve quality of life for a person with A-fib. The American Heart Association (AHA) advise that doctors prescribe three main types of drug to help a person control their heart rate.
- beta-blockers, such as atenolol, bisoprolol, carvedilol, metoprolol, nadolol, propranolol, or timolol
- calcium channel blockers, such as diltiazem or verapamil
- digitalis, or digoxin (Lanoxin), which regulates electrical currents in the heart
Managing the heart’s rhythm
Managing the heart’s rhythm is one of the more complex requirements of A-fib medications. Using medication to bring the heart back to a normal rhythm is also known as drug, or chemical, cardioversion.
According to the AHA, there are two ways to achieve chemical cardioversion. The sections below describe these in more detail.
Limiting the ability of the heart to conduct electricity
People who need this approach can take sodium blockers, such as:
- flecainide (Tambocor)
- propafenone (Rythmol)
Interfering with the disruptive electrical signals that cause irregular heart rhythms
Doctors prescribe potassium blockers to treat A-fib with this approach, such as:
- amiodarone (Pacerone)
- sotalol (Betapace)
- dofetilide (Tikosyn)
However, some doctors are cautious about prescribing these medications, which are known as antiarrhythmic drugs. This is because their side effects can significantly affect heart rate and other essential functions.
Between 2.7 and 6.1 million people in the U.S. have A-fib. It is most common in people over 65 years of age, though it can also develop in younger people.
Doctors look at a number of factors before developing a treatment plan, including:
- the person’s age
- the severity of their symptoms
- how often the symptoms occur
- their heart rate
- their risk of stroke
- any underlying heart disease or other health conditions
Many doctors are now using the CHA₂DS₂-VASc scoring approach to assess a person’s risk of stroke, as well as to determine which A-fib medications would best meet their needs.
To calculate a person’s risk of stroke, this approach awards points based on:
- whether or not a person has congestive heart failure
- the presence of high blood pressure
- if they are 65–74 years of age or older
- the presence of diabetes
- any previous strokes or blood clots
- underlying vascular disease, such as having had a heart attack in the past
- their sex (females have a higher risk)
All of these factors can increase the risk of stroke and would serve as grounds for a doctor to recommend more aggressive treatment for A-fib.
The main goal of A-fib medication is to reduce the risk of stroke, often with drugs such as warfarin or other anticoagulants. Doctors generally combine these medications with those that make the heartbeat more regular.
If anticoagulants and heart rate drugs are successful in preventing symptoms and restoring a regular heart rate, a doctor may decide that no further medication is necessary, even if a person still has A-fib.
If a doctor believes that an individual still needs to regulate their heart rhythm, or if the initial treatment did not successfully control their symptoms or heart rate, they may prescribe drugs to better control the heart’s rhythm.
The use of A-fib medications depends on the type and severity of the condition.
There are three basic types of A-fib:
- Paroxysmal: This is more common in the early stages of the condition, wherein episodes occur intermittently but not frequently.
- Persistent: This develops when an irregular heartbeat lasts for longer than 7 days.
- Long-standing persistent (formerly known as permanent): A doctor would describe A-fib as long-standing persistent when it is not possible to bring the heart back to a regular rhythm.
Although episodes of paroxysmal A-fib might appear to resolve, it is generally a long-term condition. According to the National Heart, Lung, and Blood Institute, multiple episodes of A-fib can change the heart’s electrical system and make ongoing treatment necessary.
Anyone who has an episode of A-fib needs to work with their doctor to monitor their heart health closely, even if they do not feel any symptoms. This is because A-fib does not cause noticeable symptoms in every person who has it.
Most people with A-fib will need to take medication to manage their symptoms and reduce their risk of stroke.
For some people, medication alone is not enough to control A-fib. In these cases, a doctor may recommend more intensive treatment options, such as catheter ablation, surgical maze procedures, or electrical stimulation.
Medications are important for maintaining the health and well-being of people with A-fib.
However, any medication can carry risks. People should work closely with their prescribing doctor to make sure that their drugs are working correctly and not causing too many adverse effects.
In general, a woman should tell their doctor if they are breastfeeding, pregnant, or planning a pregnancy. Some A-fib medications can be harmful in these cases.
The sections below discuss the possible risks and side effects of each main type of A-fib medication.
People taking anticoagulants should remember that these medications work by interfering with the body’s ability to stop bleeding. As a result, people taking these medications have a higher risk of excessive bleeding.
A person should make sure that their doctor, pharmacist, and dentist know about their anticoagulant use, and they should watch for signs of unusual bleeding during any other treatment.
Taking beta-blockers can cause the following adverse effects:
- bronchospasm, or spasms of the airway (though this is rare)
- interrupted sleep and insomnia
Beta-blockers may also make people more sensitive to cold weather.
Grapefruit juice might also interact with beta-blockers and reduce their effectiveness.
People taking antiarrhythmic drugs need to be aware that these can actually cause arrhythmia in some cases. In others, researchers have associated the drugs with serious damage to the lungs, liver, and thyroid, along with dizziness, difficulty seeing, and a “metallic taste.”
People taking antiarrhythmic drugs should watch carefully for changes in their heart rate, vision, and weight. Lightheadedness, shortness of breath, and swelling of the feet or legs are known side effects of these medications.
Side effects of some specific medications
Specific side effects of some A-fib medications include the following:
- Amiodarone (Pacerone), which is one of the more effective antiarrhythmic medications, can be harmful to the lungs and may cause the skin to turn blue or gray, according to one 2019 study.
- Diltiazem (Cardizem or Taztia) may cause dizziness, fatigue, and headaches, as well as a slow heart rate.
- Warfarin (Coumadin), which is an anticoagulant, can cause excessive bleeding. People using this medication will need regular blood tests to make sure that they are taking the right dosage.
Several medications are available to treat or manage the various effects of A-fib.
The type of A-fib a person has and how severe it is will dictate which medications are best. A doctor will monitor the effect of the drug over time, checking regularly for any adverse effects.
However, some drugs that interfere with clotting can increase the risk of excessive bleeding. It is best to seek consultation with a doctor on noticing side effects when taking medication for A-fib.
If medications do not resolve the irregular heart rhythms, surgical options can help treat the condition more intensively.