Atrial Fibrillation: Medication, Side Effects, and Treatment Options

Q: Atrial Fibrillation: Medication, Side Effects, and Treatment Options

Hello： Atrial fibrillation indeed increases the risk of stroke, and the use of anticoagulants should be considered based on established criteria. <br>We use the CHA2DS2-VASc score for assessment： for a 45-year-old male without heart failure, hypertension, diabetes, or a history o

Cardiac issues

Hello Dr.
Huang, I have severe arrhythmia and have undergone X-rays and echocardiograms, both of which showed no issues (the heart is not enlarged and structurally normal).
However, during a 24-hour Holter monitor test, my heart rate spiked to about 300 beats per minute! I experienced palpitations, a sensation of the heart "stuttering," and a strong pounding feeling.
The doctor informed me that this occurred over seven thousand times and diagnosed me with atrial fibrillation.
Currently, the doctor has prescribed Catapres and Lisinopril.
The doctor considers my condition serious, with the dosage being Catapres twice a day, one tablet each time, and Lisinopril at the maximum dose of three times a day, two tablets each time.
After starting the medication, my symptoms improved significantly, but I experienced noticeable side effects of dizziness and low blood pressure, measuring 105/62.
After discussing with my doctor, we reduced the Lisinopril to three tablets, but my blood pressure remained low! I often feel a stuttering sensation in my heart, and my heart rate frequently measures around 120.
I would like to ask Dr.
Huang, I read online that patients with atrial fibrillation must take anticoagulant medications.
Why hasn't my doctor prescribed this? Is my low blood pressure related to the medication? I tried stopping the medication for one day, but my low blood pressure persisted.
Additionally, the side effects of the high-dose medication are significant, but reducing the dosage hasn't improved the situation.
Should I consider undergoing catheter ablation? However, my doctor mentioned that the recurrence rate for atrial fibrillation after surgery is high, and medication is the first choice...
it's truly a dilemma.
Thank you for your response, Dr.
Huang.
Thank you.

Xiao Zhang, 40~49 year old female. Ask Date: 2021/07/17

Dr. Huang Yinghe reply Cardiology

Hello: Atrial fibrillation indeed increases the risk of stroke, and the use of anticoagulants should be considered based on established criteria.
We use the CHA2DS2-VASc score for assessment: for a 45-year-old male without heart failure, hypertension, diabetes, or a history of stroke, the total score is 0, indicating that anticoagulants are not necessary (anticoagulation is recommended for a score of 1 or higher).
Of course, the score may change with age and health status, so it should be reassessed periodically.
Dronedarone and sotalol are antiarrhythmic medications that also have some blood pressure-lowering effects; if discontinued, it may take a day or two for blood pressure to return to normal after metabolism.
If atrial fibrillation causes significant palpitations or chest discomfort, antiarrhythmic medications remain the primary treatment to alleviate these symptoms.
Catheter ablation has the potential for a permanent solution, but the long-term recurrence rate is statistically between 20%-45%, so it is primarily reserved for patients whose symptoms are difficult to control with medication.
Please discuss your treatment options further with your physician.

Reply Date: 2021/07/17

More Info

Atrial fibrillation (AF) is a common type of arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various complications, including stroke and heart failure. Understanding the medications used to treat AF, their side effects, and alternative treatment options is crucial for managing this condition effectively.

Medications for Atrial Fibrillation
In your case, the medications prescribed are Kaletra (dronedarone) and Rivaroxaban (Xarelto). Dronedarone is an antiarrhythmic medication that helps restore normal heart rhythm and maintain sinus rhythm. It works by blocking certain electrical signals in the heart that can cause AF. Rivaroxaban, on the other hand, is an anticoagulant that helps prevent blood clots, which is particularly important in patients with AF due to the increased risk of stroke.

Side Effects
While these medications can be effective, they also come with potential side effects. Common side effects of dronedarone include:
- Dizziness
- Fatigue
- Nausea
- Diarrhea
- Liver enzyme elevations
Rivaroxaban can lead to:
- Bleeding complications
- Gastrointestinal issues
- Anemia
- Liver function abnormalities
You mentioned experiencing dizziness and low blood pressure (105/62), which could be related to the medications. Dronedarone can cause bradycardia (slow heart rate), which might contribute to your symptoms of feeling faint or dizzy. It’s essential to monitor your blood pressure regularly and report any significant changes to your healthcare provider.

Blood Pressure Concerns
Your low blood pressure could indeed be influenced by the medications you are taking. Both dronedarone and rivaroxaban can affect blood pressure, and if you are experiencing persistent low readings, it’s crucial to discuss this with your doctor. They may need to adjust your medication dosages or consider alternative treatments.

Anticoagulation Therapy
You raised a valid question about the absence of anticoagulant therapy in your treatment plan. While anticoagulants are typically prescribed for AF patients to reduce the risk of stroke, the decision to initiate such therapy depends on various factors, including your individual risk profile, the presence of other medical conditions, and the potential for bleeding complications. Your doctor may have assessed that your risk of stroke does not warrant anticoagulation at this time, but it’s essential to have an open discussion with them about your concerns and the rationale behind their decision.

Alternative Treatments
Regarding the possibility of catheter ablation (often referred to as "electric burn surgery"), this procedure can be an effective treatment for AF, especially in patients who do not respond well to medication or experience significant side effects. Ablation aims to destroy the small areas of heart tissue that are causing the abnormal electrical signals. While it does carry risks, including the potential for recurrence of AF, many patients find it to be a viable option when medications are insufficient.

Conclusion
In summary, managing atrial fibrillation involves a careful balance of medication, monitoring for side effects, and considering alternative treatments when necessary. It’s crucial to maintain open communication with your healthcare provider about your symptoms, medication side effects, and any concerns you have regarding your treatment plan. If you feel that your current regimen is not adequately addressing your symptoms or if you have persistent low blood pressure, do not hesitate to seek a follow-up appointment to discuss your options further. Your health and well-being should always be the priority in managing atrial fibrillation.

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