Symptoms
If you have heart beat that is quicker than 60-80 beats per minute at rest or 90-115 beats per minutes during exercise, you might have fast and irregular heart beat or arrhythmia. There are different kinds of arrhythmia but atrial fibrillation is the most common type.
Beside a quicker heart rate, patients with atrial fibrillation also experience palpitations, chest pain, dyspnea, fatigue or light-headedness.
Diagnosis
The only way to find out whether you have atrial fibrillation is by conducting an ECG test. Patients who have arrhythmia will find their P wave absence and their R-R interval shorten in their ECG.
The good news about atrial fibrillation is that it is not life-threatening, but patients with long-term atrial fibrillation occurrence can lead to stroke and heart failure. In fact, patients with atrial fibrillation have a double risk of death, a 5-fold increase in stroke and a 3-fold increase in heart failure compared with those who do not have AF.
Treatment
Depending on your clinical situation (whether you have hypertension, diabetes or stroke or heart failure), your doctor might prescribe warfarin (Coumadin) or aspirin to prevent the incidence stroke and prescribe anti-arrhythmic drugs to slow down your heart rate and convert your heart into rhythm again. In certain situation where pharmacological therapy fails to convert the heart into rhythm, ablation might be considered.
Anticoagulant
When taking warfarin (Coumadin), it is important to keep your INR is between 2.0 and 3.0. An INR that is lower than 2 indicated that you are not protected from stroke while an INR of greater than 3 means that you might have an increased chance of bleeding.
Anti-arrhythmic agents
There are 2 methods to treat your atrial fibrillation: lower your heart rate (rate-control) or convert your heart into regular rhythm (rhythm-control).
Theoretically, rhythm-control drugs should be superior to the rate-control drugs. However, the presence of some nasty side-effects associated with the rhythm control drugs prevents these drugs to demonstrate superior mortality benefit.
As a result, the usage of one method over the other is subject to physicians' discretion. In general, youngerpatients with symptomatic AF will be given rhythm control drugs while older patients with minimal symptoms will be given rate control drugs.
A) Rhythm control drugs
Even though rhythm control drugs possess the ability to convert your heart into rhythm, it can also slow down your heart rate.
1) Amiodarone (Codarone) – Amiodarone is one of the oldest and most powerful antiarrhythmic drugs. It is used mostly in patients with heart failure and with coronary heart diseases. Its use, however, has been limited by its organ related side-effects such as hyper/hypothyroidism, pulmonary fibrosis and liver toxicity.
2) Sotalol (Betapace) – Sotalol belongs to the same class of drug as amiodarone. It is less efficacious than amiodarone and is used in AF patients with coronary heart disease. Since sotalol is very effective in reducing the heart rate, patients taking sotalol will often experience fatigue. 3) Flecainide (Tamboco) and Propafenone (Rythmol) – Flecainide and propafenone are used in AF patients without any other cardiovascular heart diseases. If used in AF patients with cardiovascular disease, it might also cause arrhythmia.
4) Dronedarone (Multaq) – Dronedarone is the latest addition to the rhythm control drugs. It is less efficacious than amiodarone in preventing AF recurrences, but has a more favourable safety profile. It is also the first and the only drug to demonstrate a reduction in cardiovascular mortality. The most common side-effects associated with dronedarone are diarrhea, nausea and vomiting.
B) Rate control drugs
Rate control drugs can slow down your heart rate, but can not convert your heart into rhythm. Most of these drugs have fewer side-effects than the rhythm control drugs.
In certain situation, physicians might prescribe a combination of beta-blockers and digoxin or calcium channel blockers and digoxin for you to control your heart rate
1) Beta-blockers (metoprolol (Lopressor), propranolol (Inderal)) - B-blockers are the most effective drugs for slowing heart rate. The effectiveness of these drugs to slow down the heart rate, however, might also make you tired. If you always experience fatigue, you might need to inform your doctor and your doctor might install a pace-maker to prevent your heart from beating too slow.
2) Calcium Channel Blockers (verapamil(Isoptin) and diltiazem(Tiazac)) – Calcium channel blockers are effective agents to slow down your heart rate with minimal adverse effects.
3) Digoxin (Lanoxin) - digoxin is more effective at controlling heart rate during exercise than b-blockers or calcium channel blockers. However, due to its narrow therapeutic range between efficacy and toxicity, digoxin is seldom used in AF patients. It is used mainly in patients with heart failure.
Ablation
Even thought ablation has a high initial success rate of 90%, it is not a cure. More than 50% of the patients will have AF recur after 6 years. Also, ablation is associated with some rare, but serious adverse side-effects (vascular access complications (1%), stroke and transient ischaemic attack (1%) and proarrhythmia (10-20%)).
If you have atrial fibrillation or other arrhythmia, it is important to get treated earlier. The longer you wait, the more difficult it is to convert your heart back to rhythm again. Your heart might have undergone extensive anatomical and electrophysiological that prevent it to respond to any anti-arrhythmic agents.
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