Medications

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.

Anti-arrhythmia medications

• 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.

Other drugs

• 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.

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