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Atrial Fibrillation (cont.)

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What is the treatment for atrial fibrillation (AFib)?

The treatment of atrial fibrillation is multi-faceted and involves:

  1. reversing the factors that cause atrial fibrillation;
  2. slowing the heart rate with medications;
  3. preventing strokes;
  4. converting atrial fibrillation to a normal heart rhythm with medications or electrical shock;
  5. preventing the recurrence of atrial fibrillation with medications; and
  6. using procedures (for example, pacemakers, defibrillators, surgery) to prevent episodes of AFib.

Reversing the risk factors that cause AFib

An important first step in the treatment of AFib is to uncover and correct conditions (such as hyperthyroidism or use of stimulant drugs) that can cause AFib. These steps include:

  • stopping the use of stimulant drugs and excessive alcohol intake;
  • controlling high blood pressure;
  • correcting hyperthyroidism (too much thyroid hormone) and low blood oxygen levels; and
  • controlling heart failure and treating the diseases of the heart and the lungs that can cause atrial fibrillation;

Slowing the heart rate with medications

Having excluded or corrected the factors that cause AFib, the next step when the ventricles are beating too rapidly usually is to slow the rate at which the ventricles beat.

Available medications to slow heart rate in AFib

Patients with AFib and healthy AV nodes usually have ventricles that beat rapidly. Medications are necessary to slow down the rapid heart rate. Medications to slow the heart rate in atrial fibrillation include:

  • digitalis (Digoxin)
  • Beta blockers such as propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor), esmolol (Brevibloc)
  • Calcium channel blockers such as verapamil (Calan), diltiazem (Cardizem)

These medications slow the heart rate by retarding conduction of the electrical discharges through the AV node. These medications, however, do not usually convert AFib back into a normal rhythm. Other drugs or treatments are necessary to achieve a normal heart rhythm.

Benefits of controlling the rate: In patients with rapid ventricle contractions as a result of AFib, slowing the rate of ventricular contractions improves the heart's efficiency in delivering blood (by allowing more time between contractions for the ventricles to fill with blood) and relieves the symptoms of inadequate flow of blood -- dizziness, weakness, and shortness of breath.

With chronic, sustained AFib, doctors may decide to leave some patients in atrial fibrillation provided that their heart rates are under control, the output of blood from the ventricles is adequate, and their blood is adequately thinned to prevent strokes. This form of treatment is called rate control therapy (see below).

Limitations of medications for controlling the heart rate: In patients with diseased AV nodes, ventricular contractions may be slower than in patients who have normal AV nodes. Moreover, some elderly patients with atrial fibrillation are extremely sensitive to medications that slow the rate of ventricular contractions, usually because of a diseased AV node. In these patients, the heart rate can become dangerously slow with small doses of medications to slow the heart. This condition is referred to as tachycardia-bradycardia syndrome, or "sick sinus syndrome." Patients with tachycardia-bradycardia syndrome need medications to control the fast heart rate and a pacemaker to provide a minimum safe heart rate.

Medications used in slowing atrial fibrillation generally cannot convert atrial fibrillation to a normal rhythm. Therefore these patients are at risk for the formation of blood clots in the heart and strokes and will need prolonged blood thinning with anticoagulants like warfarin (Coumadin).

Medically Reviewed by a Doctor on 5/4/2015


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