Medications
Medications used to treat AF fall into one of three categories based on their goals for treatment: rate control, rhythm control, and anti-coagulants. Medications are used not to cure atrial fibrillation, but to reduce the symptoms patients suffer from as a result of the disease. Long-term treatment of atrial fibrillation with only rate or rhythm control medications has been associated with an increased mortality (death). 7
Rate Control Medications have an affect on how fast the heart beats. They attempt to slow the heartbeat down to the normal range of 60-100 beats per minute. Rate-control medications do not convert AF to a normal sinus rhythm and it is unlikely they will prevent the long-term structural heart damage caused by AF.
Rhythm Control Medications, or anti-arrhythmics, attempt to regulate the electrical impulses of the heart to assist in maintaining normal sinus rhythm. This can reduce or eliminate the episodes of AF. Many of these medications, however, have serious side effects and cannot be taken by patients with certain medical conditions.
Anti-coagulants, or blood thinners, are prescribed to reduce the risk of stroke in AF patients. Usually a medication called coumadin (warfarin) is prescribed to thin the blood, prolonging the time it takes for the blood to clot. If the blood is too thin severe bleeding can occur, and if the blood is too thick, clots can form increasing the risk for stroke. Therefore, these medications require close management by a physician and include frequent lab testing to determine how thick/thin the blood is. Coumadin has been found to decrease the risk of stroke by 67% in patients with AF. 3 9 Coumadin or other forms of anti-coagulation therapy are contraindicated in some patients with atrial fibrillation, including those with bleeding disorders, history of stroke, non-compliance with therapy, and pregnancy.
3 Boriani, G, Diemberger, M, Biffi, G, et al. Electrical cardioversion for persistent atrial fibrillation or atrial flutter in clinical practice: predictors of long-term outcome. International Journal of Clinical Practice 2007; 61: 748-756. 7 Wyse, DG, 9 The Stroke Prevention in Atrial Fibrillation Investigators. The stroke prevention in atrial fibrillation study: final results. Circulation 1991; 84: 527–539.
|