When you have atrial fibrillation, the goal is to get your heart rate under control and sometimes try to bring your heart back to rhythm. In addition your doctor will want to help you prevent blood clots that can lead to a stroke. For many people with AFib, medicine is the best treatment option.
How Medicines Help
AFib prevents blood from flowing normally from your heart's upper chambers (called the atria) to the lower ones (the ventricles). Blood can pool in the atria and form clumps called clots. If one travels to your brain, it could cause a stroke.
Medicines do a few different things. They can:
- Prevent blood clots. These types of medications lower your chances of having a stroke.
- Slow your heart rate. Some medications lower the number of times your ventricles contract each minute. This slowed rhythm gives them enough time to fill with blood before pumping it out to your body.
- Control your heart rhythm. Other medicines help your atria and ventricles work together to pump blood better.
Blood Thinners to Prevent Clots and Stroke
Blood-thinning medicines help prevent blood clots. Blood clots can move to other parts of your body and cause serious medical problems, such as a stroke. Blood thinners won’t dissolve a blood clot. However, over time, the blood clot may dissolve on its own. Blood thinners may also prevent other clots from forming or growing. They can lower your chances of a stroke by 50% to 70%.
There are other blood thinners you may be given in the hospital, or even at home for a short time. These are common blood thinners you may be given either by vein (IV) or just under the skin in the hospital:
Other blood thinners come as pills you take daily. Some examples of these drugs are:
All of these medicines can raise your chances of bleeding. Be very careful when you play sports or do activities that could cause you to injure yourself and bleed.
Precautions: Blood thinners can make you more likely to bruise or bleed too much. If you take warfarin, for example, you'll see your doctor for a blood test every month to make sure it’s working and you're on the right dose.
- Call your doctor right away if:
- You have any unusual bleeding or bruising.
- You have an accident of any kind.
- You often find bruises or blood blisters.
- You feel sick, weak, faint, or dizzy.
- You think you’re pregnant.
- You notice red, dark brown, or black poop or pee.
- Your periods get heavier.
- Your gums bleed.
- You have a severe headache or stomachache that won't go away.
- You look pale (symptoms of anemia)
- You cough or vomit blood (which may look like coffee grounds)
- You have a fever or illness that gets worse
- You have unusual pain or swelling
- You have difficulty breathing
- Take your dose as instructed. Try to take it at the same time each day, like early in the evening (such as between 5 and 6 p.m.). You can take warfarin with or without food.
- If you forget a dose, don’t take an extra one to make it up. Ask your doctor what to do.
- Ask your doctor about differences if you switch from one type to another.
- Tell other doctors and your dentist if you’re taking one of these mediations if you plan to have a procedure that could cause bleeding.
- If you’re taking warfarin, tell any doctor who wants to give you a new medication. Some drugs and vitamins change the way it works in your body.
Blood thinners are not the same as clot busters, which you may get in the hospital when you have a stroke or heart attack. Clot busters, also called fibrinolytics or thrombolytics, work by dissolving existing blood clots.
Beta-Blockers to Slow Your Heart Rate
One group of AFib medications alters the electrical signals in your heart to slow your heart rate. These medicines don't necessarily fix the abnormal heart rhythm, but they can help you feel better.
Beta-blockers are a type of blood pressure medicine. Some of them are:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta, Ziac)
- Carvedilol (Coreg)
- Metoprolol (Lopressor, Toprol)
- Propranolol (Inderal, Innopran)
- Timolol (Blocadren, Istalol)
Side effects of beta-blockers can include:
Precautions: Beta-blockers don’t work for everyone:
- Let your doctor know if you have asthma. They can cause severe asthma attacks.
- If you have diabetes, be aware they could block signs of low blood sugar, like a rapid heartbeat. Check your blood sugar often.
- They can raise your triglycerides and lower your good cholesterol, but these are short-term changes.
- Don’t suddenly stop taking a beta-blocker -- you could raise your odds of having a heart attack or other problems.
Calcium Channel Blockers to Slow Your Heart Rate
These are another type of blood pressure medicine. They relax blood vessels in your heart and slow your heart rate. Examples are:
Some of the possible side effects of calcium channel blockers:
Precautions: Skip grapefruits and grapefruit juice if you’re taking calcium channel blockers. They can change the way these medications work.
Digoxin (Digox, Lanoxin) to Control Heart Rate
This medication strengthens the heart muscle's contractions and works on your heart's electrical system to slow the rate that signals move from the atria to the ventricles. Two common brands are Lanoxicaps and Lanoxin. Digoxin belongs to the digitalis class of medications..
You usually take this medication once daily. Try to take it at the same time every day. Follow the label directions on how often to take it. The time between doses and how long you take it will depend on your condition.
While taking digoxin, your doctor may tell you to check your pulse every day. They’ll tell you how fast your pulse should be. If it’s slower than that, talk to your doctor about taking digoxin that day.
Keep all your appointments with your medical team so they can keep track of how you react to the drug.
Digoxin may cause drowsiness. Don’t drive a car or use machinery until you discover how this medicine affects you.
If you have any of these side effects call your doctor right away:
- Nausea and vomiting
- Stomach pain
- Appetite loss
- Slow or fast heartbeat
- Changes in vision, such as:
- Flashes or flickering of light
- Sensitivity to light
- Seeing things larger or smaller than they are
- Color changes (especially a yellow or green tint to your vision)
- Halos or borders on objects
These could mean your dose needs to be changed. Once you and your doctor have found the correct dose, you usually won’t have side effects as long as you take digoxin exactly as prescribed.
Channel Blockers to Control Heart Rhythm
These medications control your heart rhythm by slowing the electrical signals through your heart. This type of treatment is called cardioversion with drugs, or sometimes chemical cardioversion.
Your doctor might recommend one of these medicines if rate control drugs alone haven't helped you. Heart rhythm medications work best if you just recently started having AFib. Options include:
Sodium channel blockers, which slow your heart's ability to conduct electricity:
Potassium channel blockers, which slow the electrical signals that cause AFib:
You might need to take a blood-thinning medicine for a few weeks before you start on one of these drugs to prevent a clot.
Medicines are one option for treating AFib. If they don't work or you can't live with the side effects, you do have other choices, including surgery. Discuss all of your options with your doctor.