Antiarrhythmic Medication for Afib/Arrhythmias

When you are diagnosed with arrhythmia or irregular heartbeat, the ideal solution would be an immediate lifestyle change that reduces or eliminates the symptoms associated with the condition. However, we all know that not only is it challenging for patients to change their lifestyle sufficiently to affect the arrhythmia, but during that time, even if they do, the arrhythmia may have progressed to where lifestyle change is not enough. As such, most arrhythmia patients are started on a medication regimen that includes antiarrhythmics. Antiarrhythmics can be very effective in regulating the heart and reducing many of the symptoms associated with an irregular heartbeat, including but not limited to chest pain, palpitations, lightheadedness or fainting, and shortness of breath.

Antiarrhythmic Mechanism of Function

There is no one-size-fits-all medication to treat an arrhythmia like atrial fibrillation (Afib), and as such, there are several classes of prescription drugs that can be tried. Each class of drug targets a different function of the cardiovascular system. As such, a qualified cardiologist or electrophysiologist can advise on the best medications to take. Generally speaking, there are four classes of drugs considered antiarrhythmics.

• Class 1 medications are known as sodium channel blockers which block the entry of sodium into cells and slow the exit of potassium. This medication slows down the heart rate as a result.
• Class 2 drugs are beta blockers that reduce the influences of hormones like adrenaline and slow or stop the electrical activity causing the problematic heart rhythm. You may know someone who currently takes beta blockers to reduce blood pressure, a condition linked to arrhythmias.
• Class 3 antiarrhythmics can resynchronize the heart’s electrical activity by blocking its potassium channels.
• Lastly, class 4 drugs block the calcium channels of the heart to normalize electrical activity. These are also used for blood pressure management.

During the initial treatment phase for your arrhythmia, we may need to try different medications to see which is most effective in treating the arrhythmia. Additional diagnostic testing and monitoring may also be necessary to understand the effectiveness of the drug. We may, in addition, vary dosages to get the right balance. It is important to remember that everyone experiences arrhythmias differently, just as the effects of medications may vary – no two cases are the same. There is some necessary trial and error before settling on a medication and dosage that works best for you.

What Is Digoxin?

Digoxin is a medication used to treat congestive heart failure and certain arrhythmias and does not fall into any of the categories listed above. As with all medications, we will tailor your regimen based on your circumstance, and digoxin may be part of the treatment plan.

Considerations of Antiarrhythmic Medication

As with all medications, we must be vigilant about their interactions with the other drugs. As such, it is essential that you tell Dr. Tordini what other medications you are taking. This is not limited to prescription medications. If you are taking supplements, these should be listed for your electrophysiologist or pharmacist to evaluate. For example, certain antiarrhythmic medications may alter how your body uses and reacts to diabetes medications like metformin and insulin. Other considerations of certain antiarrhythmic drugs can include:

• Increased skin photosensitivity. This can happen even in winter and when wearing light clothing or mild sunscreen. If you receive too much sun, your skin may turn a shade of blue for some time afterward. The skin usually returns to its regular coloring in time.
• Antiarrhythmics do not reduce the risk of stroke, though controlling an arrhythmia can minimize later risks. Many patients will also need anticoagulant medication to reduce the risk of stroke, as previously untreated arrhythmia may have caused a buildup of stagnant blood in the left atrial appendage, which can increase the risk of stroke by up to five times.
• Some antiarrhythmics may cause or worsen arrhythmias despite being prescribed to minimize them. Your doctor will discuss these concerns during the consultation.
• Beta-blockers may worsen obstructive breathing issues, including asthma, COPD, emphysema, or chronic bronchitis. If you have been diagnosed with lung or breathing problems, you must tell Dr. Tordini, as this will help direct care.

This is by no means a comprehensive list of side effects. With that said, over 50% of patients experience unacceptable side effects from their anti-arrhythmic medication. Most importantly, we encourage you to have an open and candid communication line with your electrophysiologist because there are options.

Early treatment and management of Afib and other arrhythmias opens the greatest number of potential treatment options and gives you the highest chance of success in controlling or even reversing the condition.