Antiarrhythmic medications for atrial fibrillation

Examples

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Brand Name	Chemical Name
Pacerone	amiodarone

Brand Name	Chemical Name
Norpace	disopyramide

Brand Name	Chemical Name
Tikosyn	dofetilide

Brand Name	Chemical Name
Tambocor	flecainide

Brand Name	Chemical Name
Procanbid	procainamide

Brand Name	Chemical Name
Rythmol	propafenone

Brand Name	Chemical Name
Quinidex	quinidine

Brand Name	Chemical Name
Betapace AF	sotalol

How It Works

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Antiarrhythmic medications help return the heart to its normal sinus rhythm, maintain the rhythm after it has been achieved, and/or reduce the heart rate while you are in atrial fibrillation. These medications stabilize the heart muscle tissue. Antiarrhythmics such as amiodarone or sotalol also slow the heart rate by blocking impulses that pass through the AV node in the heart.

Why It Is Used

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Antiarrhythmic medications are used to convert atrial fibrillation to a normal rhythm. These medications may be used before electrical cardioversion and may help maintain a normal heart rhythm after successful cardioversion. Ibutilide, another antiarrhythmic, has been shown to improve chances of successful cardioversion when used before cardioversion.¹

How Well It Works

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Antiarrhythmic medicines can maintain a normal rhythm in 35% to 75% of the people who use them.²

Side Effects

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Antiarrhythmic medications may increase the risk of developing a more severe irregular heart rate problem (ventricular tachycardia or ventricular fibrillation). Close monitoring while taking the medication is important. The risk of side effects is greater with more severe underlying heart disease.

Side effects of antiarrhythmics include:

• Slow heartbeat.
• Palpitations.
• Fatigue.
• Headache.
• Dizziness.
• Nausea or vomiting.
• Unusual taste in the mouth.
• Stomach pain.
• Constipation or diarrhea.
• Difficulty breathing.
• Rash.
• Vision problems.
• Urinary retention in men.
• Arrhythmia.

Other, less common side effects include:

• Sensitivity to light (photosensitivity).
• Thyroid disorders.
• Cirrhosis of the liver.
• Peripheral neuropathies.

Rare side effects of amiodarone include:

• Scarring of the lungs (pulmonary toxicity).
• A blue tinge to the skin.
• Vision problems.
• Numbness.
• Tremor.

The U.S. Food and Drug Administration (FDA) recently issued warnings about the medication amiodarone (Cordarone). People taking this medication should be aware that it may cause serious side effects that can lead to death, including lung damage, liver damage, and more severe heartbeat problems. Amiodarone is typically used for people who have severe symptoms when other medications have failed. The FDA recommends that you talk to your doctor if you have any side effects or any concerns about taking amiodarone.³ People may be able to take amiodarone safely when they are checked carefully by their doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Antiarrhythmics must be used carefully to treat atrial fibrillation because they can cause severe irregular heart rate problems and other serious side effects. They often are used for people who have severe symptoms of atrial fibrillation or whose symptoms are bothersome. Antiarrhythmics also are used after cardioversion to control heart rhythm.

For some people, antiarrhythmic medications may not be the preferred treatment. In a study called the AFFIRM trial, medications to slow the heart rate, such as beta-blockers, calcium channel blockers, and digoxin, were found to be preferable to antiarrhythmic medications as a first-line treatment for certain people with atrial fibrillation, specifically older people at risk for stroke who did not have severe symptoms of atrial fibrillation.⁴

Taking medications that only slow your heart rate will leave you in atrial fibrillation. But most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute. Also, the AFFIRM study found that antiarrhythmic medications were expensive, often had side effects, and frequently did not prevent atrial fibrillation from recurring.⁴ So, treatment with a rate control medicine and an anticoagulant might be a good option for people who do not have atrial fibrillation symptoms when their heart rate is controlled.

Amiodarone is an effective antiarrhythmic for treating atrial fibrillation, but its use is limited by its potential severe side effects.

Sotalol has both antiarrhythmic and beta-blocking properties.

Because atrial fibrillation often returns, you may also need to take anticoagulant medication (warfarin, such as Coumadin).

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Oral H, et al. (1999). Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment. New England Journal of Medicine, 340(24): 1849–1854.

2. Olgin JE, Zipes DP (2004). Atrial fibrillation section of Specific arrhythmias: Diagnosis and treatment. In DP Zipes et al., eds., Braunwald's Heart Disease, 7th ed., pp. 816–819. Philadelphia: Elsevier Saunders.

3. U.S. Food and Drug Administration (2005). 2005 safety alert: Cordarone (amiodarone HCl). FDA Med Watch. Available online: http://www.fda.gov/medwatch/SAFETY/2005/cordarone_DHCP.htm.

4. Wyse DG (2002). Rate Versus Rhythm Control in the Management of Atrial Fibrillation. Available online: http://www.americanheart.org/presenter.jhtml?identifier=3005618.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Laurence Epstein, MD - Cardiac Electrophysiologist
Last Updated	January 18, 2007