1. “Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?”
A doctor’s choice of drug therapy depends on one’s overall heart health, i.e., if there’s a heart condition other than Atrial Fibrillation.
In general, current medications don’t always work on A-Fib. People tend to react differently to meds. What works for one person may be terrible for another. What medications are best for you is a judgment call only you and your doctor can make..
When trying a new med, there is a fine line between allowing time for your body to adjust to it versus recognizing that this drug is causing bad, unacceptable side effects.
When starting a new med, your doctor may hospitalize you in order to monitor how the drug affects you and to get the dosage right.
If you’ve just been diagnosed with paroxysmal (occasional) A-Fib, flecainide (brand name Tambocor) or propafenone (Rythmol) might work for you. Some people have had good luck with the relatively new drugs dofetilide (brand name Tikosyn) and Rhythmol SR (propafenone sustained release). The newest antiarrhythmic med is Multaq (dronedarone) which is a less toxic substitute for amiodarone. Also see Treatments/Drug Therapies.
Guidelines from the ACC/AHA/ESC based on one’s overall heart health and heart conditions other than Atrial Fibrillation:
• Minimal or no heart disease. Flecainide, propafenone, sotalol. The object is to “minimize organ toxicity,” to select drugs that will not harm the rest of the body. The above drugs can cause “proarrhythmia” (an increase in heart rhythm problems), “but in patients without heart disease, this risk is extremely small.”
• If these drugs don’t work, then dofetilide and amiodarone can be considered. And “in experienced hands one might choose (Pulmonary Vein) Ablation (Isolation) for a primary cure.”
• Congestive heart failure. Only dofetilide and amiodarone have been demonstrated to be safe in randomized trials.
• Congestive heart failure and significant lung disease. “I would likely consider dofetilide as my first choice.”
• Congestive heart failure who are “hypokalemic” (have low levels of potassium). Amiodarone.
• Coronary artery disease. Sotalol is recommended because of its beta blocking and antiarrhythmic effects. Amiodarone or dofetilide combined with a beta blocker can also be used. Propafenone and flecainide aren’t recommended.
• Hypertension. Propafenone or flecainide.
• Hypertension and substantial left ventricular “hypertrophy” (increase in size). Amiodarone, because it has the least proarrhythmic effect.
(These guidelines are based on a presentation by Dr. Eric Prystowsky, see Boston AF/2003/ Prystowsky.)
Return to FAQ Drug Therapies
“Upstream Therapy” Concept: Alternative Therapies for A-Fib?
Report by Steve S. Ryan, PhD
Dr. Eric Prystowsky of The Care Group in Indianapolis, IN introduced the thought-provoking concept of “Upstream Therapy” in his presentation Alternative Therapies for Atrial Fibrillation.
Up to now, most A-Fib research has been focused on meds or devices to stop or control A-Fib. But can we find ways to stop A-Fib from developing in the first place? Dr. Eric Prystowsky lectured on the concept of “Upstream Therapies”
What is Upstream Therapy?
An example of an Upstream Therapy is the Galectin-3 inhibitor which prevents fibrosis from developing in the heart thereby also preventing A-Fib from developing or progressing. (See Dr. Jalife’s 2014 presentation: The Holy Grail: Preventing A-Fib by a GAl-3 Inhibitor)
We know, for example, that High Blood Pressure (HBP) often triggers or causes A-Fib, probably because of the pressure and strain HPB puts on the Pulmonary Vein openings in the Left Atrium.
Can therapies like Angiotensin Receptor Blockers, Ace Inhibitors or Hypertensive Therapy (Upstream Therapies) lower HPB and keep someone from developing A-Fib?
six Potential Upstream Therapies
Dr. Prystowsky discussed six potential Upstream Therapies which might show promise in A-Fib.
1. ACE-I/ARBs. ACE Inhibitors and Angiotensin Receptor Blockers may potentially prevent A-Fib by:
• Limiting Substrate Modification such as dilation, fibrosis and conduction velocity slowing
• Improve Hemodynamic Function by lowering atrial and blood pressure and reducing heart failure
• Reducing Initiators of A-Fib by decreasing stretch-activated ion channels Dr. Prystowsky showed how in one study the angiotensin II receptor blocker Irbesartan lowered A-Fib recurrence. But other studies (ACTIVE I) were not so conclusive.
2. Statins. In one study Atorvastatin significantly lowered the rate of recurrence of A-Fib. But other studies didn’t show statins having much effect on A-Fib.
3. PUFAs (Polyunsaturated Fatty Acids). He discussed two studies in which PUFAs weren’t very effective.
4. Acupuncture. In one study persistent A-Fib patients after Electrical Cardioversion were randomized to acupuncture or sham acupuncture for 10 sessions of 15/20 minutes weekly starting 48 hours after the cardioversion. Acupuncture was effective, but the sham acupuncture wasn’t (no placebo effect). This indicates the acupuncturist must be very knowledgeable, experienced and hit the right spots for acupuncture to be effective.
5. Renal Denervation. In a small study PVI combined with Renal Ablation resulted in less recurrence than just a PVI. (See also: the disappointing news about Renal Denervation in the satellite case Renal Denervation and Pulmonary Vein Isolation for PAF from Siberia, Russia in which it was announced that the Medtronic Symplicity HTN-3 trial didn’t reduce blood pressure )
6. Tarantula Peptide Inhibits A-Fib.
Alternative Therapies for Atrial Fibrillation
Dr. Prystowsky offers scientists and researchers the thought-provoking concept of “Upstream Therapy”. Divert the contributing factors that contribute to Atrial Fibrillation. What a worthy goal. Stop A-Fib from developing in the first place! (See also, Dr. Jalife’s presentation at this year’s Symposium “http://europace.oxfordjournals.org/content/early/2013/02/28/europace.eut038.full.pdf” )
In addition to upstream therapies which reduce high blood pressure, we might also consider therapies that:
• reduce or cure sleep apnea which is a trigger or cause of A-Fib
• reduce or cure diabetes, another trigger or cause of A-Fib
• keep people from excessive alcohol consumption “holiday heart” which triggers A-Fib.
In a limited study acupuncture was effective to some extent, but right now we don’t have enough data to say acupuncture can make people A-Fib free like a successful catheter ablation. More scientific studies need to be made of acupuncture. And effective acupuncturists need to be identified and listed in a directory similar to the listings of EPs (and surgeons) in A-Fib.com. Acupuncturists need to go through a certification process to verify they can effectively treat A-Fib patients.
For A-Fib patients today, statins, polyunsaturated fatty acids, and Renal Denervation aren’t very effective.
The most promising, exciting upstream therapy for A-Fib is the Galectin-3 inhibitor which prevents fibrosis from developing in the heart and reduces fibrosis already in the heart (See Dr. Jalife’s presentation at this year’s Symposium “http://europace.oxfordjournals.org/content/early/2013/02/28/europace.eut038.full.pdf” )
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Last updated: Friday, August 28, 2015