| If you have heart beat that is quicker than 60-80 | | | | antiarrhythmic drugs. It is used mostly in |
| beats per minute at rest or 90-115 beats per | | | | patients with heart failure and with coronary heart |
| minutes during exercise, you might have fast and | | | | diseases. Its use, however, has been limited by |
| irregular heart beat or arrhythmia. There are | | | | its organ related side-effects such as hyper |
| different kinds of arrhythmia but atrial fibrillation | | | | hypothyroidism, pulmonary fibrosis and liver |
| (AF) is the most common type | | | | toxicity. |
| Causes | | | | 2) Sotalol (Betapace) – Sotalol belongs to the |
| AF occurs when more than one cardiac cell in the | | | | same class of drug as amiodarone. It is less |
| upper chamber (atrial) of your heart are beating. | | | | efficacious than amiodarone and is used in AF |
| This usually occurs in patients who have | | | | patients with coronary heart disease. Since |
| pre-existing cardiovascular diseases (secondary | | | | sotalol is very effective in reducing the heart rate, |
| AF) such as coronary artery disease, cardiac | | | | patients taking sotalol will often experience fatigue. |
| surgery, hypertension, myocardial infarction, valve | | | | 3) Flecainide (Tamboco) and Propafenone |
| disorders (e.g. mitral valve disease) and congestive | | | | (Rythmol) – Flecainide and propafenone are |
| heart failure. The changes in cardiac structure | | | | used in AF patients without any other |
| associated with these diseases have damaged the | | | | cardiovascular heart diseases. If used in AF |
| conduction pathway of the cardiac muscle, making | | | | patients with cardiovascular disease, it might also |
| AF more prone to happen. | | | | cause arrhythmia. |
| There are, however, some instances where there | | | | 4) Dronedarone (Multaq) – Dronedarone is the |
| is no evidence of underlying disease and AF | | | | latest addition to the rhythm control drugs. It is |
| occurs spontaneously. These are termed "lone | | | | less efficacious than amiodarone in preventing AF |
| AF" and happened in approximately 20% of AF | | | | recurrences, but has a more favourable safety |
| patients. | | | | profile. It is also the first and the only drug to |
| Symptoms | | | | demonstrate a reduction in cardiovascular |
| Beside a quicker heart rate, patients with AF also | | | | mortality. The most common side-effects |
| experience palpitations, chest pain, dyspnea, | | | | associated with dronedarone are diarrhea, nausea |
| fatigue or light-headedness. | | | | and vomiting. |
| Diagnosis and Prognosis | | | | B) Rate control drugs |
| The only way to find out whether you have AF is | | | | Rate control drugs can slow down your heart |
| by conducting an ECG test. Patients who have | | | | rate, but can not convert your heart into |
| arrhythmia will find their P wave absence and their | | | | rhythm. Most of these drugs have fewer |
| R-R interval shorten in their ECG. | | | | side-effects than the rhythm control drugs. |
| The good news about AF is that it is not | | | | In certain situation, physicians might prescribe a |
| life-threatening, but patients with long-term AF | | | | combination of beta-blockers and digoxin or |
| occurrence can lead to stroke and heart failure. | | | | calcium channel blockers and digoxin for you to |
| In fact, patients with AF have a double risk of | | | | control your heart rate |
| death, a 5-fold increase in stroke and a 3-fold | | | | 1) Beta-blockers (metoprolol (Lopressor), |
| increase in heart failure compared with those who | | | | propranolol (Inderal)) - B-blockers are the most |
| do not have AF. | | | | effective drugs for slowing heart rate. The |
| Treatment | | | | effectiveness of these drugs to slow down the |
| Depending on your clinical situation (whether you | | | | heart rate, however, might also make you tired. |
| have hypertension, diabetes or stroke or heart | | | | If you always experience fatigue, you might need |
| failure), your doctor might prescribe warfarin | | | | to inform your doctor and your doctor might |
| (Coumadin) or aspirin to prevent stroke and | | | | install a pace-maker to prevent your heart from |
| prescribe anti-arrhythmic drugs to slow down | | | | beating too slow. |
| your heart rate and convert your heart into | | | | 2) Calcium Channel Blockers |
| rhythm again. In certain situations where | | | | (verapamil(Isoptin) and diltiazem(Tiazac)) – |
| pharmacological therapy fails to convert the heart | | | | Calcium channel blockers are effective agents to |
| into rhythm, ablation might be considered. | | | | slow down your heart rate with minimal adverse |
| Anticoagulant | | | | effects. |
| When taking warfarin (Coumadin), it is important | | | | 3) Digoxin (Lanoxin) - digoxin is more |
| to keep your INR is between 2.0 and 3.0. An | | | | effective at controlling heart rate during exercise |
| INR that is lower than 2 indicated that you are | | | | than b-blockers or calcium channel blockers. |
| not protected from stroke while an INR of | | | | However, due to its narrow therapeutic range |
| greater than 3 means that you might have an | | | | between efficacy and toxicity, digoxin is seldom |
| increased chance of bleeding. | | | | used in AF patients. It is used mainly in patients |
| Anti-arrhythmic agents | | | | with heart failure. |
| There are 2 methods to treat your AF: lower | | | | Radiofrequency Ablation |
| your heart rate (rate-control) or convert your | | | | Radiofrequency ablation involves inserting a |
| heart into regular rhythm (rhythm-control). | | | | catheter with an electrode at its tip into the heart |
| Theoretically, rhythm-control drugs should be | | | | and then using radiofrequency energy to destroy |
| superior to the rate-control drugs. However, the | | | | abnormal cardiac cells that stimulate AF. |
| presence of some nasty side-effects associated | | | | Even thought ablation has a high initial success |
| with the rhythm control drugs prevents these | | | | rate of 90%, it is not a cure. More than 50% of |
| drugs to demonstrate superior mortality benefit. | | | | the patients will have AF recur after 6 years. |
| As a result, the usage of one method over the | | | | Also, ablation is associated with some rare, but |
| other is subject to physicians' discretion. In | | | | serious adverse side-effects (vascular access |
| general, younger patients with symptomatic AF | | | | complications (1%), stroke and transient ischaemic |
| will be given rhythm control drugs while older | | | | attack (1%) and proarrhythmia (10-20%)). |
| patients with minimal symptoms will be given rate | | | | If you have AF or other arrhythmia, it is |
| control drugs. | | | | important to get treated earlier. The longer you |
| A) Rhythm control drugs | | | | wait, the more difficult it is to convert your heart |
| Even though rhythm control drugs possess the | | | | back to rhythm again. Your heart might have |
| ability to convert your heart into rhythm, it can | | | | undergone extensive anatomical and |
| also slow down your heart rate. | | | | electrophysiological that prevent it to respond to |
| 1) Amiodarone (Codarone) – Amiodarone is | | | | any anti-arrhythmic agents or surgical procedures. |
| one of the oldest and most powerful | | | | |