Medications for Atrial Fibrillation
Learn more about your options for managing AFib
Medically reviewed by Lindsay Cook, PharmD
Atrial fibrillation (AFib) 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 AFib. It can cause blood clots, stroke, or death if untreated.
Treatment of AFib may involve drugs to control heart rate or rhythm, blood thinners to prevent blood clots, electrical cardioversion (shock therapy) to restore rhythm, and surgeries or procedures to block irregular electrical signals in the heart.
Here's what you need to know about the medications commonly used to treat atrial fibrillation.
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Female healthcare provider explaining medicine dose to older female at homeWhat Medications Are Available for Atrial Fibrillation?
Along with treating AFib, conditions that cause atrial fibrillation, including high blood pressure, diabetes, and sleep apnea, also should be treated. The American Heart Association recommends the following lifestyle modifications for managing AFib:
Maintain a healthy weight.
Be physically active (with a goal of 210 minutes of activity per week).
Stop smoking.
Limit or eliminate alcohol.
Avoid caffeine if it triggers your symptoms.
Eat a healthy diet.
Managing any risk factors
The main treatments for AFib aim to control heart rate and rhythm and decrease stroke risk.
Types of medications most often used for AFib 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 older anticoagulant option is Coumadin (warfarin), which carries the risk of more interactions compared to other medications in this drug class and requires frequent monitoring. It may be used as an alternative option for some people or a first-choice anticoagulant for certain groups.
Rate-control medications: These types of medications decrease the heart rate with a target of less than 100 to 110 beats per minute (bpm). 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)
Of these drugs, beta-blockers are associated with the lowest risk of death, so they are typically used as a first-line treatment.
Digox or Lanoxin (digoxin) is another option. It works by slowing the conduction of electrical signals from the atria to the ventricles.
Rhythm-control medications: These drugs are also called antiarrhythmic medications. They restore a normal (sinus) heart rhythm. They are recommended for select people with AFib, such as those with bothersome symptoms, heart failure, or a recent diagnosis. 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 AFib lasting less than a week (called paroxysmal AFib). Sometimes, these medications are termed "pill-in-the-pocket" treatments because they may only be needed for acute episodes of AFib.
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 AFib (persistent AFib).
Nexterone or Pacerone (amiodarone) is another option that is reserved for use when other rhythm control medications aren't effective or can't be used, due to its serious side effects and drug interactions. It may also be given intravenously (IV) to restore rhythm in emergencies.
What Causes AFib?
Anything that causes stress or damage to the heart can cause AFib, including the following:
Side Effects
Medications used to treat AFib 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. 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).
Related: Can Atrial Fibrillation Be Caused by Anxiety?
Precautions
Blood thinners are not recommended for people at risk of severe bleeding due to untreatable causes.
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:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen) or Aleve (naproxen sodium)
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, AFib 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 AFib plus heart failure who don't respond to medications. However, in some cases it may be used as a first option before medications.
Catheter radiofrequency ablation and cryoablation may be able to remove the source of the fibrillation. These procedures are recommended for people with AFib who have failed rhythm control medications, or as first-line treatment in select cases, such as in people with heart failure.
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 AFib who need open-heart surgery. Due to high risks, surgery for AFib typically is not done unless heart surgery is already needed.
Atrial Fibrillation Symptoms
Some people with AFib will have no symptoms at all, while others may experience symptoms like the following:
Complications of Atrial Fibrillation
AFib, especially if untreated, can cause serious complications, such as the following:
If you suspect you have AFib, seek medical attention immediately to minimize the risk of complications. It's also important to follow your treatment plan closely if you have AFib 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 AFib. Studies show that for people who are overweight, losing at least 10% of their body weight can slash the odds of AFib.
Moderate physical activity is also essential in lessening the chances of developing AFib. Consistent, moderate-intensity aerobic exercise (cardio) lowers the risk for AFib, while inactivity and extreme exercise increase the risk.
Having even one alcoholic drink a day can raise your risk for AFib. Binge drinking makes you 3 times more likely to develop AFib than someone who drinks occasionally. Abstaining from alcohol can lower the risk of AFib or future episodes.
Tobacco use also increases the risk of AFib and stroke. Quitting smoking is essential in optimizing health.
Though more research is needed, plant-based diets (like the Mediterranean diet) may help control AFib 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 AFib, especially in people with diabetes.
Supplements can also play a role in AFib. Some studies show that vitamin C and vitamin D supplements may reduce the risk of AFib after heart surgery.
However, a review of five studies concluded that high amounts of another antioxidant, omega-3 fatty acids, can contribute to AFib. If you have AFib, 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:
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
AFib is a common irregular heartbeat that can cause stroke, dementia, or heart attacks if not corrected.
Often, AFib 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 AFib.
Several medications may be used to treat or prevent recurrent episodes of AFib. These include medicines that help control heart rate or rhythm. Blood thinners may also be used to prevent strokes. 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 AFib 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 AFib, 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 AFib 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 AFib.
What can trigger an AFib episode?
In one study, about 75% of people with short-term (paroxysmal) AFib experienced triggers.
Some common triggers of AFib episodes are alcohol, caffeine, strenuous exercise, and sleep deprivation.
How do you calm down an AFib episode?
Mindfulness rituals like deep breathing exercises, tai chi, and restorative yoga are beneficial for healthy heart functioning and may improve symptoms of AFib.
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.
