Tretment of Atrial Fibrillation

I am curious. My doctor has prescribed Metopropol to treat my Atrial Fibrillation. Why is a beta blocker prescribed instead of a drug which will actually treat the Afib?  The beta blocker will lower my heart rate, but I go into Afib at night usually when my heart rate is low anyway.  I have only once gone into it while running.

So it seems to me that the Metopropol will not avoid the Afib, just control them.  Is that correct?

Thanks!

[Brooke_38]

Hello...

The first step in managing atrial fibrillation is typically to treat it with medications, starting with a rate control drug to slow the heart rate in combination with anticoagulation by a blood thinner to reduce the risk of stroke.

There are three types of medications used in treating and managing atrial fibrillation:

Rate control medication to control the heart rate
Rhythm control medication, sometimes called drug cardioversion, to put the heart back into normal sinus rhythm

Your doctor will decide which rhythm control drug is best for you based on the type of atrial fibrillation you have and your medical history, including the presence or absence of other existing heart disease. Here are the types of drugs used for rhythm control:

Sodium channel blockers, which improve the heart's rhythm by slowing the heart's electrical conduction. Examples include Flecainide (Tambocor), Propafenone (Rythmol), and Quinidine (Various).
Potassium channel blockers, which relax the heart muscle and slow the electrical signals that cause afib. Examples include Amiodarone (Cordarone, Pacerone) and Sotalol (Betapace).
These medications are not considered to be highly effective and many have major side effects. For example, quinidine is only about 50 percent effective in maintaining a normal sinus rhythm over the long term, and flecainide, propafenone and sotalol are not much better.

Amiodarone is considered superior to these other medications in attaining and maintaining normal sinus rhythm, but may be the medication of last resort due to its lung toxicity and potential for long-term adverse effects.  Some people who took amiodarone mentioned that it can make you to turn blue like a "Smurf." Who wants to turn blue!

Many people that were on rhythm control drugs said that those medications just left them feeling badly and persistently tired. For most, these medications worked at first, and in some cases controlled their afib for years, but eventually just stopped working.

Anticoagulant medication, such as warfarin or Coumadin, to control blood thickness and avoid blood clots and stroke
The latest clinical trials have changed the thinking of doctors about how to manage and treat atrial fibrillation by discovering that it's less important than originally thought to get afib patients into normal sinus rhythm. Afib patients, however, should always be anticoagulated. The newest strategy for doctors in managing atrial fibrillation is:

Control heart rate and anticoagulate, and if there are no symptoms and the heart rate is controlled, then leave the patient in afib
Cardioversion for patients who still have symptoms and the heart rate can't be controlled, or for whom normal sinus rhythm is preferred .

I hope this helps explain your Dr's thinking in treating your Atrial Fibrillation. :)

[Brooke_38]

Hello...

The first step in managing atrial fibrillation is typically to treat it with medications, starting with a rate control drug to slow the heart rate in combination with anticoagulation by a blood thinner to reduce the risk of stroke.

There are three types of medications used in treating and managing atrial fibrillation:

Rate control medication to control the heart rate
Rhythm control medication, sometimes called drug cardioversion, to put the heart back into normal sinus rhythm

Your doctor will decide which rhythm control drug is best for you based on the type of atrial fibrillation you have and your medical history, including the presence or absence of other existing heart disease. Here are the types of drugs used for rhythm control:

Sodium channel blockers, which improve the heart's rhythm by slowing the heart's electrical conduction. Examples include Flecainide (Tambocor), Propafenone (Rythmol), and Quinidine (Various).
Potassium channel blockers, which relax the heart muscle and slow the electrical signals that cause afib. Examples include Amiodarone (Cordarone, Pacerone) and Sotalol (Betapace).
These medications are not considered to be highly effective and many have major side effects. For example, quinidine is only about 50 percent effective in maintaining a normal sinus rhythm over the long term, and flecainide, propafenone and sotalol are not much better.

Amiodarone is considered superior to these other medications in attaining and maintaining normal sinus rhythm, but may be the medication of last resort due to its lung toxicity and potential for long-term adverse effects.  Some people who took amiodarone mentioned that it can make you to turn blue like a "Smurf." Who wants to turn blue!

Many people that were on rhythm control drugs said that those medications just left them feeling badly and persistently tired. For most, these medications worked at first, and in some cases controlled their afib for years, but eventually just stopped working.

Anticoagulant medication, such as warfarin or Coumadin, to control blood thickness and avoid blood clots and stroke
The latest clinical trials have changed the thinking of doctors about how to manage and treat atrial fibrillation by discovering that it's less important than originally thought to get afib patients into normal sinus rhythm. Afib patients, however, should always be anticoagulated. The newest strategy for doctors in managing atrial fibrillation is:

Control heart rate and anticoagulate, and if there are no symptoms and the heart rate is controlled, then leave the patient in afib
Cardioversion for patients who still have symptoms and the heart rate can't be controlled, or for whom normal sinus rhythm is preferred .

I hope this helps explain your Dr's thinking in treating your Atrial Fibrillation. :)

[Jerry_NJ]

Great response and very informative.

You didn't mention calcium channel blocker in your listing. Can you tell us/me where it falls into the picture you have drawn?  I take both a BB and a CCB for "rate control"... as I am in permanent AFib with mild symptoms (I think most of my limiting "symptoms" now are side-effects from the drugs).  Indeed, my Cardiologist and a consulted (same practice partnership) EP adhere no to the rate control and anticoagulant routine for those with tolerable AFib symptoms.  They have in effect refused to try a Ablation on me due to the risks and low probability of any success.  I have already had a mini-maze procedure that didn't hold, it was done when I was opened for valve repair.

[LindaTX]

Hi and welcome to Medhelp.  Sorry you are having to deal with this annoying affliction.  Have you had these episodes for very long and how long do they normally last?  I don't know why your Dr. hasn't suggested an anti-arrhythmic drug because metoprolol is not going to control your a-fib.  The anti-arrhythmics work great for awhile, even a yr or longer and as long as you have a structurally normal heart you might do well for a long time. The problem is...a-fib is progressive and there are a lot of things that trigger it.  You may or may not have an idea of what triggers your episodes.  But in the end it doesn't really matter.  You can either go with the drugs or you can go with the ablation. Have you discussed either of these options with your Dr, preferably an electrophysiologist?

[enough_is_enough]

THANK YOU!! Your answer is much more than I had hoped for. It is beyond informative. This forum is lucky to have you! :)

I see that you are from the Boston area as well. Can you tell me who your EP Dr is?

Jerry_NJ and LindaTX, thank you for your input as well.