In this article, I discuss Afib medications for rate control. Which ones work, which ones to avoid, and what are the potential side effects?

Afib Rate Control Medications Meds that Work, Meds to Avoid, Potential Side Effects

Whether your treatment strategy for Afib is Rhythm Control, which means to stay in regular (or sinus) rhythm, or Rate Control, which means to just keep the heart rate from going too fast, you may need to be on medications that slow the heart rate in addition to medications to prevent stroke.

 

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For most people, but not all, Afib makes the heart rate faster. That’s because the electrical signals in the top part of the heart called the atria are not traveling in the usual coordinated fashion.

The AV node, which is the electrical gatekeeper between the atria and the bottom chambers of the heart called the ventricles, is being bombarded by multiple electrical signals. The result can be that the heart rate is fast and irregular. Because of this, doctors use medications to slow the electrical signals through the gatekeeper or AV node to slow the heart rate.

 

Commonly used rate control medications for Afib

There are two types of rate control medications that are commonly used to slow the electrical signals through the gatekeeper or AV node to slow the heart rate to prevent Afib.

 

Beta-blockers

Beta-blockers are the most commonly used medications for rate control in Afib, with the most frequently used one being metoprolol. Atenolol and carvedilol are also sometimes used.
Beta-blockers are also blood pressure medications, and they can cause low blood pressure and dizziness in some people. Other side effects of beta-blockers include fatigue, depression, and erectile dysfunction, although these are uncommon.

 

Calcium channel blockers

The most common calcium channel blockers that are used for rate control in Afib are diltiazem and verapamil. Diltiazem is most commonly used because verapamil tends to have more issues with constipation. It’s important to note that some calcium channel blockers do not lower the heart rate, such as amlodipine and felodipine.

Diltiazem and verapamil should NOT be used in those with a decreased ejection fraction or squeeze function of the heart.

Diltiazem tends to be well tolerated. The most common side effects are swelling in the ankles, and low blood pressure as diltiazem is also a blood pressure medication.
Other medications can slow the heart rate, although these are rarely used because of their risk for side effects.

 

Digoxin

Digoxin is rarely used for rate control in Afib because it can more easily get to toxic levels than most other medications. Another reason digoxin is seldom used is because of research studies showing some people have a higher mortality or death rate when taking digoxin.

Digoxin is used more frequently in patients with low blood pressure because beta-blockers and calcium channel blockers lower the blood pressure, whereas digoxin does not. It is also used in some people with a history of heart failure as it may help reduce the risk of hospitalization.

If at toxic levels, digoxin has numerous side effects, including heart rhythm problems that can be life-threatening, nausea, and visual problems.

Amiodarone - Pacerone®

Amiodarone is the most effective med for keeping people in regular (sinus) rhythm, but it is also can slow the heart rate. Cardiologists are reluctant to use amiodarone just for rate control because of its potential side effects. The side effects of amiodarone include toxicity to the thyroid, liver, lungs, eyes, and skin. Typically, patients on long term amiodarone have periodic screening for thyroid, lung, liver, and eye issues.

 

In Summary

Many people with Afib need medications to slow their heart rate down. The most common choices are metoprolol and diltiazem, but other options may be better depending on the patient. Talk to your doctor to determine if you need rate slowing medication, and if so, which is the best choice for you.

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