Background: Atrial fibrillation typically presents with tachycardia; atrial fibrillation with bradycardia is much less common. Bradycardia may be due to increased vagal tone, drugs affecting the atrioventricular node, or conduction system disease. Symptomatic bradycardia caused by conduction system disease is often treated with a pacemaker, because medications are not usually effective. Atropine, glycopyrrolate, hyoscyamine, and other anticholinergic drugs inhibit receptors that are present in smooth and cardiac muscle, the sinoatrial and atrioventricular node, and the exocrine glands (1–3). These drugs are often used to inhibit gastrointestinal propulsion and decrease urinary bladder contractions and secretions of the pharynx, stomach, trachea, and ... Show
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The treatment of atrial fibrillation (AF) varies from person to person and depends on:
Some people may be treated by their GP, whereas others may be referred to a cardiologist. Finding an underlying causeThe first step is to try to find out the cause of the atrial fibrillation. If a cause is found, treatment for this may be enough. For example, medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation. If there is no underlying cause foundIf no underlying cause of the atrial fibrillation can be found, the treatment options are:
You can find out more about each of these below. Medicines to control atrial fibrillationMedicines called anti-arrhythmics can control atrial fibrillation by:
The choice of anti-arrhythmic medicine depends on:
Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it. Restoring a normal heart rhythmThere are a number of drugs that can be used to try to restore a normal heart. The best option for you will be decided by your cardiologist and /or GP. Commonly, these drugs include:
Dronedarone may also be used for certain people. It is important you know what side effects to look out for if taking such medication and seek medical advice if you experience any of them. To find out about side effects, read the patient information leaflet that comes with your medicine for more details. Medicines to reduce the risk of a strokeThe way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (our complications of atrial fibrillation section has more information on this). Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:
You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk. Depending on your level of risk, you may be prescribed warfarin. AnticoagulantsAnticoagulants help to reduce the risk of stroke in patients with atrial fibrillation. Newer anticoagulants like apixaban, dabigatran, edoxaban and rivoroxaban are now more commonly used than warfarin. They do not require dose changes and continuous blood test monitoring. Warfarin may still be used in patients who can't be treated with a newer anticoagulant, or in those patients with other conditions where treatment with warfarin is preferred. CardioversionCardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm. The procedure normally takes place in hospital with heavy sedation or anaesthetic and careful monitoring. In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke. If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke. Catheter ablationCatheter ablation is a procedure that very carefully interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated. Catheters (thin, soft wires) are guided through one of your veins into your heart where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue. This procedure commonly takes two to three hours, so it may be done under general anaesthetic, where you are put to sleep. Find out more about catheter ablation for atrial fibrillation on the Arrhythmia Alliance website Having a pacemaker fittedA pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone. It will not cure, reverse or actively treat your atrial fibrillation. A pacemaker provides beats where your heart is not supplying its own. If your heart beat is very slow the pacemaker will override this and pace at a set rate. If there are significant pauses between your heart beats beats, the pacemaker will supply a beat, acting as a 'safety net'. Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed). How do you treat atrial fibrillation with a slow ventricular response?Ventricular slowing is accomplished with medications affecting the AV node (Table 1). The most commonly used drug classes are beta blockers and calcium channel blockers. Most patients with persistent atrial fibrillation receive daily suppressive therapy.
What is atrial fibrillation with ventricular response?Some cases of Afib involve atrial fibrillation with rapid ventricular response (RVR). This is when the rapid contractions of the atria make the ventricles beat too quickly. If the ventricles beat too fast, they can't receive enough blood. So they can't meet the body's need for oxygenated blood.
Can you have AFib with a slow heart rate?Atrial fibrillation (AF) is a condition that causes an irregular heart rate. Most commonly, the heart rate will be unusually fast with this condition; but it is possible for the heart rate to be within accepted limits or slower and still be in atrial fibrillation.
What is the difference between atrial fibrillation and atrial fibrillation with rapid ventricular response?Atrial fibrillation with rapid ventricular response is a fancy name for an irregular heartbeat. When your heart's electrical signals aren't working right, it can lead to a heartbeat that's too fast. This abnormal heart rhythm is what doctors call atrial fibrillation, or AFib for short.
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Atrial fibrillation with slow ventricular response causes
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