You feel a flip-flop in your chest. Or maybe a fluttering feeling. Are you experiencing atrial fibrillation (AFib)? AFib is a condition that causes an abnormal or irregular heartbeat. During an episode of AFib, the heart’s two upper chambers start beating in an irregular manner, leading to heart palpitations, weakness, and shortness of breath.
AFib is not necessarily a persistent condition; many people have symptoms that last for a few minutes and then subside. However, in some cases, the condition is permanent and requires medication to control.
Treating AFib can be done in a number of ways and usually depends on how long you’ve had it or how severe your symptoms are. The two main goals in treating AFib are controlling the heart rate and preventing blood clots. The treatment you decide on is dependent on multiple factors, such as your history of heart problems and your response to certain medications. The first step in treating AFib is resetting your heart rate to a normal level through a process called cardioversion, which can be done two different ways, with or without medication.
Cardioversion without medication
Electrical cardioversion is done by delivering an electric shock to the chest, which travels to your heart and stops its electrical activity for a brief period of time. A person who undergoes electrical cardioversion therapy will receive a dose of a sedative drug prior to the procedure, so they will not feel the shock.
Cardioversion with medication
Cardioversion with medication is a form of cardioversion in which doctors use a variety of anti-arrhythmic drugs to try and get the heart to beat normally. If the patient’s heartbeat continues to beat normally after the procedure, doctors will prescribe the same medications for the patient to use regularly.
Medications used after cardioversion
After a patient undergoes a cardioversion procedure, doctors may prescribe anti-arrhythmic drugs to maintain a normal heart rate. Some common medications include:
- Dofetilide
- Flecainide
- Propafenone
- Amiodarone
- Sotalol
These drugs can, however, have a number of side effects, including nausea, dizziness, and fatigue.
Other medications to control your heart rate may be prescribed as well, such as:
- Digoxin, which is taken orally or intravenously. It is used to control resting heart rate but is not as effective when the patient’s heart rate is elevated. Most people who take digoxin need to take other additional medications.
- Beta blockers, which can control both resting and elevated heart rate but may cause side effects such as high blood pressure.
- Calcium channel blockers, which control heart rate but are not recommended for those with heart failure or low blood pressure.
Finally, your doctor may recommend blood-thinning medications, because people with AFib are at higher risk for blood clots, which can lead to stroke. Medications may include:
- DOAC or direct acting oral anticoagulants which include dabigatran, rivaroxaban, apixaban, and edoxaban. These drugs do not have the same side effects as warfarin and do not require the patient to undergo regular blood tests.
- Warfarin, a common blood-thinner which prevents blood clots but comes with the risk of dangerous bleeding. Patients who have been prescribed warfarin need to have regular blood tests.
Additionally, if you have symptoms you may be a candidate for radiofrequency ablation done by an electrophysiologist with experience doing such procedures. Be aware that the first ablation is usually about 60% effective and sometimes a second attempt may be necessary to get about 80% success.
Alternatively, your doctor may recommend a Watchman device which basically is plug for the left atrial appendage where the clots that cause stroke related to atrial fibrillation arise. By plugging the appendage with a device that gives an adequate seal (confirmed within 45-90 days after the procedure), your doctor may be able to discontinue the anticoagulants and go to an aspirin daily regimen.
If you have AFib, work with your healthcare provider to find the right combination of medications for you. You want your heart to be as healthy as it can be.
Written by Natan Rosenfeld
