Post by Admin on Feb 2, 2023 23:26:56 GMT -7
www.nhs.uk/conditions/atrial-fibrillation/treatment/
Home Health A to Z Atrial fibrillation
Treatment - Atrial fibrillation
Contents
Overview
Symptoms
Causes
Diagnosis
Treatment
Complications
Treatments for atrial fibrillation include medicines to control heart rate and reduce the risk of stroke, and procedures to restore normal heart rhythm.
It may be possible for you to be treated by a GP, or you may be referred to a heart specialist (a cardiologist).
Some cardiologists, known as electrophysiologists, specialise in the management of abnormalities of heart rhythm.
You'll have a treatment plan and work closely with your healthcare team to decide the most suitable and appropriate treatment for you.
Factors that will be taken into consideration include:
your age
your overall health
the type of atrial fibrillation you have
your symptoms
whether you have an underlying cause that needs to be treated
The first step is to try to find the cause of the atrial fibrillation. If a cause can be identified, you may only need treatment for this.
For example, if you have an overactive thyroid gland (hyperthyroidism), medicine to treat it may also cure atrial fibrillation.
If no underlying cause can be found, the treatment options are:
medicines to reduce the risk of a stroke
medicines to control atrial fibrillation
cardioversion (electric shock treatment)
catheter ablation
having a pacemaker fitted
You'll be quickly referred to your specialist treatment team if one type of treatment fails to control your symptoms of atrial fibrillation and more specialised management is needed.
Medicines to control atrial fibrillation
Medicines called anti-arrhythmics can control atrial fibrillation by:
restoring a normal heart rhythm
controlling the rate at which the heart beats
The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen, and how well the atrial fibrillation responds.
Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.
Restoring a normal heart rhythm
A variety of medicines are available to restore normal heart rhythm, including:
flecainide
beta blockers, particularly sotalol
An alternative medicine may be recommended if a particular medicine does not work or the side effects are troublesome.
Controlling the rate of the heartbeat
The aim is to reduce your heart rate to less than 90 beats per minute when you are resting.
A beta blocker, such as bisoprolol or atenolol, or a calcium channel blocker, such as verapamil or diltiazem, will be prescribed.
The medicine you'll be offered will depend on what symptoms you're having and your general health.
A medicine called digoxin may be offered if other drugs are not suitable.
If one medicine is not controlling your symptoms, you may be offered another alongside it.
Side effects
As with any medicine, anti-arrhythmics can cause side effects.
The most common side effects of anti-arrhythmics are:
beta blockers – tiredness, cold hands and feet, low blood pressure, nightmares and impotence
flecainide – feeling sick, being sick and heart rhythm disorders
verapamil – constipation, low blood pressure, ankle swelling and heart failure
Read the patient information leaflet that comes with the medicine for more details.
Medicines to reduce the risk of a stroke
The way the heart beats in atrial fibrillation means there's a risk of blood clots forming in the heart chambers.
If these enter the bloodstream, they can cause a stroke.
Find out more about complications of atrial fibrillation
Your doctor will assess and discuss your risk with you, and try to minimise your chance of having a stroke.
They'll consider your age and whether you have a history of any of the following:
stroke or blood clots
heart valve problems
heart failure
high blood pressure (hypertension)
diabetes
heart disease
You may be given medicine according to your risk of having a stroke.
Depending on your level of risk, you may be prescribed warfarin or an anticoagulant, such as dabigatran, rivaroxaban, apixaban or edoxaban.
If you're prescribed an anticoagulant, your doctor will assess and discuss your risk of bleeding with you both before you start the medicine and while you're taking it.
Aspirin is not recommended to prevent strokes caused by atrial fibrillation.
Anticoagulants
Anticoagulants stop your blood from clotting and can help lower your risk of having a stroke.
Direct-acting anticoagulants
Direct-acting anticoagulants such as rivaroxaban, dabigatran, apixaban and edoxaban are recommended for people who have a high or moderate risk of having a stroke.
The National Institute for Health and Care Excellence (NICE) states that you should be offered a choice of anticoagulation and the opportunity to discuss the merits of each medicine.
Rivaroxaban, dabigatran, apixaban and edoxaban do not interact with other medicines and do not require regular blood tests.
Warfarin
Warfarin is an anticoagulant that you may be offered if direct-acting anticoagulants are not suitable for you.
There's an increased risk of bleeding in people who take warfarin, but this small risk is usually outweighed by the benefits of preventing a stroke.
It's important to take warfarin as directed by your doctor. If you're prescribed warfarin, you need to have regular blood tests and, after these, your dose may be changed.
Many medicines can interact with warfarin and cause serious problems, so check that any new medicines you're prescribed are safe to take with warfarin.
While taking warfarin, you should be careful about drinking too much alcohol regularly and avoid binge drinking.
Drinking cranberry juice and grapefruit juice can also interact with warfarin and is not recommended.