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Medications

The choice of medication depends on the type of atrial fibrillation you have, the underlying cause, your other medical conditions and overall health, and the other medications you take. Ironically, many anti-arrhythmia medications may induce abnormal heart rhythms.

Anti-arrhythmia medications

• Miscellaneous anti-arrhythmia medications: These drugs control the heart rhythm rather than rate. They reduce the frequency and duration of atrial fibrillation episodes. They are often given to prevent return of atrial fibrillation after cardioversion. The most commonly used drugs are amiodarone (Cordarone, Pacerone), sotalol (Betapace), propafenone (Rythmol), and flecainide (Tambocor). Overall, these drugs are 50-70% effective.
  
  
• Beta-blockers: These drugs slow the heart rate by decreasing the rate of the SA node and by slowing conduction through the AV node. Therefore, the heart's demand for oxygen is decreased, and the blood pressure is stabilized. Examples include propranolol (Inderal) or metoprolol (Lopressor Toprol XL).
  
  
• Calcium channel blockers: These drugs also slow heart rate by similar mechanisms as beta-blockers. Verapamil (Calan, Isoptin) and diltiazem (Cardizem) are examples of calcium channel blockers.
  
  
• Digoxin (Lanoxin): This drug decreases the conductivity of electrical impulses through the AV node, but onset of action is slower than beta-blockers and calcium-blockers. Digoxin is currently used primarily in patients with associated heart disease, such as a poorly functioning left ventricle.
  
  
• Dofetilide (Tikosyn): This is an oral anti-arrhythmic drug that must be initiated in the hospital over a three-day period. Hospitalization is needed to closely monitor the heart rhythm during the initial dosing period. If the atrial fibrillation responds favorably during the initial dosing, a maintenance dose is established to be continued at home.

Other drugs

• Warfarin (Coumadin): This drug is an anticoagulant (blood thinner). It reduces the ability of the blood to clot. It lowers the risk of an unwanted blood clot forming in the heart or in a blood vessel. Atrial fibrillation increases the risk of forming such blood clots. There are other anticoagulant drugs, but warfarin is the only one taken in pill form and is usually given for daily use. It is extremely important to follow the exact dosing prescribed and to have regular blood tests (INR) when recommended by your doctor.