Atrial Fibrillation Treatment and Medications

Atrial fibrillation (AFib) is an irregular heartbeat that originates in the upper two chambers of the heart, called the atria. Usually, the heart beats at a steady rate with a coordinated rhythm between these upper chambers and the lower chambers, called the ventricles. In AFib, abnormal electrical signals cause an irregular heartbeat, a condition called heart arrhythmia. If the heart is unable to pump blood through the heart correctly, blood can pool in the upper chambers and form a blood clot. When the clot exits the heart, it can block a blood vessel and damage the body's organs or cause a stroke. In fact, people with untreated AFib are five times more likely to have a stroke than the rest of the population. It also significantly increases the risk of heart failure and other complications. If you have AFib, your healthcare provider will recommend the best treatment for your condition. 

How is atrial fibrillation diagnosed?

The first step is to recognize the symptoms of atrial fibrillation:

• Heart palpitations

• General fatigue or tiredness

• Dizziness

• Shortness of breath

• Excessive sweating

• Chest pain or discomfort

Some people show no symptoms. They do not realize there's a problem until a health practitioner notices an irregular heartbeat or pulse. However, many people with no symptoms do experience "hidden" symptoms like occasional shortness of breath, unexplained sweating, or fatigue. Some people with the condition just don't feel good, which is often overlooked.

RELATED: 15 signs of heart problems worth worrying about

Risk factors for AFib include, but are not limited to: 

• Advancing age

• Heart disease

• High blood pressure

• Obesity

• Diabetes

• Overactive thyroid

• Alcohol use

• Enlargement of the heart

• Structural heart defects

AFib is often diagnosed during a visit with your healthcare provider. Some patients, however, are first diagnosed in an emergency during an active episode. Smartwatches with a built-in heart monitor are also helping with early AFib diagnosis. 

Diagnosis involves identifying the condition, a possible cause, and determining the risk for stroke. The healthcare provider will perform the following tests:

• Physical exam and medical history

• An electrocardiogram (EKG) that shows the heart's electrical activity

• An ultrasound echocardiogram (ECG) that allows the healthcare professional to watch the heart beating.

The EKG is usually enough to support a diagnosis of AFib. The physician, however, may perform more procedures:

• A transesophageal echocardiogram (TEE) may be performed if there might be a blood clot in the heart that poses an immediate risk for stroke. A long, thin tube is inserted down the throat so the healthcare provider can image the heart without the ribs obscuring any blood clot.

• Blood tests can determine a cause for the condition, such as an electrolyte imbalance, infection, or overactive thyroid.

Atrial fibrillation treatment options

Although there is no AFib cure, it is highly treatable and manageable. Atrial fibrillation treatment is meant to achieve one or more of these goals:

• Prevent blood clots

• Restore a normal heart rate

• Restore a normal heart rhythm

AFib treatment options will depend on factors such as the patient's age, risk for stroke, heart rate, symptoms, medical conditions, and tolerance for side effects.

Electrical cardioversion

Electrical cardioversion applies a low-energy electrical shock directly to the chest. It is often used in an emergency to "reset" the heart to a normal heart rhythm (sinus rhythm). It may also be used at any time during treatment. Before applying electrical cardioversion, the physician will perform a transesophageal echocardiogram (TEE) to identify blood clots in the heart. A normal rate will pump the blood clot out of the heart, so the patient will have to be treated with blood thinners first.

Surgery

As with medications, surgical procedures can help reduce the risk of stroke, restore a normal heart rate, or restore an organized heartbeat. There are various surgical procedures used to treat AFib, including catheter ablation, the Maze procedure, left atrial appendage closure, and pacemakers. 

Medications

The paramount goal of AFib treatment is to prevent stroke or other blood vessel blockage. Healthcare providers will often prescribe a blood thinner to reduce the risk of blood clotting. They may prescribe medication to control the rate or rhythm of the heart. The choice between medicines will depend on factors such as the patient’s age, symptoms, medical conditions, and tolerance for side effects.

Types of AFib medication

AFib medications can prevent blood clots, return the heart to a normal rate, or restore the heart's normal rhythm.

Blood thinners

Blood thinners reduce the body's ability to form blood clots. Anticoagulant drugs, such as Xarelto (rivaroxaban), Eliquis (apixaban), warfarin, or dabigatran, may be prescribed to reduce the risk of blood clots and stroke. 

RELATED: Do you have to take blood thinners for AFib?

Rate control medications

AFib may cause the heart to beat too quickly, which can damage the lower chambers of the heart (the ventricles). Rate control medications slow the heart down, preventing the heart from speeding up. Rate-control medications work by interfering with the chemical processes responsible for muscle contractions. 

Beta blockers are commonly used for rate control. Calcium-channel blockers, such as verapamil or diltiazem, may also be used. Cardiac glycosides, such as digoxin, may be used in certain patients, such as those with heart failure, low blood pressure, who are highly sedentary, and who are older. 

RELATED: What is a beta blocker?

Rhythm control medications

Rhythm control medications, or antiarrhythmic drugs, are prescribed to restore or maintain a normal heart rhythm. The prescribed medication will be based on the type of irregular heartbeat and the patient's tolerance for side effects. The most common rhythm control medications prescribed are propafenone, flecainide, amiodarone, dofetilide, dronedarone, and sotalol.

Over-the-counter AFib medicine

There are no over-the-counter medicines that treat AFib. Also, some OTC medicines may not be safe in people with AFib, so you should check with your healthcare provider before using any OTC medicines, such as cough and cold remedies.

Most patients diagnosed with atrial fibrillation will be prescribed a blood thinner to prevent stroke. They will often be put on rate control or rhythm control medication as well.

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