drugs

Medications to treat atrial fibrillation

Definition

Atrial fibrillation is one of the most common forms of cardiac arrhythmia, consisting of the chaotic and fragmentary contraction of the atria, which therefore gives rise to an irregular and often accelerated heart rhythm; it is a supraventricular tachyarrhythmia characterized by progressive damage to the mechanical atrial function. Atrial fibrillation can become chronic or appear suddenly and resolve within a few days.

Causes

Cardiac anomalies, in terms of structure and functionality, are the etiopathological elements most involved in the manifestation of atrial fibrillation; other predisposing factors include: drug abuse, alcoholism, heart valve abnormalities, sleep apnea, heart attacks, congenital heart defects, exposure to stimulant drugs, emphysema, viral infections, heart surgery, hypertension, hyperthyroidism, excessive stress.

Symptoms

In atrial fibrillation the heart does not pump blood efficiently; in some patients the disorder does not create any appreciable symptoms, while in others, atrial fibrillation can cause drop in blood pressure, confusion, weakness, chest pain, shortness of breath and palpitations

  • Clinical evidence: in atrial fibrillation the heart rate can vary from 100 to 175 beats / min (the normal range is between 60 and 100 bpm)

Information on atrial fibrillation - Drugs for the treatment of atrial fibrillation is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking atrial fibrillation - Drugs for the treatment of atrial fibrillation.

drugs

As with most diseases, the treatment of choice for treating atrial fibrillation depends on the triggering cause: for example, when the alteration of the heartbeat depends on a disease affecting the thyroid or an alteration of pressure, the treatment of the diseases that originate from it also involves controlling the heart rate and rhythm. In this case, atrial fibrillation is of simple resolution; unfortunately, in practice it is not always so easy to keep the heart rate within the normal range, for which further pharmacological and non-pharmacological treatments are necessary. Among the most validated therapeutic strategies, we recall:

  1. Pharmacological control of heart rate
  2. Prevention of complications (stroke, heart failure)
  3. Electrical or pharmacological cardioversion with antiarrhythmic drugs (in order to restore sinus rhythm)
  4. Prevention of thrombus formation
  5. Cardiac catheterization (for extreme cases)
  6. Ablation of the atrioventricular node in association with anticoagulant therapy

Antiarrhythmics : after electrical cardioversion to restore the physiological heartbeat, it is recommended to administer antiarrhythmic drugs, for the prevention of further, possible recurrences of atrial fibrillation episodes. These active ingredients are not without side effects (fatigue, nausea, dizziness. Rarely can cause ventricular arrhythmias): it is recommended to respect the dosage prescribed by the doctor.

  • Amiodarone (eg Cordarone, Amiodarone SAN, Amiodar, Angoron): for the treatment of atrial fibrillation, take 200 mg of drug, three times a day for 7 days. After a week, reduce the dose to 200 mg, to be taken twice a day for 7 days. The maintenance dose involves administering 200 mg of active ingredient per day. The drug can also be administered by intravenous infusion. Consult your doctor.
  • Dronedarone (eg. Multiaq): indicated for patients with a history of atrial fibrillation or who suffer from this disorder in a non-permanent manner. Orally administer one 400 mg tablet twice a day (preferably during breakfast and dinner). Do not take along with grapefruit juice.
  • Propafenone (eg. Rytmonorm, Cardiofenone, Normarit): indicated for cardioversion of atrial fibrillation, as well as for controlling the heartbeat. It is recommended to take 600 mg of the drug orally or 1.5-2 mg / kg, for an IV infusion lasting 20 minutes. For the prevention of relapses of atrial fibrillation, take 450-900 mg a day of medication, orally. The drug can cause visual impairment, asthenia, diarrhea, nausea, dry mouth and vomiting.
  • Sotalol (eg Rytmobeta, Sotalex, Sotalol VTE): for the treatment of atrial fibrillation in adults, it is recommended to take the drug orally at an indicative dose of 80 mg, twice a day. If the dose just described does not show any appreciable benefit to the patient, it is possible to increase the dosage up to 120-160 mg. Consult your doctor. The maintenance dosage involves administering the drug at a dose of 120-160 mg, orally, in a double daily dose. Alternatively, parenteral therapy can also be undertaken: starting therapy with 112.5 mg, intravenously, once or twice a day. The maintenance dose suggests taking 112.5-150 mg, intravenously, once or twice a day. The drug can also be taken by children suffering from atrial fibrillation, at a different dosage, established by the doctor based on age, the weight of the child and the severity of the pathology.
  • Dofetilide (eg. Tikosyn): powerful third-class antiarrhythmic drug, used both in the treatment of tachycardia and for the treatment of atrial fibrillation. The indicative dose is to take 125-500 mcg of active ingredient once or twice a day. The precise dose should be established by the doctor.
  • Flecainide (eg. Almarytm, Flecainide SAN): start therapy with a dose of drug equal to 100 mg, to be taken by mouth every 12 hours. The maintenance dose may increase by 50 mg every 4 days compared to the initial dose. Do not exceed 400 mg a day.
  • Vernakalant hydrochloride (eg Brinavess): indicated to restore normal heartbeat in patients with recent atrial fibrillation. As an indication, administer the drug at a dose of 3 mg / kg for a 10-minute intravenous infusion. If necessary, proceed with a second administration of active ingredient (2mg / kg) if after 15 minutes the heartbeat has not returned to regular. Do not exceed a total of 5mg / kg per day.

Fluidifying and anticoagulants :

  • Warfarin (eg. Coumadin): to be taken for a few weeks, in order to reduce the risk of thrombus formation and stroke. Generally, the administration of this drug follows cardioversion. The dosage must be carefully established by the doctor; in general, however, it is advisable to administer the drug maintaining a therapeutic range between 2 and 3 of INR (prothrombin time). To obtain a higher therapeutic effect, it is recommended to administer the drug in combination with heparin.
  • Dabigatran (eg. Pradaxa): useful for the prevention of the formation of clots (hence of thromboembolism) in the context of atrial fibrillation; the efficacy of this drug is comparable to that of warfarin. As we know, blood clots in the arteries can cause stroke, so in the context of atrial fibrillation, similar therapy is recommended. Initiate therapy with an active dose of 110-150 mg, twice a day, orally.

Factor Xa inhibitor

The drug is used in therapy for the anticoagulant properties, capable of inhibiting one of the factors involved in the mechanism of blood coagulation (factor Xa). By blocking the Xa factor, the synthesis of thrombin is denied, which reflexively prevents the formation of thrombi.

  • Rivaroxaban (eg. Xarelto): indicated for the prevention of complications from atrial fibrillation, such as venous thromboembolism, especially in patients who have previously undergone surgery on their knees and hips. The recommended dose is 20 mg, to be taken orally, once a day, with the evening meal.

Digitalis drugs : indicated for controlling heart rate (in the physiological range 60-100 bpm)

  • Digoxin (eg Lanoxin, Eudigox, Digoss FN): the drug is an anti-arrhythmic that can control the heart rate of a patient at rest but NOT during physical activity. Very often patients with marked atrial fibrillation also need calcium channel blockers (eg verapamil, contraindicated, however, in the treatment of atrial fibrillation with pre-excitation and in children), ACE inhibitors or beta blockers, for the treatment of hypertension . For heart rate control in patients with atrial fibrillation, the indicative dose of the drug is 8-12 mcg / kg. The doses of digoxin taken for the treatment of chronic atrial fibrillation must be titrated to the minimum dose, useful to allow the desired therapeutic effect (control of the heartbeat), without causing heavy side effects. The administration of digitalis and antihypertensive drugs reduces the risk of complications of atrial fibrillation.