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Medications to control the rate and rhythm of your heartbeat

Controlling the rate of your heartbeat1

Atrial fibrillation (AF) can make the heart beat too quickly or slowly. There are several types of rate control which your doctor may use to slow the heartbeat and maintain it at a safer 80 beats a minute at rest.

Several treatments may be tried before the best one is found for you, and your doctor will want to monitor your progress through regular check-ups. Should your treatment make you feel unwell, you should discuss this with your doctor immediately.

  • Beta blockers are especially effective for active patients. Beta blockers include atenolol, metoprolol, and bisoprolol. They are, however, not usually prescribed for patients with asthma or emphysema.
  • Verapamil and Diltiazem also slow the heart rate. They are not suitable for patients with heart failure. Pre-existing medical conditions and current medications should be discussed with your physician to establish whether any contraindications or drug interactions exist. Any adverse effects should be reported to your doctor immediately.
  • Other rate control drugs such as digoxin may occasionally be used, sometimes in combination with beta blockers.

Controlling the rhythm of your heartbeat1,2

A treatment called cardioversion is recommended for people whose rate control treatment isn’t working well, or who have had AF for less than six months. Your doctor will discuss the best cardioversion treatment appropriate for you.

  • Pharmacological cardioversion – is most likely to be used within the first 48 hours of AF starting. These ‘antiarrhythmic’ drugs are used to help your heart return to a normal rhythm. Your doctor will decide which one to offer you after considering a number of factors, including whether you have heart disease that affects the structure of the heart.
  • Electrical cardioversion is likely to be offered if your AF has lasted longer than 48 hours. It is a brief, controlled electric shock to the heart, often this is administered under sedation or a light general anesthetic, usually through two pads placed on the wall of the chest. Antiarrhythmic drugs may also be used to help maintain a regular heartbeat after the procedure.

Surgical options3,4

If medications to control the rate and rhythm of your heartbeat are not successful, there are some surgical interventions your doctor may want to discuss with you. The theory behind all of these techniques is to scar the tissue of the atrial chambers of the heart. These surgically-created scars permanently interrupt the abnormal electrical signals that cause irregular heartbeats.

  • Catheter ablation is where a catheter-based energy source is inserted through the groin, neck, or arm and threaded to the heart, where it scars the tissue.
  • Cox maze III procedure (also known as the ‘maze procedure’) is open-heart surgery that uses a "cut-and-sew" technique or energy source to scar the tissue in the atria. It is considered the gold standard for curing atrial fibrillation.
  • Mini maze procedure is a minimally-invasive surgical ablation that doesn't require opening the chest, so it has a shorter recovery time. It is less invasive than the maze procedure but more invasive than catheter ablation.
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1. Atrial fibrillation drug information. Atrial Fibrillation Society. February 2011.
2. Cardioversion. Atrial Fibrillation Society. January 2009. http://www.atrialfibrillation.org.uk/files/file/PVAFACardioversion090413.pdf Accessed 9 May 2011.
3. Shea J and Sears S, A patient’s guide to living with atrial fibrillation, Circulation. May 2008. http://www.stopafib.org/maze-surgery.cfm Accessed 9 May 2011.
4. Cox Maze III Procedure http://www.stopafib.org/maze-surgery.cfm Accessed 9 May 2011