There is a wide range of available treatments for atrial fibrillation. Patients may be entirely treated by their GP (general practitioner, primary care physician), while others may require the expertise of a cardiologist. Determining treatment depends largely on what caused the atrial fibrillation.
Sometimes all that is required is to treat the cause, as may be the case with an overactive thyroid gland (hyperthyroidism) - treat the overactive thyroid and the atrial fibrillation problem goes away. Sometimes no underlying cause is found and the doctor may have to try out different treatments before finding the most appropriate one for the patient.
Medications to control atrial fibrillation (anti-arrhythmics)
Controlling atrial fibrillation can be approached in two ways:
- The normal heart rhythm can be restored.
- The rate at which the heart beats can be controlled.
Available drugs can do one of three things:
- Restore normal heart rhythm.
- Control the heart rate.
- Both restore normal heart rhythm and control the heart rate.
Which anti-rrhythmic medication to use depends on:
- The type of atrial fibrillation.
- Other medical conditions the patient might have.
- Side effects of the chosen drug.
- How well the patient's atrial fibrillation responds to treatment.
Sometimes a patient will need to take more than one anti-arrhythmic drug.
Restoring normal heart rhythm - the doctor will start by using a beta-blocker. Examples of beta-blockers are atenolol, bisoprolol, or sotalol. If they do not work, or if their side effects are too unpleasant, the doctor may try flecainide or amiodarone.
Controlling the rate of the heartbeat - the aim here is to bring the heart rate to below 90 beats per minutes. In some cases the aim may be a maximum of 110 beats per minute. The doctor may try a beta-blocker first, or a channel blocker, such as verapamil or diltiazem. One of these drugs may be given in combination with digoxin, or amiodarone to further control the heart rate.
The U.S. Food and Drug Administration has approved Multaq tablets (dronedarone) to help maintain normal heart rhythms in patients with a history of atrial fibrillation or atrial flutter (heart rhythm disorders). The drug is approved to be used in patients whose hearts have returned to normal rhythm or who will undergo drug or electric-shock treatment to restore a normal heart beat. The drug's label will contain a boxed warning, the FDA's strongest warning, cautioning that the drug should not be used in severe heart failure patients. In a multinational clinical trial with more than 4,600 patients, Multaq reduced cardiovascular hospitalization or death from any cause by 24 percent, when compared with an inactive pill (placebo).
Side effects of anti-arrhythmics
- Beta-blockers - fatigue, cold hands and feet, hypotension (low blood pressure), erectile dysfunction (male impotence), and nightmares.
- Frelainide - vomiting, nausea, heart rhythm problems.
- Amiodarone - skin becomes sensitive to sunlight, lung problems, changes to liver function, changes to thyroid function, deposits in the eye (which go away when treatment is stopped).
- Verapamil - hypotension (low blood pressure), heart failure, swelling of the ankles, constipation.
- Multaq - diarrhea, nausea, vomiting, fatigue and weakness.
Drugs to prevent stroke
Patients with atrial fibrillation have a higher risk of blood clots forming in the heart chambers which can get into the bloodstream and cause a stroke. The doctor will determine whether the patient has a high, moderate or low risk of developing a stroke and will then decide on whether to prescribe medication; and which one to prescribe.
Risk factors include the patient's age, whether there is a past history of stroke, blood clots, heart valve problems, heart failure, hypertension, diabetes or heart disease. If medication is deemed to be necessary, the doctor will prescribe either warfarin or aspirin.
Warfarin - for patients with either high or moderate risk of developing stroke. Warfarin makes it harder for the blood to clot. Although warfarin increases the risk of bleeding, it is prescribed for patients whose risk of stroke is greater than their risk of bleeding. Patients need to have regular blood tests - sometimes, depending on the results of the blood tests, the warfarin dosages need to be altered.
It is crucial that the patient takes the warfarin as directed by the doctor. As warfarin can interact harmfully with many medications, it is vital that the patient and doctor check for this every time a new medication is prescribed or bought over the counter. A trained pharmacist will know which medications interact with warfarin. Even alcohol and cranberry juice can affect warfarin.
- Aspirin - for patients with a low risk of stroke. Also, for patients who are unable to take warfarin. The aspirin dose is a low one and is taken daily.
Cardioversion - the heart is given a controlled electric shock. The aim is to restore normal rhythm. Cardioversion is used when the atrial fibrillation is diagnosed early. This is done in a hospital. Experts say that cardioversion has a success rate of over 90% in early-diagnose patients.
When atrial firbrillation is not diagnosed early - if it has been ongoing for more than a couple of days - cardioversion has the risk of clot formation and embolism. These patients need to be given a blood-thinning drug, such as warfarin, for three weeks before a cardioversion and at least four weeks after it; otherwise the patient is at serious risk of developing a stroke. Patients deemed at high risk of an atrial fibrillation recurrence need to continue with warfarin.
- Pacemaker - this device replaces the job of the atrioventricular node. A pacemaker is a small device that is placed under the skin of the chest or abdomen to help control abnormal heart rhythms; it uses electrical pulses to prompt the heart to beat at a normal rate.