Heart rate control

You may be prescribed medications to control your heart rate and restore it to a normal rate. Heart rate control can be achieved through several medications.

The medication digoxin (Lanoxin) may control heart rate at rest, but not as well during activity. Most people require additional or alternative medications, such as calcium channel blockers or beta blockers.

Beta blockers may cause side effects such as worsening of heart failure and low blood pressure (hypotension). Calcium channel blockers can also cause side effects, and may need to be avoided if you have heart failure or low blood pressure.

Other surgical and catheter procedures

Sometimes medications or cardioversion to control atrial fibrillation doesn't work. In those cases, your doctor may recommend a procedure to destroy the area of heart tissue that's causing the erratic electrical signals and restore your heart to a normal rhythm. These options can include:

  • Catheter ablation. In many people who have atrial fibrillation and an otherwise normal heart, atrial fibrillation is caused by rapidly discharging triggers, or "hot spots." These hot spots are like abnormal pacemaker cells that fire so rapidly that the upper chambers of your heart quiver instead of beating efficiently.

    In catheter ablation, a doctor inserts long, thin tubes (catheters) into your groin and guides them through blood vessels to your heart. Electrodes at the catheter tips can use radiofrequency energy, extreme cold (cryotherapy) or heat to destroy these hot spots, scarring the tissue so that the erratic signals are normalized. This corrects the arrhythmia without the need for medications or implantable devices.

  • Surgical maze procedure. The maze procedure is conducted during an open-heart surgery. Using a scalpel, doctors create several precise incisions in the upper chambers of your heart to create a pattern of scar tissue. Because scar tissue doesn't carry electricity, it interferes with stray electrical impulses that cause atrial fibrillation. Radiofrequency or cryotherapy also can be used to create the scars, and there are several variations of the surgical maze technique.

    The procedure has a high success rate, but atrial fibrillation may recur. Some people may need catheter ablation or other treatment if atrial fibrillation recurs.

    Also, because the procedure usually requires open-heart surgery, it's generally reserved for people who don't respond to other treatments or when it can be done during other necessary heart surgery, such as coronary artery bypass surgery or heart valve repair.

  • Atrioventricular (AV) node ablation. If medications don't work, or you have side effects, AV node ablation may be another option. The procedure involves applying radiofrequency energy to the pathway connecting the upper and lower chambers of your heart (AV node) through a long, thin tube (catheter) to destroy this small area of tissue.
  • The procedure prevents the atria from sending electrical impulses to the ventricles. The atria continue to fibrillate, though, and anticoagulant medication is still required. A pacemaker is then implanted to establish a normal rhythm. After AV node ablation, you'll need to continue to take blood-thinning medications to reduce the risk of stroke, because your heart rhythm is still in atrial fibrillation.

Preventing blood clots

Many people with atrial fibrillation or those who are undergoing certain treatments for atrial fibrillation are at especially high risk of blood clots that can lead to stroke. The risk is even higher if other heart disease is present along with atrial fibrillation. Your doctor may prescribe blood-thinning medications (anticoagulants) such as:

  • Warfarin (Coumadin). Warfarin may be prescribed to prevent blood clots. If you're prescribed warfarin, carefully follow your doctor's instructions on taking it. Warfarin is a powerful medication that can have dangerous side effects. You'll need to have regular blood tests to monitor warfarin's effects.
  • Newer anticoagulants. Several newer blood-thinning medications (anticoagulants) are available. These medications are shorter acting than warfarin and don't require monitoring. It's very important to take these medications exactly as prescribed. You shouldn't take the newer anticoagulants if you have a mechanical heart valve.

    Dabigatran (Pradaxa) is an anticoagulant medication that's as effective as warfarin at preventing blood clots that can lead to strokes, and doesn't require blood tests to make sure you're getting the proper dose.

    Rivaroxaban (Xarelto) is another anticoagulant medication that's as effective as warfarin for preventing strokes. Rivaroxaban is a once-daily medication.

    Apixaban (Eliquis) is another anticoagulant medication that's as effective as warfarin for preventing strokes.

    Talk to your doctor about taking one of these newer anticoagulants as an alternative to warfarin if you're concerned about your risk of stroke. Follow your doctor's dosing instructions carefully and don't stop taking any of these medications without talking to your doctor first.

Many people have spells of atrial fibrillation and don't even know it — so you may need lifelong anticoagulants even after your rhythm has been restored to normal.

Jul. 18, 2014 See more In-depth