How do medications treat atrial fibrillation (AFib)?

Medications can treat three major problems of atrial fibrillation: rapid heart rate, irregular rhythm, and risk of stroke. Calcium channel blocks are used to slow down the pumping of the lower heart chambers (ventricles) by slowing down the transmission of electrical impulses to them. Beta blockers and a drug called digoxin also slow down the contractions of the ventricles.

To control irregular rhythm, doctors use medications called anti-arrhythmic drugs such as amiodarone, flecainide, propafenone, and sotalol which are supposed to keep the heart beating at a normal rate.

The last way that medications treat atrial fibrillation is by reducing the risk of blood clots, which can travel to the brain and cause a stroke. These medications, called anticoagulants or blood thinners, keep blood from clotting.

Dr. Ronald M. Firth, MD
Family Practitioner
Even if the atria (the upper chambers of your heart) are pumping too fast, medication can help control the rate of your overall heartbeat. They include:
  • beta blockers, which block the effects of certain hormones to slow down your heart rate
  • calcium channel blockers, which lower your blood pressure and slow down your heart
  • digoxin, which can slow your heart rate and help your heart pump more blood with each beat
As with blood thinning medication, be sure to follow your doctor’s directions.

There are different strategies to treat atrial fibrillation (AFib), and the goal may be to achieve some or all of the treatment objectives. Which approach is best for you depends on various factors, including whether you are currently being treated for other heart or medical problems.

Sometimes you may need a combination of treatments to effectively treat your AFib. The different drug treatments include:

  • Prevention of blood clots - The two most common drugs used to prevent blood clot formation (and reduce the risk of stroke) are warfarin and aspirin. Warfarin (more commonly known as Coumadin) is more effective than aspirin for preventing stroke due to blood clots. If you have at least one high-risk factor, you likely will receive warfarin. Aspirin is usually the standard treatment for people under 75 years of age who are without other risk factors for stroke. If you have only one moderate risk factor for stroke in addition to atrial fibrillation (such as hypertension, diabetes or heart failure), either aspirin or warfarin may be considered to reduce stroke risk.
  • Heart rate control - To slow the heart rate, doctors usually rely on beta-blockers or calcium channel blockers. Other agents can also be prescribed, depending on your particular needs.
  • Rhythm control - Ideally, you want to get your heart back to its normal rhythm. However, this objective becomes more difficult the longer you have AFib. To convert the heart to a normal rhythm, your doctors may use cardioversion, which is defined as the conversion of one cardiac rhythm or electrical pattern to another. This is accomplished with drug therapy or medical procedures.
Dr. Douglas E. Severance, MD
Family Practitioner

There are many types of medications used to treat atrial fibrillation. Blood-thinning medications prevent blood clots and strokes. Thinning the blood is the most vital factor in treating atrial fibrillation. Some medications slow down the heart rate, such as beta blockers, calcium channel blockers, and digitalis. Other medications control the heart's rhythm; these medications are most effective in someone who was recently diagnosed with atrial fibrillation.

There are a number of different medications used to control heartbeat in atrial fibrillation. Usually, physicians use medications called beta-blockers or calcium channel blockers. These medications are often used to treat high blood pressure but also help keep the heartbeat under control.

For occasional atrial fibrillation, if patients are having symptoms we use the medications to control their symptoms, called rhythm control medications. They aren’t very effective in the long term. So the majority of patients end up undergoing what we call catheter ablation, which is a minimally invasive procedure. In catheter ablation, the doctor puts flexible wires through the vein into the heart and it destroys areas of tissue in the heart that are firing abnormal electrical impulses that cause fibrillation. You can either use heat to destroy this tissue or you can freeze them using cryotechnology.

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Medications are effective in 30 percent to 60 percent of cases, but they may lose their effectiveness over time. In some cases, the medications may cause other types of irregular heartbeats.

If you have been diagnosed with atrial fibrillation, there’s a good chance you’ll get to know your local pharmacist on a first-name basis. For starters, you will most likely need to take blood-thinning drugs to prevent clots from forming. Some patients may only need to take aspirin, however. Other potential medications to add to your daily pill box may include:

  • medicines to slow down your heart. Drugs that control heart rate include beta-blockers (such as metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil), and digitalis (digoxin).
  • medicines to restore heart rhythm. They include amiodarone, sotalol, flecainide, and others.
Joan Haizlip, MSN
Cardiologist (Heart Specialist)

There are three types of medications to treat atrial fibrillation (A Fib):

  • Blood-thinning medications help prevent blood clots
  • Rhythm medications help the heart restore a normal rhythm
  • Rate medications help slow the heart rate

Your healthcare provider will choose the best treatment plan for you.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.