Managing Atrial Fibrillation with Medication
The first step in managing atrial fibrillation is typically to treat it with medications, starting with a rate control drug to slow the heart rate in combination with anticoagulation by a blood thinner to reduce the risk of stroke. If that doesn't work, then the afib is treated with a rhythm control drug to restore a normal heart rate, called "normal sinus rhythm".
Some patients have success with electrical cardioversion, which shocks the heart into a normal sinus rhythm, followed by rhythm control drugs to maintain that normal sinus rhythm.
There are three types of medications used in treating and managing atrial fibrillation:
- Rate control medication to control the heart rate
- Rhythm control medication, sometimes called drug or chemical cardioversion, to put the heart back into normal sinus rhythm
- Anticoagulant medication, such as warfarin or Coumadin®, to control blood thickness and avoid blood clots and stroke
Some clinical trials have suggested that it's less important than originally thought to get afib patients into normal sinus rhythm. Even if they are left in afib, patients should generally be anticoagulated. A typical strategy for doctors in managing atrial fibrillation is:1
- Control heart rate and anticoagulate, and if there are no symptoms and the heart rate is controlled, then leave the patient in afib
- Cardioversion for patients who still have symptoms and the heart rate can't be controlled, or for whom normal sinus rhythm is preferred
- Refer to an experienced electrophysiologist if considering ablation