Atrial Fibrillation (A Fib) Medical Treatment

Treatment for atrial fibrillation traditionally seeks three goals: to slow down the heart rate, to restore and maintain normal heart rhythm, and to prevent blood clots that may lead to strokes.

  • Cardiac rate control: The first treatment goal is to slow down the ventricular rate, if it is fast.
    • If patients experience serious clinical symptoms, such as chest pain or shortness of breath related to the ventricular rate, the health care professional in the emergency department will try to decrease the heart rate rapidly with intravenous (IV) medications.
    • If patients have no serious symptoms, they may be given medications by mouth.
    • Sometimes patients may require more than one type of oral medication to control the heart rate.
  • Restore and maintain normal cardiac rhythm: About half of the people with newly diagnosed atrial fibrillation will convert to normal rhythm spontaneously in 24-48 hours. However, atrial fibrillation typically returns in many patients.
    • As already mentioned, not everyone with atrial fibrillation needs to take medication to maintain normal rhythm.
    • The frequency with which arrhythmia returns and the symptoms it causes partly determine whether individuals receive rhythm-controlling medication, which is usually termed antiarrhythmia medication.
    • Medical professionals tailor each person’s antiarrhythmia medication(s) carefully to produce the desired effect, a normal cardiac rhythm.
    • Most of these medications cause unwanted side effects, which limit their use. These medications should be discussed with a doctor.
  • Prevent clot formation (strokes): Stroke is a devastating complication of atrial fibrillation. Blood clots can form in the atria when their motility is impaired as in A fib. Stroke can occur when a piece of a blood clot formed in the heart breaks off and travels to the brain, where it blocks blood flow.
    • Coexisting medical conditions, such as hypertension, congestive heart failure, heart valve abnormalities, or coronary heart disease, significantly increase the risk of stroke. Age older than 65 years also increases the risk of stroke.
    • Most people with atrial fibrillation take a blood-thinning drug called warfarin (Coumadin) to lower this risk of stroke and heart failure. Warfarin blocks certain factors in the blood that promote clotting. Acutely, the initial blood thinner is IV or subcutaneous heparin to thin a patient’s blood rapidly. Then a decision is made whether they need oral warfarin.
    • People at lower risk of stroke and those who cannot take warfarin may use aspirin. It may be used in conjunction with Plavix. Aspirin is not without its own side effects, including bleeding problems and stomach ulcers.
    • Clopidogrel (Plavix) is another medication that is also used by many physicians to prevent clot formation in cardiovasular diseases, including A fib.
    • Other drugs that may be used by some cardiologists include Lovenox, Pradaxa, and Xarelto. The choice of these drugs which are used to reduce the chance of clot formation in patients with chronic A fib is often determined by the patient’s problems with Coumadin and the preference or experience of the cardiologist with these drugs.

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