Managing Atrial Fibrillation: Medication Interactions and Treatment Options

Arrhythmia

Hello, Director: In the past few weeks, I have experienced recurrent atrial fibrillation (with episodes lasting from 20 minutes to 1 hour for six consecutive days) and a sensation of missed or extra heartbeats (occurring almost daily for about 10 minutes).
Sometimes this happens after meals, and other times when I lie down to sleep at night.
The doctor has prescribed me two RYTMONORM 150MG tablets and one CONCOR 1.25 tablet to take during episodes of atrial fibrillation.
Due to heart-related issues, my sleep has been affected, which in turn impacts my mental state, so my psychiatrist has prescribed me one Mirtazapine to take before bed.
I would like to ask the director: (1) Can I take the medications prescribed by the cardiologist together with those prescribed by the psychiatrist? I am concerned that an episode of atrial fibrillation might occur right before sleep.
Should I space them out by a few hours? (2) If the frequency of atrial fibrillation increases within a day, how should I adjust my medication? (3) For occasional missed beats, is there a need for medication to control them? (4) The cardiologist believes that if I experience atrial fibrillation more than twice a week on average, I should consider catheter ablation.
However, in the past few weeks, the episodes have been sporadic, sometimes consecutive and sometimes more than a week apart.
Should I continue with medication management first, or is non-pharmacological management necessary? (5) I found information online suggesting that autonomic nervous system dysregulation can lead to ventricular ectopic beats and atrial fibrillation.
If I can first address the autonomic nervous system dysregulation (with the Mirtazapine prescribed by my psychiatrist), will the frequency of my arrhythmias decrease?

Niming, 20~29 year old female. Ask Date: 2022/01/26

Dr. Wu Xueming reply Cardiology

The frequency and occurrence of atrial fibrillation can be assessed using a 24-hour Holter monitor.
It is recommended to visit a hospital for relevant examinations and discuss medication dosages with a physician.

Reply Date: 2022/01/26

More Info

Managing atrial fibrillation (AF) can be quite complex, especially when considering medication interactions and treatment options. Based on your situation, it’s crucial to address your concerns systematically.

1. Medication Interactions: You are currently prescribed RYTMONORM (a rhythm control medication) and CONCOR (a beta-blocker) for your atrial fibrillation, along with Meishuyu (an antidepressant) for sleep issues. Generally, these medications can be taken together, but it’s essential to monitor for any potential interactions. RYTMONORM can affect heart rhythm, while CONCOR can lower heart rate. Meishuyu, on the other hand, can cause sedation. It’s advisable to take these medications at different times to minimize any potential interactions, especially if you notice that your AF episodes coincide with taking Meishuyu. Always consult your healthcare provider for personalized advice on timing and dosage.

2. Increased Frequency of AF Episodes: If you experience an increase in the frequency of atrial fibrillation episodes, it’s essential to follow your doctor’s instructions regarding medication. You may need to take your prescribed medications more consistently or adjust dosages under your physician’s guidance. Keeping a diary of your episodes, including triggers and duration, can help your healthcare provider make informed decisions about your treatment plan.

3. Managing Occasional Palpitations: Occasional palpitations (like feeling a missed beat) are common in individuals with AF. If these episodes are infrequent and not associated with significant symptoms (like dizziness or chest pain), they may not require specific medication. However, if you find them distressing or if they increase in frequency, it’s worth discussing with your healthcare provider whether additional treatment is necessary.

4. Considering Non-Pharmacological Options: Your cardiologist has suggested catheter ablation (electrophysiological procedure) if you experience AF more than twice a week. This procedure can be effective in managing AF and may reduce the need for long-term medication. However, it’s essential to weigh the risks and benefits with your doctor. If your episodes are sporadic, you might start with medication management before considering more invasive options.

5. Autonomic Nervous System and AF: You mentioned that you found information linking autonomic nervous system dysregulation to AF. Stress and anxiety can indeed exacerbate heart rhythm issues. If Meishuyu helps manage your anxiety and improves your overall well-being, it may indirectly reduce the frequency of your AF episodes. However, it’s important to remember that while addressing psychological factors can be beneficial, it may not completely resolve the underlying cardiac issues.
In summary, managing atrial fibrillation involves a comprehensive approach that includes medication management, lifestyle modifications, and possibly non-pharmacological interventions. Regular follow-ups with your healthcare providers are crucial to ensure that your treatment plan is effective and adjusted as needed. Always communicate any new symptoms or concerns to your healthcare team, as they can provide the best guidance tailored to your specific situation.

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