Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The choice of medication depends on the underlying cause, other medical
conditions and overall health, and other medications being taken. Ironically,
many anti-arrhythmia medications may induce abnormal heart rhythms.
Miscellaneous anti-arrhythmia medications: They reduce the frequency and
duration of atrial flutter episodes and thus can prevent future episodes. They
are often given to prevent the return of atrial flutter after defibrillation.
The most commonly used drugs are amiodarone (Cordarone, Pacerone), sotalol
(Betapace), propafenone (Rythmol), and flecainide (Tambocor).
Digoxin (Lanoxin): This medication decreases the conductivity of the
electrical impulses through the SA and AV nodes, slowing down the heart rate.
Digoxin is not used as much as it was before beta-blockers and calcium blockers
became available, except if the person has underlying heart failure due to a
poorly functioning left ventricle.
Beta-blockers: These drugs decrease the heart rate by slowing conduction
through the AV node, decreasing the heart's demand for oxygen, and by
stabilizing the blood pressure. Examples include propranolol (Inderal) or
metoprolol (Lopressor Toprol XL).
Calcium channel blockers:
These drugs also slow down the heart rate by
slowing AV node conduction. Verapamil (Calan, Isoptin) and diltiazem (Cardizem)
are examples of calcium channel blockers.
Dofetilide (Tikosyn): Administration of this oral anti-arrhythmic drug
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.
Anticoagulants: These drugs reduce the ability of the blood to clot, thus
reducing the risk of an unwanted blood clot forming in the heart or in a blood
vessel. Atrial flutter increases the risk of such blood clots forming in the
left atrium. Warfarin (Coumadin) is the most common drug used for clot
prevention caused by arrhythmias.