Many prescription medications are available to help manage atrial fibrillation (A-fib). Examples include anticoagulants, antiplatelets, and more. Different medications can help to control heart rate, prevent blood clots, and restore the rhythm of the heart.

Also known as A-fib, this condition is a type of arrhythmia, meaning that a person has an irregular heart rhythm. The beating of the upper two chambers of the heart, known as the atria, is irregular. It occurs after damage to heart tissue or a problem with electrical signaling, typically as a result of other conditions. Due to this irregular beating, the heart is unable to pump blood efficiently, which can lead to blood collecting in the heart and an increased risk of clots.

A-fib is the most common clinical arrhythmia. Although it can occur at any stage of life, the risk of developing A-fib increases with age. The treatment options include medications that help control the heart’s rhythm and rate and drugs that prevent blood clots from forming.

In this article, we discuss the different types of medications that can help manage atrial fibrillation.

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Image credit: Matt Cardy/Getty Image.

Due to the irregular heartbeat that may occur with A-fib, blood can pool in the heart and increase the risk of blood clots. If these blood clots enter the bloodstream, they can lead to a stroke. As such, people may receive drugs known as blood thinners to prevent blood clot formation or to treat an existing blood clot. Examples of drugs that help prevent blood clots include:

Anticoagulants

Anticoagulants are a group of medications that reduce the body’s ability to form blood clots by interrupting the blood clotting process. The formation of a blood clot relies on substances called clotting factors undergoing a coagulation cascade. By preventing these substances from working correctly, anticoagulants can help reduce the formation of blood clots.

Possible side effects of anticoagulants include:

  • excessive bleeding
  • dizziness
  • headaches
  • changes in bowel movements

Examples of anticoagulants include:

Antiplatelets

Antiplatelet drugs describe medications that prevent platelets, also known as thrombocytes, from sticking together. Platelets are small fragments of cells, and their main function is to stick to the lining of blood vessels and form a blood clot to help stop or prevent bleeding.

However, a high number of platelets can result in unnecessary clotting, which can increase the risk of a stroke. As such, a doctor may only recommend antiplatelets for individuals with a high risk of A-fib or other cardiovascular events. A person should not start or stop aspirin without first consulting a doctor.

Possible side effects of antiplatelets include:

  • bleeding more easily
  • stomach pain
  • diarrhea
  • indigestion or heartburn

Examples of antiplatelets include clopidogrel bisulfate and aspirin.

These medications, which are known as anti-arrhythmic drugs, help control heart rate. Typically, they slow the heart rate by blocking irregular electrical signals in the atria, which prevents their transmission to the ventricles. Examples of heart rate-controlling medications include:

Beta-blockers

Beta-blockers, also known as beta-adrenergic blocking agents, are a group of drugs that block the action of certain hormones that can affect the heart rate. They can block the release of epinephrine and norepinephrine, which would otherwise cause a rapid heartbeat and heart palpitations.

Beta-blockers can also reduce the production of angiotensin II. In doing so, they help blood vessels relax, easing the passage of blood.

Generally, people are able to tolerate beta-blockers well. However, some individuals may still experience side effects, such as:

Examples of beta-blockers include:

Calcium channel blockers

Calcium channel blockers (CCBs) can increase blood flow and oxygen to the heart. Calcium plays a vital role in enabling muscle contraction and allowing the heart to pump blood around the body. CCBs reduce the amount of calcium that can enter cardiac muscle cells and blood vessel walls, which helps lower blood pressure and slow a person’s heart rate.

Side effects from CCBs are rare, but they can include:

  • constipation
  • slow heart rate
  • low blood pressure
  • dizziness

Examples of calcium channel blockers include diltiazem hydrochloride and verapamil hydrochloride.

Digoxin

Digoxin is a drug that can help manage heart rate. It influences the electrical activity in the heart, increasing the force of contraction while slowing conduction to decrease heart rate. A doctor may prescribe digoxin if a person is unable to tolerate beta-blockers or CCBs. Alternatively, they may suggest using digoxin in addition to these drugs if a person requires a further reduction in their heart rate.

Potential side effects of digoxin include:

  • confusion
  • dizziness
  • nausea
  • diarrhea
  • blurry vision
  • skin rashes

These types of drugs attempt to restore the heart rhythm to normal. Experts may also refer to this as pharmacological or chemical cardioversion. Electrical signals help the heart contract in a coordinated way. A-fib disrupts this signaling pathway, leading to an abnormal heart rhythm. These drugs allow the heart to reset into a normal rhythm. Examples of heart rhythm controlling medications include:

Sodium channel blockers

The heart features many different ion channels, including sodium channels, which help create an electrical action potential that promotes rhythmic contraction of the heart. Therefore, sodium channel blockers help restore the heart’s rhythm by slowing its ability to conduct electricity.

Potential side effects of sodium channel blockers include:

  • vision problems
  • dizziness
  • headaches
  • changes in bowel movements

Examples of sodium channel blockers include:

Potassium channel blockers

Potassium is an essential macromineral that plays a role in heart function. High levels of potassium, known as hyperkalemia, can result in an abnormal heart rhythm. As such, potassium channel blockers can help restore heart rhythm by slowing electrical signals that can cause A-fib.

Possible side effects of potassium channel blockers include:

  • headaches
  • dizziness
  • abdominal pain
  • insomnia

Examples of potassium channel blockers include:

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 will describe A-fib as long standing persistent when it is not possible to bring the heart back to a regular rhythm.

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.

Doctors look at various factors before developing a treatment plan. These include:

  • 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 use the CHA₂DS₂-VASc score to assess a person’s risk of stroke and to determine which A-fib medications would best meet their needs. This approach calculates a person’s risk of stroke by awarding points based on whether the person:

  • has congestive heart failure
  • has high blood pressure
  • is aged 65–74 years or older
  • has diabetes
  • has previously had a stroke or blood clot
  • has underlying vascular disease, such as having had a heart attack in the past
  • was assigned female at birth

Several medications are available to treat or manage the various effects of A-fib. The type and severity of A-fib will dictate which medications are best. A doctor will monitor the person’s response to the drug over time, checking regularly for any adverse effects and any changes in symptoms.

As with any drug, some people may experience side effects when taking A-fib medications. These may include a risk of excessive bleeding, hypotension, and a slow heart rate. If medications do not resolve the irregular heart rhythms, a doctor may suggest surgical options to help treat the condition.