Atrial Fibrillation and Heart Disease
How Is Atrial Fibrillation Treated?
Many options are available to treat AF, including medication, lifestyle changes, certain medical procedures, and surgery. The choice of treatment for you is based on your heart rate and symptoms. The goals of AF treatment are to:
- Regain normal heart rhythm (sinus rhythm)
- Control the heart rate
- Prevent blood clots
- Reduce the risk of stroke
How Are Medications Used to Treat Atrial Fibrillation?
Medications are prescribed depending on the overall treatment goal. If the goal is to restore normal heart rhythm, a type of drug called an antiarrhythmic is prescribed. If it's not possible to achieve this goal, doctors will try to manage your condition by slowing down the heart rate. In both cases, your doctor will give you drugs called anticoagulants to decrease blood clot formation.
Restore normal heart rhythm. These drugs help return the heart to normal rhythm and maintain that rhythm.
- Many drugs are available to restore and maintain a normal heart rhythm, including: amiodarone (Cordarone), dofetilide (Tikosyn), flecainide acetate (Tambocor), propafenone (Rythmol), and sotalol (Betapace AF. You may have to stay in the hospital when you first start taking these drugs so that your heart rhythm can be carefully monitored. These medications are effective 30%-60% of the time, but may lose their effectiveness over time. You may need to try several medications so your doctor can find the best one for you.
- Some rhythm control drugs may actually cause more arrhythmias, so it is important to discuss symptoms and any changes in your condition with your doctor.
- The FDA wants patients to be aware that a clinical trial of dronedarone (Multaq), called PALLAS, was halted when the drug doubled the risk of death, stroke, and heart failure hospitalization in heart patients with permanent atrial fibrillation.
Heart rate control. Heart rate control drugs, such as digoxin (Lanoxin), metoprolol (Toprol XL, Lopressor), other beta-blockers, and calcium channel blockers, are used to help slow the heart rate during atrial fibrillation. You may need to take two different medications to keep your heart rate controlled.
Blood thinners or anticoagulation drugs. Anticoagulant drugs -- such as apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin (Coumadin) -- or antiplatelet drugs -- for example, aspirin, clopidogrel (Plavix), and prasugrel (Effient) -- reduce the risk of blood clots and stroke. Although anticoagulant or antiplatelet drugs reduce the risk of stroke, they do not eliminate the risk. Regular blood tests are required when taking warfarin to evaluate the effectiveness and minimize the risks of the drug. Talk to your doctor about the anticoagulant drug that is right for you.