Medications for Atrial Fibrillation

Learn more about your options for managing A-fib

Medically reviewed by Lindsay Cook, PharmD

Atrial fibrillation (A-fib) is the most common type of irregular heartbeat. It is caused by abnormal electrical firing in the heart's chambers. A fast, irregular heartbeat characterizes A-fib. It can cause blood clots, stroke, or death if untreated.

Treatment of A-fib may involve blood thinners to prevent blood clots, drugs to control heart rate or rhythm, or surgeries.

Here's what you need to know about the medications commonly used to treat atrial fibrillation.

What Medications Are Available for Atrial Fibrillation?

Along with treating A-fib, conditions that cause atrial fibrillation, including high blood pressure and sleep apnea, also should be treated. The American Heart Association recommends the following lifestyle modifications for managing A-fib:

• Weight loss

• Aerobic exercise

• Managing any risk factors

The main treatments for A-fib aim to control heart rate and rhythm and decrease stroke risk.

Types of medications most often used for A-fib are:

Anticoagulants (blood thinners): These drugs protect against strokes by breaking down blood clots. A class of drugs called new oral anticoagulants or novel oral anticoagulants (NOACs) is often used. Drugs in this class include the following:

• Eliquis (apixaban)

• Pradaxa (dabigatran)

• Savaysa (edoxaban)

• Xarelto (rivaroxaban)

An alternative anticoagulant is Jantoven (warfarin), which carries the risk of more interactions compared to other medications in this drug class and requires frequent monitoring.

Rate-control medications: These types of medications decrease the heart rate to less than 110 beats per minute (bpm). Your heart rate goal may be closer to 80 bpm, depending on your symptoms. These medications are beneficial for people older than 65 without severe symptoms. Several drugs fall into this group, such as the following:

• Beta-blockers like Lopressor (metoprolol), Cardicor or Cengescor (bisoprolol), and Tenormin (atenolol)

• Calcium channel blockers like Cartia XT and Tiazac (diltiazem) and Calan or Veralan (verapamil); Digox or Lanoxin (digoxin) and Nexterone or Pacerone (amiodarone)

Of these drugs, beta-blockers are associated with the lowest risk of death, so they are typically used as a first-line treatment.

Rhythm-control medications: These drugs are also called antiarrhythmic medications. They restore a normal (sinus) heart rhythm. They are most likely to benefit people younger than 65 newly diagnosed with A-fib. There are two main types of rhythm control medications:

• Sodium channel blockers like Tambacor (flecainide) and Rhythmol (propafenone) are often used for short episodes of A-fib lasting less than a week (called paroxysmal A-fib). Sometimes, these medications are termed "pill-in-the-pocket" treatments because they may only be needed for acute episodes of A-fib.

• Potassium channel blockers like Betapace (sotalol), amiodarone (blocks calcium as well as potassium and sodium channels), or Tikosyn (dofetilide) are typically used for long-lasting A-fib (persistent A-fib).

Ranexa (ranolazine) blocks multiple channels and, though not approved by the Food and Drug Administration (FDA) for A-fib, is also effective for rhythm control.

What Causes A-Fib?

Anything that causes stress or damage to the heart can cause A-fib, including the following:

• Older age

• High blood pressure

• Heart disease

• Lung disease

• High amounts of alcohol

• Diabetes

• Stroke

• Obstructive sleep apnea

• Stress or anxiety

Side Effects

Medications used to treat A-fib can cause side effects that may be mild or severe. Here are some important ones to watch out for in each drug class:

• Anticoagulants: The primary side effects of NOACs and warfarin are major bleeds, including intracranial hemorrhage (brain bleeds) and gastrointestinal (GI) bleeds.

• Rate-control medications: Beta-blockers are known to cause fatigue and may even induce A-fib. Calcium channel blockers can cause constipation, slow heart rate, headache, dizziness, and swelling. Digoxin toxicity is marked by nausea, vomiting, stomach pain, confusion, and vision changes.

• Rhythm-control medications: These drugs are more likely to cause adverse effects than rate-control medicines. Serious side effects include anaphylaxis (a life-threatening allergic reaction), loss of consciousness, low heart rate, low blood pressure, and other irregular heartbeats (arrhythmia).

Precautions

Blood thinners are not recommended for people with the following conditions:

• Advanced kidney disease

• Hemodialysis

• Pregnancy

People taking anticoagulants like warfarin should stop them five or six days before scheduled surgeries to decrease the risk of bleeding. Supplements that impact blood clotting should also be stopped two weeks prior to surgery,

Some medications can increase bleeding risk and cause interactions with blood thinners. These include the following:

• Antidepressants

• Antibiotics

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen) or Aleve (naproxen sodium)

• Tylenol (acetaminophen)

• Acid reflux medications

• Alcohol

Medications for heart rate and rhythm control have precautions that vary from drug to drug. To select the best drug for you, your healthcare provider will consider the following:

• Other medications and supplements you take

• Your health history

• Any chronic conditions you have
  

Other Interventions

For some people, A-fib will persist despite treatment with medications. When this happens, more invasive interventions may be needed. These procedures include:

• Cardioversion uses a defibrillator to shock the heart and restore a normal rhythm. This may be needed for people with A-fib plus heart failure who don't respond to medications. It's most effective in people with persistent A-fib that lasts less than 60 days.

• Catheter ablation and cryoballoon ablation target the pulmonary veins and may be able to remove the source of the fibrillation. These procedures are recommended for people with paroxysmal A-fib (lasting less than a week) who have failed rhythm control medications and those over 65.

• Left atrial appendage closure, an alternative to anticoagulants, this procedure decreases the risk of stroke and is best for older adults or those who can't take anticoagulant medications long term.

• Surgeries like the Maze procedure are primarily reserved for people with A-fib who need open-heart surgery. Due to high risks, surgery for A-fib typically is not done unless heart surgery is already needed.

Atrial Fibrillation Symptoms

Some people with A-fib will have no symptoms at all, while others may experience symptoms like the following:

• Dizziness

• Chest pain

• Shortness of breath

• Swelling of the legs

• Stroke

Complications of Atrial Fibrillation

A-fib, especially if untreated, can cause serious complications, such as the following:

• Blood clots

• Stroke

• Heart failure

• Dementia

• Cardiac arrest

If you suspect you have A-fib, seek medical attention immediately to minimize the risk of complications. It's also important to follow your treatment plan closely if you have A-fib and discuss any questions or concerns with your healthcare provider or pharmacist.

Nutrition Considerations

Lifestyle changes like increasing exercise and maintaining a healthy weight help lower the risk of A-fib. Studies show that for people who are overweight, losing at least 10% of their body weight can slash the odds of A-fib.

Moderate physical activity is also essential in lessening the chances of developing A-fib. Consistent, moderate-intensity aerobic exercise (cardio) lowers the risk for A-fib, while inactivity and extreme exercise increase the risk.

Having even one alcoholic drink a day can raise your risk for A-fib. Binge drinking makes you 3 times more likely to develop A-fib than someone who drinks occasionally. Abstaining from alcohol can lower the risk of A-fib or future episodes.

Tobacco use also increases the risk of A-fib and stroke. Quitting smoking is essential in optimizing health.

Though more research is needed, plant-based diets (like the Mediterranean diet) may help control A-fib or its risk factors. On the other hand, diets high in fats and low in carbs (like the ketogenic diet) can increase the risk for A-fib, especially in people with diabetes.

Supplements can also play a role in A-fib. Some studies show that the following antioxidants may reduce the risk of A-fib after heart surgery:

• Polyunsaturated fatty acids (PUFAs)

• N-acetylcysteine (NAC)

• Vitamin C

However, a review of five studies concluded that high amounts of another antioxidant, omega-3 fatty acids, can contribute to A-fib. If you have A-fib, discuss the use of any supplements with your healthcare provider before taking them.

Many types of supplements can interfere with blood clotting and increase bleeding risk. Some supplements that shouldn't be taken with anticoagulants are:

• Garlic

• Gingko biloba

• Turmeric

• Fenugreek

• Fish oil

Of note, vitamin K increases blood clots. Be aware of taking the following with anticoagulants:

• Vitamin K supplements

• Multivitamins containing vitamin K

• Foods containing vitamin K

Warfarin and other anticoagulants deplete clotting factors that depend on vitamin K to form. Sudden changes in vitamin K intake could change the blood-thinning effect of anticoagulant medications. If you are prescribed warfarin or other anticoagulants, it's essential that you keep your vitamin K intake consistent.

Summary

A-fib is a common irregular heartbeat that can cause stroke, dementia, or heart attacks if not corrected.

Often, A-fib is linked to several health conditions, including diabetes, high blood pressure, and sleep apnea. Lifestyle changes like exercise and abstaining from tobacco and alcohol can help prevent or allow you to manage A-fib.

Several medications may be used to treat or prevent recurrent episodes of A-fib. These include blood thinners and medicines that help control heart rate or rhythm. The best drug for you will depend on your symptoms, age, and underlying conditions.

Discuss how you are supposed to take your medication with your healthcare provider and pharmacist to optimize therapy. Keep an eye out for side effects since all the medicines used for A-fib can cause serious ones.

Frequently Asked Questions

What are three drugs for atrial fibrillation?

Flecainide, metoprolol, and apixaban are a few drugs that may be used for A-fib, but there are many choices. Your healthcare provider can help you determine the best medicine to optimize your therapy.

How can I control my anxiety with atrial fibrillation?

Managing stress may help protect against A-fib episodes. A few evidence-based strategies are cognitive behavioral therapy and mindfulness exercises. These have been shown to improve the quality of life of people with A-fib.

What can trigger an A-fib episode?

In one study, about 75% of people with short-term (paroxysmal) A-fIb experienced triggers.

Some common triggers of A-fib episodes are alcohol, caffeine, strenuous exercise, and sleep deprivation.

How do you calm down an A-fib episode?

Mindfulness rituals like deep breathing exercises, tai chi, and restorative yoga are beneficial for healthy heart functioning and may improve symptoms of A-fib.

Should I stop using my heart medication and start using supplements to manage my A-fib?

No. Quitting your heart medication could be dangerous. Please do not change your medication regime. Instead, discuss your questions and concerns about your medication or supplements with your healthcare provider.

Read the original article on Verywell Health.