Atrial Fibrillation: Treatment Options and Concerns

Atrial Fibrillation Treatment

During the Lunar New Year, 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 decreased 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 normal at 70-80 beats per minute, and it became regular.
During this time, I was taking Dronedarone, antihypertensive medication, and anticoagulants.
Subsequent echocardiogram and 24-hour Holter monitor tests showed normal results.
The doctor suggested that I continue with medication for now, but I found online that Dronedarone may have an impact on thyroid issues.
I believe I had mild hyperthyroidism in the past, so I would like to ask the doctor if there are medications with fewer side effects.
I previously experienced episodes of increased heart rate, but at least it was regular.
My health check indicated that I have premature beats, but they do not affect heart function.
Why do normal individuals experience premature beats? Are there any additional tests that can identify the underlying causes so that appropriate treatment can be administered? I have been smoke and alcohol-free for over two years.
1.
The attending physician suggested that I discontinue Dronedarone.
Is there a high chance of recurrence? I am currently taking half a 100 mg tablet daily, along with half a tablet of Clopidogrel, and I have been on this regimen for about two weeks.
Are there alternative medications for atrial fibrillation? I am very anxious about experiencing irregular heartbeats again.
2.
Is my condition considered severe? Does severity mean that medication is difficult to control?
3.
During my hospitalization, the 24-hour ECG mentioned the issue of premature beats, which I don't recall having before.
Can premature beats be treated?

A Zhi, 30~39 year old female. Ask Date: 2021/03/06

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about "the treatment of atrial fibrillation," based on your description, this is your first experience, and you have returned to normal rhythm, which indicates that it is paroxysmal atrial fibrillation.
If there are no underlying cardiopulmonary diseases or hyperthyroidism, the risk is generally low.
However, this type of arrhythmia can lead to the formation of atrial thrombi, which increases the risk of arterial thromboembolism, particularly stroke.
Therefore, anticoagulation therapy recommendations should be based on your stroke risk score.
In your case, if you do not have diabetes, hypertension, known atherosclerotic cardiovascular disease, or heart failure, your stroke risk score may be 0, which is similar to the general population, so it may not be necessary to take anticoagulants at this time.
Regarding the management of atrial fibrillation itself, there are considerations for both rhythm control and rate control.
The former aims to restore normal rhythm, while the latter focuses on controlling heart rate.
If you experience symptomatic episodes, such as palpitations, discomfort, dizziness, or more severe symptoms, rhythm control should be considered.
However, the trade-off may involve tolerating higher-risk antiarrhythmic medications.
Given your situation, if episodes are infrequent, you might consider "as-needed" medication, taking it only during episodes, but not "dronedarone"; instead, a Class Ic agent like propafenone could be appropriate.
For long-term management, some individuals may find that beta-blockers, which are less potent but have fewer side effects, are effective.
It is advisable to consult with your attending physician for a tailored treatment plan.
Take care, and best wishes from Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/03/06

More Info

Atrial fibrillation (AF) is a common arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various symptoms, including palpitations, fatigue, and an increased risk of stroke. Given your recent experience with AF, it’s understandable that you have concerns about treatment options, potential side effects, and the implications of your condition.

Understanding Atrial Fibrillation and Treatment Options
AF can be triggered by various factors, including stress, alcohol consumption, and underlying health conditions such as hyperthyroidism. In your case, the rapid heart rate you experienced (up to 150 beats per minute) is typical of AF, and the subsequent treatment with intravenous medications helped restore your heart rate to a more normal range. The medications you mentioned, such as beta-blockers (like "臟得樂") and anticoagulants, are commonly used to manage AF. Beta-blockers help control heart rate and reduce symptoms, while anticoagulants are crucial for preventing blood clots, which can lead to strokes.

Concerns About Medication Side Effects
You raised a valid concern regarding the potential side effects of beta-blockers, particularly their impact on thyroid function. While beta-blockers can affect thyroid hormone levels, they are generally well-tolerated. If you have a history of hyperthyroidism, it’s essential to monitor your thyroid function regularly while on these medications. If you experience any symptoms of thyroid dysfunction (such as weight changes, mood swings, or changes in energy levels), you should discuss these with your healthcare provider.

If you are concerned about the side effects of your current medication, it’s worth discussing alternative options with your doctor. There are other classes of medications for AF, such as calcium channel blockers and antiarrhythmic drugs, which may be suitable for you depending on your overall health and specific circumstances.

Frequency and Severity of Atrial Fibrillation
Regarding the severity of your AF, it’s important to note that AF can vary significantly among individuals. Some people experience occasional episodes (paroxysmal AF), while others may have persistent or permanent AF. The fact that your heart rate returned to normal after treatment is a positive sign. However, the recurrence of AF can happen, especially if underlying triggers are not addressed. Lifestyle modifications, such as maintaining a healthy diet, regular exercise, and avoiding stimulants (like caffeine and nicotine), can help reduce the frequency of episodes.

Early Beats (Premature Atrial Contractions)
You mentioned experiencing premature beats (early contractions). These are common and can occur in healthy individuals without any underlying heart disease. They can be triggered by stress, caffeine, or fatigue. In many cases, they do not require treatment unless they are frequent or symptomatic. If they are bothersome, your doctor may recommend lifestyle changes or, in some cases, medication.

Monitoring and Follow-Up
Given your history and the recent episode of AF, regular follow-up with your healthcare provider is crucial. They may recommend periodic monitoring of your heart rhythm, thyroid function, and overall cardiovascular health. If you have concerns about the recurrence of AF or the effectiveness of your current treatment, do not hesitate to seek a second opinion or discuss your worries with your healthcare provider.

In summary, while AF can be concerning, with appropriate management and lifestyle modifications, many individuals lead healthy lives. Open communication with your healthcare team about your symptoms, treatment options, and any side effects you experience is key to effectively managing your condition.

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