AFib

I have been diagnosed with AFib.  I am on Cardizem and Lanoxin plus one aspirin a day.  Can you explain what this medication does and why I can still expect to have occurrences of AFib?  

Confused in Florida

[Cleveland Clinic, MD]

Afib is a chronic problem in most people and drugs do nto cure it, only help to decrease the number of episodes.  These two drugs both work to "stabilize" the electrical system of the heart and also slow the heart rate when you do go into an afib episode.  There are many other medications that can be tried in addition should these fail.

Here is some additional information on afib.

Atrial fibrillation
Definition:
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles.

Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.

The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.

Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.

Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.

Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.

Symptoms:

     sensation of feeling heart beat (palpitations)
     pulse may feel rapid, racing, pounding, fluttering,
     pulse may feel regular or irregular
     dizziness, lightheadedness
     fainting
     confusion
     fatigue
     shortness of breath
     breathing difficulty, lying down
     sensation of tightness in the chest

Note: Symptoms may begin and/or stop suddenly.

Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low.

An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia).

Tests to determine the cause may include:

     an echocardiogram
     a coronary angiography (rarely)
     an exercise treadmill ECG


Treatment:
Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.

Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm.

There is not a consensus on the best long term management  of atrial fibrillation but many doctors feel it is important to try everything, including cardioversion (shock) to try to get the heart back into regular rhythm.  The risks of staying in afib are stroke (if not on anticoagulation) and decreased heart heart function (tachycardia induced cardiomyopathy).  Not all afib can be maintained in regular rhythm and those patients must live with the afib and take chronic anticoagulation (blood thinners).


Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem.

Potential Complications:

     incomplete emptying of the atria which can reduce the amount of blood the heart can pump
     emboli to the brain (stroke) or elsewhere--rare


Calling your health care provider:
Call your health care provider if symptoms indicate atrial
fibrillation or flutter may be present.

Q: Are there other safe drugs I could take at home to avoid cardioversion?
A: There are many different drugs that are used in the attempt to keep the heart in sinus rhythm (SR) but as with any medication they all have various side-effects.  You doctor can work with you on finding the best drug for your case.

Q:  What are the side effects to Toprol.
A: Toprol XL is a long acting version of metoprolol.  This drug is a beta-blocker.  Potential side-effects of beta-blockers include fatigue, problems with diabetic control, and impotence.

Q:  It seems that the better physical shape I stay in the less I have a problem with A.F. Could exercise have an impact?
A: There is no known effect of exercise on atrial fibrillation (AF).

Q: Is a pacemaker an alternative?
A: In some people who are unable to be controlled with drugs the electrical connection between the atria (upper heart chambers) and ventricles (lower heart chambers) is electrically severed and a pacemaker is placed to control the ventricles.  The atria remain in fibrillation but the side effect of the rapid heart rate is eliminated.  Chronic anticoagulation is required, as there is a risk of blood clots forming in the atria.



The links below are good sources of information about atrial fibrillation.

http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm

[Deb]

Hi,

I too have a-fib now and then.  I am lucky I guess, I do not have to be on meds right now.  I only get shorts blurps of it and it lasts only a few seconds to a minute or two every other month or so.

Here is a site that might interest you. http://members.aol.com/mazern/index.htm

Good luck to you.

[Cleveland Clinic, MD]

Afib is a chronic problem in most people and drugs do nto cure it, only help to decrease the number of episodes.  These two drugs both work to "stabilize" the electrical system of the heart and also slow the heart rate when you do go into an afib episode.  There are many other medications that can be tried in addition should these fail.

Here is some additional information on afib.

Atrial fibrillation
Definition:
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles.

Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.

The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.

Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.

Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.

Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.

Symptoms:

     sensation of feeling heart beat (palpitations)
     pulse may feel rapid, racing, pounding, fluttering,
     pulse may feel regular or irregular
     dizziness, lightheadedness
     fainting
     confusion
     fatigue
     shortness of breath
     breathing difficulty, lying down
     sensation of tightness in the chest

Note: Symptoms may begin and/or stop suddenly.

Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low.

An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia).

Tests to determine the cause may include:

     an echocardiogram
     a coronary angiography (rarely)
     an exercise treadmill ECG


Treatment:
Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.

Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm.

There is not a consensus on the best long term management  of atrial fibrillation but many doctors feel it is important to try everything, including cardioversion (shock) to try to get the heart back into regular rhythm.  The risks of staying in afib are stroke (if not on anticoagulation) and decreased heart heart function (tachycardia induced cardiomyopathy).  Not all afib can be maintained in regular rhythm and those patients must live with the afib and take chronic anticoagulation (blood thinners).


Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem.

Potential Complications:

     incomplete emptying of the atria which can reduce the amount of blood the heart can pump
     emboli to the brain (stroke) or elsewhere--rare

The links below are good sources of information about atrial fibrillation.

http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm

[Cleveland Clinic, MD]

Afib is a chronic problem and drugs do not cure it, only help to decrease the number of episodes.  These two drugs both work to "stabilize" the electrical system of the heart and also slow the heart rate when you do go into an afib episode.  There are many other medications that can be tried in addition should these fail.

Here is some additional information on afib.

Atrial fibrillation
Definition:
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles.

Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.

The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.

Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.

Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.

Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.



Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem.

Potential Complications:

     incomplete emptying of the atria which can reduce the amount of blood the heart can pump
     emboli to the brain (stroke) or elsewhere--rare

The links below are good sources of information about atrial fibrillation.

http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm

[Jackie]

I have been diagnosed with ectopic atrial tachycardia. I wonder if my chances are greater for developing atrial fibrillation than
your average person.

[Cleveland Clinic, MD]

Probably not.  Yours is a different sort of animal.

[Marlene]

I really appreciate you quick response, and reading, not only your response, but the other questions and responses relating to my condition has helped me tremendously.

Should I insist that my present doctor try another medication me since the second episode of AFib was worst than the first?

Should I assume I can lead a somewhat normal life i.e. working, exercising etc.?

[allan]

I was on Lanxoin and could not handle the arrythmias, wow, I don't know which is worse afib or the arrythmias.

[Cleveland Clinic, MD]

Thanks for your comments.  As with all drugs the benefits and the side effects must be weighed and choices made.

[hawk-8]

My husband had to go to ER a couple of nights ago, due to symptoms of faintness, shortness of breath, weakness, etc.  He was diagnosed with A fib and flutter,  after a couple of days in the hospital they got his heart rate down (from near 400 to 70), and a normal sinus rythum, he was also given blood thinning injections to protect him from possible blood clots.  

The stress test and eco were normal, he was sent home on wayfarin and amidarone.  We were told they did not know the cause, but he would be on these medicines for the rest of his life, that they were sure he would go out of rythum without the meds, leaving him with high risks for blot clots.

He has been on 40 mg of prednisone for over months and just decreasing the dose when this episode occurred.  I have read that cortisteroids can cause Afib, but the doctors do not see to think this a  possibility.  We were also not given any hope of doign any other procedure, just told that this is chronic.  I am having a difficult time understanding how this is determined chronic since  this is the first episode and nothing else has been tried and his heart is back in rythum with the meds.

The medicines prescribed seemed to have so many potential side effects.  My husband 1s 57 and basically healthy at this time, but he does have some lung and kidney damage due to high dose chemotherapy, bone marror transplant., but he is in remission at this time.

When I see the pulmonary possbile side effects of amiodarone, the lung problem concerns me. since my husband has some lung damage.  My husband also takes rituxan every 2 months for cancer prevention and IGG infusions for low gamma globulin  counts.  My question is:  With all the other meds and health issues, it seems it would be worth a try to do some procedure that would not require him to remain on wayfarin and amidarone and to assess the possibility of taking him off the meds once the prednisone is discontinued to see if it could have caused the Afib and flutter.  It seems from what I read there are several alternate procedures to fix the rythum problem, my husband's heart is not damaged.    Thanks

[bmwbiker]

A related discussion, A/fib  staying in sinus rythm was started.