Atrial Fibrillation Treatment: Managing Irregular Heartbeats

Atrial fibrillation treatment

Hello, Doctor: During the New Year period, I experienced episodes of my heart suddenly beating very fast and then very slow, irregularly.
I later went to the emergency room, where the doctor diagnosed me with atrial fibrillation, with a heart rate of about 150 beats per minute.
After receiving an injection, my heart rate slowed to around 110, but it remained irregular.
The hospital recommended that I be admitted for continuous intravenous medication.
After about 24 hours, my heart rate returned to a normal range of 70-80 beats per minute, and it became regular, with blood pressure between 110/65 (during this time, I was taking Dronedarone, antihypertensive medication, and a medication for coronary artery dilation).
Later, an echocardiogram and a 24-hour Holter monitor showed normal results.
The doctor suggested trying medication for control.
However, I found online that Dronedarone may have an impact on thyroid issues, and I believe I had mild hyperthyroidism in the past.
Therefore, I would like to ask the doctor if there are medications with the least side effects.
I have previously experienced episodes of tachycardia, but at least they were regular beats.
This time, however, it was irregular.
My health check indicated that I have premature ventricular contractions, but they do not affect my heart function or daily life.
It seems that most people do not have premature contractions.
Are there any additional tests that can identify the cause and allow for targeted treatment? I have quit smoking and drinking for over two years.

A-Zhi, 30~39 year old female. Ask Date: 2021/03/04

Dr. He Dongjin reply Cardiology

Hello, long-term excessive use of certain medications can affect the thyroid gland.
You are currently in the acute phase, and the medication regimen is likely to be adjusted later.
The reasons for thyroid dysfunction may not always be detectable through tests.
Hyperthyroidism can also lead to atrial fibrillation.
Please cooperate with your attending physician for further examinations and medication adjustments.
Changhua Hospital cares about your well-being.

Reply Date: 2021/03/04

More Info

Atrial fibrillation (AF) is a common arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various complications, including stroke and heart failure, making its management crucial. Your experience of sudden irregular heartbeats, which were later diagnosed as AF, is not uncommon. The treatment of AF typically involves rate control, rhythm control, and anticoagulation to prevent thromboembolic events.

In your case, it appears that you were initially treated with intravenous medications to control your heart rate, which is a standard approach in acute AF management. The transition to oral medications, such as beta-blockers (like "Zang De Le" or metoprolol), is common for long-term management. These medications help to slow down the heart rate and can improve symptoms. However, as you mentioned, there are concerns regarding potential side effects, particularly with your history of mild hyperthyroidism.
Beta-blockers can sometimes influence thyroid function, and in patients with pre-existing thyroid issues, careful monitoring is essential. If you are concerned about the side effects of your current medication, it is crucial to discuss this with your healthcare provider. They may consider alternative medications, such as calcium channel blockers (e.g., diltiazem or verapamil) or even antiarrhythmic drugs like flecainide or propafenone, depending on your specific situation and overall health.

Regarding your question about further testing, it is essential to identify any underlying causes of your AF. Common causes include hypertension, heart valve disease, coronary artery disease, and hyperthyroidism. Since you have a history of premature ventricular contractions (PVCs), it may be worthwhile to explore this further, as frequent PVCs can sometimes contribute to the development of AF. An echocardiogram, which you have already undergone, is a valuable tool to assess heart structure and function. Additionally, a Holter monitor (24-hour ECG) can provide more insight into your heart rhythm over time and help correlate symptoms with arrhythmias.

Lifestyle modifications are also critical in managing AF. You mentioned that you have quit smoking and drinking for over two years, which is commendable. Continuing to maintain a healthy lifestyle, including regular exercise, a balanced diet, and stress management, can significantly impact your heart health.
In summary, managing atrial fibrillation involves a comprehensive approach that includes medication, lifestyle changes, and regular follow-up with your healthcare provider. If you have concerns about your current treatment plan or potential side effects, do not hesitate to reach out to your doctor for a thorough discussion. They can help tailor your treatment to minimize side effects while effectively managing your AF.

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