Can These Afib Rate Controlling Drugs Slow Your Heart Too Much
Wee seen countless patientssually olderonesdmitted to the emergency rooms of the hospitals where we work withheart rates of under 45 beats per minute and are either fainting or comingclose to fainting from such a slow heart rate. That why,if you are on a rate controller, it vital to invest in a smartwatch or other device with which you can monitor your heart rate.
What Are The Treatments For Atrial Fibrillation
The main goals of Afib treatment include:
- Controlling your heart rate.
- Regaining a normal heart rhythm.
- Reducing your risk of having a stroke.
Based on your symptoms, your healthcare provider will likely first prescribe medications to see if they help.
Medications
Medications to treat Afib may include:
- Rate control medications to prevent the ventricles from beating too fast. Examples include digoxin, metoprolol, verapamil or diltiazem.
- Rhythm control medications to help your heart beat in a normal sinus rhythm. Examples include procainamide, disopyramide, flecainide acetate, propafenone, sotalol, dofetilide or amiodarone.
- Blood thinners to reduce the risk of blood clots and stroke. Examples include warfarin, warfarin alternatives or aspirin.
Any medications can cause side effects. Rate control and rhythm control medications may make your arrhythmia worse or impact your lungs, liver or other organs. Blood thinners can cause bleeding, indigestion or a heart attack. Usually, the benefits of taking these medications outweigh your risk of side effects. Its important to discuss all risks and side effects with your provider.
Procedures and surgeries
If medications dont help your Afib, you may need a procedure or surgery.
Many procedures can be non-invasive, and newer treatment methods and technologies are constantly developing. Talk with your provider about the options that are best for you.
Can Afib go away?
What Happens During A Chemical Cardioversion
The procedure may be done in a hospital. Or it may be done in a healthcare providers office or in your home. Your healthcare provider will give you an antiarrhythmic medicine. This is given by mouth or through an IV. If you are treated at home, you will need careful follow-up with a cardiologist. If you have chemical cardioversion at a hospital, someone will check your heart rate and rhythm.
The type of medicine used will vary based on your type of abnormal rhythm and your other medical problems. The following are some examples of medicines that your healthcare provider might use:
- Flecainide, dofetilide, propafenone, amiodarone or ibutilide, for AF
- Adenosine or verapamil, for supraventricular tachycardia
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If You Forget To Take It
If you miss a dose of sotalol, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
How And When To Take Sotalol
Take sotalol exactly as your doctor has told you, and follow the instructions on the label. If you’re not sure, check with your doctor or pharmacist.
You’ll usually take sotalol once or twice a day.
Your doctor may advise you to take your first dose before bedtime, because it can make you feel dizzy. After the first dose, if you do not feel dizzy, you can take sotalol in the morning.
If you take sotalol twice a day, try to take it in the morning and in the evening.
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Common Questions About Sotalol
Sotalol is a type of medicine called a beta blocker.
Like other beta blockers, sotalol works by changing the way your body responds to some nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for your heart to pump blood around your body.
Sotalol starts to work after about 4 hours, but it can take 2 to 3 days to fully take effect.
Usually, treatment with sotalol is long term, even for the rest of your life.
Sotalol is generally safe to take for a long time. In fact, it works best when you take it for a long time.
Talk to your doctor if you want to stop taking sotalol.
Stopping sotalol suddenly can make your condition worse.
If you’re bothered by side effects, your doctor may be able to prescribe a different medicine for your heart problems.
If you stop taking sotalol, it will take about 4 days for it to be completely out of your body.
You will have regular blood tests to check that your kidneys are healthy .
Your blood test may also check that you have the right amounts of potassium and magnesium in your blood. If there’s too little of these in your blood it can cause side effects.
Sotalol is not considered as a typical beta blocker. This is because it is not generally used to treat high blood pressure and is mainly used for irregular heartbeats. Sotalol is classed as a potassium blocker.
There are 4 main types of medicines for treating irregular heartbeats:
- sodium channel blockers like flecainide
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What Are The Risks For Chemical Cardioversion
Although many people have a successful chemical cardioversion, the procedure has certain risks. Your own risks may differ based on your age, the type of abnormal heart rhythm you have, and your other medical conditions. Ask your healthcare provider about the risks for you.
In rare cases, a chemical cardioversion can cause a new, more dangerous heart rhythm. If that happens, you will get medicines or a stronger electric shock to stop this rhythm. Some other risks are:
- Increased frequency of the original abnormal rhythm
- Other more dangerous abnormal heart rhythms
- Dislodged blood clot
A medicine called blood thinner may be given before and after the procedure to reduce your risk of blood clots especially if you have atrial fibrillation or flutter.
Each of the medicines used in chemical cardioversion has risks and possible side effects. Ask your healthcare provider about the risks of the medicines you will be using.
In some cases, the cardioversion may not restore a normal heart rhythm. Or, you might go back to your abnormal rhythm shortly after your cardioversion.
How Is Atrial Fibrillation Defined
Atrial fibrillation is defined in various ways, depending on how it affects you:
- paroxysmal atrial fibrillation – this comes and goes, usually stopping within 48 hours without any treatment.
- persistent atrial fibrillation – this lasts for longer than seven days, or less when it is treated.
- longstanding persistent atrial fibrillation – this means you have had continuous atrial fibrillation for a year or longer.
- permanent atrial fibrillation – this is when atrial fibrillation is present all the time and no more attempts to restore normal heart rhythm will be made
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When Should I See My Healthcare Provider
Theres no single schedule to follow. It all depends on your symptoms and treatment plan, and whether you need follow-ups after a procedure. So, its important to talk with your provider and make a plan together. Make sure you go to all your scheduled appointments. Keep track of the medications youre taking, and bring a list of your medications to every appointment. Its also a good idea to keep the list in your wallet so its with you in emergencies.
What should I discuss with my healthcare provider?
At each visit, be sure to share any new symptoms or problems youre having, such as side effects from medication.
Your provider will ask you questions, but its important to ask your own questions, too. For example, ask for advice on how to reduce your risk factors. Starting a new diet or exercise plan can feel overwhelming. Your provider will offer advice and also connect you with others who can help, such as dietitians. You may also want to ask about available health and fitness programs, including those that support your mind-body connection.
Finally, be sure to ask your provider before taking over-the-counter medicines, such as those for cold and flu, and nutritional supplements. Sometimes these products can affect your heart rate or interact with your prescription medications.
A note from Cleveland Clinic
Calcium Channel Blocker Diltiazem/verapamil
Calcium channel blockers can be used as part of a rate or rhythm control strategy for AF.
There are two types of calcium channel blockers, dihydropyridines and non-dihydropyridines. Dihydropyridines such as amlodipine and nifedipine control blood pressure or angina. Non-dihydropyridines such as diltiazem and verapamil can also control blood pressure and angina and be used as part of a rate and rhythm control as well.
Diltiazem and verapamil work by reducing the movement of calcium into the AV-node and in the arteries and veins. This causes the force and rate of the heart’s contractions to decrease. This relaxes the arteries and then reduces blood pressure . They can be used on their own or with other anti-arrhythmic drugs to enhance their effects.
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Drugs That Decrease Heart Rate
A slow heart rate, called bradycardia, may result from various medications. Some drugs were developed specifically to slow the heart rate. But bradycardia may be an unwanted side effect of a wide range of other medications that were not developed to have any impact on the heart. When taking more than one medication that can slow the heart rate, the additive effect has the potential to be profound.
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Why Does Atrial Fibrillation Happen And How Common Is It
Atrial fibrillation is the most common heart rhythm disturbance and affects up to 800,000 people in the UK.
The cause of atrial fibrillation is not fully understood, but it tends to occur in certain groups of people and may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking.
The condition can affect adults of any age or gender but:
- is more common the older you get
- affects about 10% of people over 75
- more common in men than women
Atrial fibrillation is more likely to occur in people with other conditions, such as:
- high blood pressure
Find out more abou the causes of atrial fibrillation and how it’s diagnosed
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Types Of Rate Control Medications
You and your doctor will decide what rate control medication are best for you based on your symptoms, heart function, presence of heart failure or other medical conditions, and what afib triggers you might have.
Beta blockers are the most commonly used medications, followed by calcium channel blockers and digoxin. Amiodarone or dronedarone may be used as they are antiarrhythmic drugs with beta-blocking properties.
Rate control medications dont cure atrial fibrillation, so you may need to take them throughout your life. However, this may lead to atrial enlargement, in which the muscle cells of the atria enlarge because they are overworked. This can increase the risk of stroke. Eventually, these cells may die, leading to scarring and heart failure.
To learn more about the rate control medications, see:
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How To Check Your Heart Rate
According to certified personal trainer Marianna Johnson, MSW, a good time to check your heart rate is right after you wake up, while youre still in bed. Johnson, owner of Mind Body Health & Fitness in Falls Church, Virginia, says a midday reading is also fine if taken after a few minutes of rest.
To take your heart rate, place your index and middle finger on your wrist or the side of your neck to locate your pulse. Count the number of beats in a minute.
Do You Also Need An Afib Rate Controller If You Are Also On An Antiarrhythmic
Given the side effects and other concerns of the AFib rate controlling drugs, people often wonder ifthey really need these drugs, especially if they are also on an antiarrhythmic. Ifthe antiarrhythmic your doctor has prescribed is flecainide or propafenone, theanswer is es.This is because the atrial flutter proarrhythmic effects offlecainide and propafenone are serious enough that you need a rate controlleraround to make sure the heart never beats too fast.
However, some antiarrhythmics do have some rate controlling effects. This isespecially the case with amiodarone, sotalol, and Multaq . As aresult, if you are combining antiarrhythmics with rate controllingmedicationsnd especially if your are elderlyou will need to monitor yourheart rate very closely, lest you find yourself with a heart rate that is so lowthat you pass out from lack of oxygen to your brain or or develop severe lowblood pressure.
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Drugs To Reduce Heart Rate
There are different pharmacological groups of drugs from which one or more drugs are selected according to the indications for their use.
It is important to note that the independent use of any medication is fraught with serious complications, therefore, the use of a medication to lower the heart rate is possible only after consultation with the attending physician, cardiologist or arrhythmologist.
Much depends on the cause that caused a frequent pulse, because if it is a physiological tachycardia that occurs due to physical stress, fear, emotional stress, then special drugs are not prescribed.
Depending on the condition of the patient and concomitant diseases, the doctor can prescribe drugs from the following pharmaceutical groups:
These drugs reduce the pulse by expanding the arteries. They also reduce blood pressure and improve the flow of blood to the kidneys and its circulation throughout the body. The doctor can also prescribe these medicines if the patient has diabetes or determines the protein in the urine, which will protect the kidneys. Some examples of this group of drugs are Enalapril Maleate , Lysinopril and Fosinopril Sodium .
If the rapid pulse is caused by anxiety, the doctor may prescribe an antidepressant drug called anxiolytics. These drugs help to relax, get rid of fears. It is important to take such medicines only when anxiety is felt. It is important to take them, not to use heavy equipment and not drive a car.
- Calcium channel blockers
Dr John Day Cardiologist
| Dr. John DayDr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology. |
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How Much Afib Rate Controlling Do You Need
As long as you aren having anysymptoms, studies suggest an AFib resting heart rate below 110 beats perminute is best.129Under the right conditions, rate controllers can help withthat and, fortunately, these drugs tend to be available as generics, and arequite inexpensive. But theye not all the same, so let look at the top 3 drugs your cardiologist will probably want to use to slow your AFib heart rate.