February 5, 2018

Tara Mudd, APRN, with Norton Heart & Vascular Institute’s Heart Rhythm Center, answers questions about atrial fibrillation medications, their risks, side effects and what happens if they don’t work.

Q: How often and for how long do people have to take atrial fibrillation drugs?

Anti-arrhythmic medications can be taken anywhere from once daily to three times daily, depending on the particular medication used. The length of therapy depends on how well the patient responds to the medication — is it doing its intended purpose and preventing the arrhythmia? If so, is the patient having side effects that may require us to stop it prematurely? Some anti-arrhythmics are safe to use long term (sometimes over 20 years in some patients), while others have an increased risk of side effects the longer they are taken.

Q: Are the drugs expensive? 

Most anti-arrhythmic drugs are generic and therefore generally affordable. A few name-brand drugs are prescribed and can cost more out of pocket. Ultimately, it comes down to each patient’s prescription drug coverage. We take that into consideration when selecting which medication may be right for you.

Q: Are there side effects? What are the risks?

Anti-arrhythmic medications come with the potential for side effects and risks. The potential for side effects will depend on which drug is selected for you. Some medications can have side effects ranging from gastrointestinal upset or fatigue, while others can have the potential to cause toxicity to organs such as the liver, thyroid and lungs.

Anti-arrhythmic medications are designed to help prevent an abnormal heart rhythm. However, with each class of anti-arrhythmic medication, the medication has the potential to cause an abnormal heart rhythm in some patients. As a result, some types of anti-arrhythmic medications will be started in a hospital setting. That allows us to more closely monitor for an abnormal rhythm. We consider the potential side effects and inherent risks associated with the medication when we determine how and when to start the patient on a new medication.

Q: Of the people who take atrial fibrillation drugs, how many are helped?

Based on studies looking at the effectiveness of these medications, on average they are successful about 50 percent of the time. Many extraneous factors contribute to the success of these medications. Part of their success also has to do with risk factors. Patients who take care of their blood pressure, diabetes, sleep apnea and quit smoking generally have greater success.

Q: What’s the best outcome I can expect?

That you feel better. Our primary goal with preventing arrhythmia means that you have relief in your symptoms. This may not mean that they are gone 100 percent of the time. We rarely are able to eliminate things 100 percent of the time. However, if we can help prevent the arrhythmia so you can be active and do the things you’d like to do with minimal interruption, we consider that the best possible outcome.

Q: If the drugs don’t work, what’s next?

It depends on the arrhythmia we are trying to prevent and how you feel. In certain cases, we can consider more invasive options like a catheter ablation to eliminate the arrhythmia. Catheter ablation is a procedure that uses energy to make small scars in the heart tissue to block abnormal electrical signals. Radiofrequency (RF) ablation uses high-energy, locally delivered RF signals to make the scars. Cryoablation uses extremely cold temperatures to make the scars. This is something that should be discussed at length with your heart rhythm specialist.