Treating AFib: Lifestyle, Medications, Pacemakers.
Whats on this page:
Lifestyle changes can improve AFib.
SLEEP APNEA IS VERY IMPORTANT.
Sleep apnea is common, particularly in patients with AFib. It makes AFib symptoms occur more frequently. It makes AFib harder to treat. Some patients with Sleep Apnea have symptoms of snoring or drowsiness in the afternoon, but many patients with Sleep Apnea do not have apparent symptoms. Patients with AFib should be tested for Sleep Apnea. An overnight oxygen saturation test at home is a good place to start. Sleep studies in a hospital or diagnostic center is sometimes needed.
Binges of alcohol use are well known to bring on AFib. If you have AFib do not drink excessively. Some patients are sensitive to even small amounts of alcohol and cannot drink at all.
Obesity and Lack of Exercise.
Weight loss and exercise will make a difference in controlling the symptoms of AFib.
If you have hypertension and AFib it is very important to control the BP well to reduce symptoms and to slow the progression of AFib.
These medication are very different from rate control medication. Antiarrhythmic medications are designed to prevent episodes of AFib. Antiarrythmic medications reduce the number of triggers firing and make the atrium less vulnerable to going into AFib.
Flecainide (Tambocor).Flecainide is safe only in patients with no underlying heart problems like coronary disease, congestive heart failure, left ventricular hypertrophy, or conduction problems like Right or Left Bundle Branch Block. Most common side effects are headache, dizziness, and weakness.
Propafenone (Rhytmol).Very much like flecainide but it also has heart rate slowing properties so beta blockers are not usually given together with propafenone.
Sotalol (Betapace).Safe to use in patients with underlying heart problems but not safe in patients with kidney failure or "long QT". Most common side effect is fatigue.
Dofedilide (Tikosyn).Very much like sotalol but doesn't slow heart rate so beta blocker is often given with tikosyn. Tikosin is always started in hospital setting to watch for "long QT" on the ECG.
Amiodarone (Pacerone).By far the most powerful medication for AFib but has not infrequent (5-10% per year) risk of side effects and requires close follow up.
Dronedarone (Multaq).Similiar to amiodarone but with lower risk of side effects but also has lower probability of preventing AFib.
Lifestyle changes are fundamental to maximizing your quality of life. AFib is a lifelong problem, with a healthy lifestyle AFib treatment is more successful and recurrence can be reduced.
This is the first priority of AFib treatment because strokes are devastating. Calculate your risk of stroke and do something about it if it is high.
Dealing with the fast and irregular pulse that results when AFib occurs is usually the first priority. Controlling the rapid pulse rate can improve symptoms, even if AFib is still going on.
This refers to therapy to prevent AFib. Medications to accomplish this are called antiarrhythmic medications. These medications have not been shown to prolong life or prevent strokes but can make a big difference by reducing symptoms of AFib. When prescribed intelligently and monitored closely they can be safe and effective. It can be helpful to combine these medications with ablation in difficult cases.
The power of ablation therapy to prevent recurrent episodes of AFib continues to improve. Cryoablation is well tolerated, safe, and effective for AFib in patients who do not do well with antiarrhythmic therapy or do not want antiarrhythmic therapy. The power of ablation as stand alone therapy for AFib is less when AFib has been persistent for a prolonged time, but depending on symptoms, should sometimes be tried.
Side effects occur, but not usually.
Don't expect to get a side effect from a medication, expect it to help you feel better. But if you don't feel better with the medication, get rid of it. Most side effects occur infrequently. If the chance of the medication helping you wasn't higher than the risk of a side effect, your doctor wouldn't have given it to you.
A good AFib doctor will help you select a medication that is safe for you, adjust the dose, watch you closely for side effects, stop it if it isn't right for you, and if necessary, find something that works better.
I don't want to be tired or impotent. Newer beta blocker medications are available. With the right medication and the right dose, fatigue and sexual dysfunction are very unusual.
"Medications don't work for AFib". They don't always work. They aren't always free of side effects. They don't always work forever. However, medications for AFib can improve quality of life in some patients with AFib. Trying one or more medications before an ablation is not necessary but is prudent.
Give medicines a chance to help you, if they don't, consider Cryoablation.
Pacemakers in AFib patients.
Pacemakers don't help AFib directly, but there are patients who have slow heart rates along with their AFib. Some patients have slow heart rates caused by medications to treat the AFib. In cases where the heart rate is so slow as to cause symptoms, a pacemaker can restore a normal heart rate.
Pacemakers and AV Node Ablation.
A few patients have both permanent AFib and, in spite of medications, they have a very high heart rate. Destroying the AV Node with ablation will prevent electrical conduction from the atrium to the ventricle, stopping the rapid heart rate. After AV Node ablation the heart rate is very slow and a pacemaker is needed to restore a normal rate. AFib continues in this case, but does not cause symptoms related to fast heart rates.
Meds to control heart rate.
Medications to prevent AFib.
AFib Treatment: Overview.
Should I try medications?
Pacemakers for AFib.