Afib Rhythm Control Strategy Treatment - What You Need to Know About Afib Medications. In this article, I discuss Afib medications. Which ones work, and what are the potential side effects?
Rhythm control strategies
For those who pursue a rhythm control strategy for Afib, which means that their treatment plan is to stay in regular (or sinus) rhythm, there are three treatment options:
- Ablation or surgery
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Afib Rhythm Control Medications
I want to start by defining the term Afib medication. What I mean are the medications that are used to try to keep someone in regular rhythm. I’m not referring to the blood thinner or rate control meds that are commonly used in Afib and that we talk about in other videos.
Afib medications are commonly used in treating Afib, but they are often not greatly effective. Even the best Afib medications may only work in 70% of people at one year of treatment. And less than 50% effectiveness at one year has been reported for several Afib medications.
Here is a brief review of the five most common medications used to keep people with Afib in regular (sinus) rhythm.
Amiodarone - Pacerone®
Amiodarone is the most effective med for keeping people in regular (sinus) rhythm, but it is also the one that has the most potential side effects outside of the heart. Amiodarone is used frequently in the hospital and for short term use. However, cardiologists are more reluctant to use amiodarone in younger, healthier patients for the long term unless there are no other good options. 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.
Flecainide - Tambocor®
Flecainide can be used in those patients without structural heart issues like low ejection fraction or thick heart walls. Dizziness and vision issues are the most commonly reported side effects of flecainide.
Propafenone - Rhythmol®
Propafenone can be used like flecainde in those patients without structural heart issues like low ejection fraction or thick heart walls. It’s most worrisome side effect is causing potentially life-threatening rhythm problems.
Dofetilide - Tikosyn®
Along with amiodarone, dofetilide can be used in those with heart failure and a low ejection fraction. The most worrisome side effect of dofetilide is causing a potentially life-threatening heart rhythm problem called torsades de pointes. Patients on this medication have frequent ECGs to monitor their QT interval, which, if it becomes prolonged, is an indication to stop the medication possibly.
Sotalol - Betapace®
Sotalol can be used in those with heart artery disease. Sotalol also can lead to potentially lethal heart rhythm issues and has been reported to increase mortality (death rate). Sotalol can slow the heart rate and cause feelings of fatigue in some patients.
It is common to use Afib medications in a rhythm control strategy. However, these medications are often not greatly effective and have significant potential side effects.
Talk to your doctor to determine if these medications are right for you.