RHYTHM CONTROL TREATMENTS
ANTIARRHYTHMIC DRUG TREATMENTS
‘Antiarrhythmic drugs’ refers to a group of medications, which are designed to suppress the onset of arrhythmia and to help maintain the heart in normal rhythm. They are used to treat AF but are also used for treatment of other heart rhythm conditions. The different medications may vary in their efficacy in controlling AF from person to person and also have different possible side effects and potential safety issues.
Amiodarone – A very effective medication for preventing and treating episodes of AF. It has some potential serious, but rare, side effects especially when used over a prolonged period of years. It is often used after other medications have been tried and have been unsuccessful. It can be used in patients with any type of underlying heart conditions.
Flecainide – A very effective medication for preventing and treating episodes of AF. It probably has the least side effects but cannot be used in people who have had a heart attack, significant coronary artery blockages or weakness of the heart muscle.
Sotalol - A useful medication for preventing AF episodes. It is from a class of medications called beta-blockers (which counteract the effects of adrenaline on the body and heart) but has additional rhythm stabilising properties. It may have effects on lowering blood pressure also. Rarely it can lead to a dangerous heart rhythm disturbance from interactions with other medications. You should always tell your doctors and your pharmacist if you are taking Sotalol when a new medication is being prescribed.
For people who are in continuous AF and the rhythm has not returned to normal on its own a cardioversion procedure may be required to restore the normal heart rhythm.
Electrical cardioversion (also known as direct-current or DC cardioversion) is a procedure whereby a synchronised electrical current (shock) is delivered through the chest wall to the heart. The shock is delivered through special adhesive electrodes or paddles on the chest and back.
The purpose of the cardioversion is to interrupt the abnormal electrical signals in the heart and to restore a normal heartbeat, like rebooting a computer. The delivered shock causes all the heart cells to contract simultaneously, thereby interrupting and terminating the abnormal electrical rhythm without damaging the heart. The heart’s electrical trigger then restarts the normal heart rhythm.
The procedure is performed under anesthesia in hospital, often as a day patient. Sometimes a cardioversion procedure is combined with a transoesophageal echocardiogram procedure at the same time. There are usually special requirements for “blood thinner” treatment around the time of cardioversion.
PERMANENT PACEMAKER IMPLANT
A small number of people with AF may also have an abnormality of the heart’s natural pacemaker or electrical trigger (called the “sinus node”), which controls the normal heart rhythm.
The heart may beat too slowly or even pause at times. This condition is called “sick sinus syndrome”. Drug treatments for AF may worsen the problem.
Implant of a permanent pacemaker may be required to correct “slow heart beats” while drug treatments for AF are continued to correct fast or erratic heart rhythms.