Afib: Rhythm or rate control

During a bout of atrial fibrillation (afib), the heart beats very rapidly and irregularly. As a result, the heart may not pump effectively, which may cause symptoms such as breathlessness and fatigue. These episodes may be occasional and fleeting, or they may last hours, days, months, or even years.

Treatment for afib varies from one person to another and depends on your symptoms as well as your age and any other health conditions you may have. There are two main approaches to manage the chaotic heartbeats that characterize afib. One is rate control, which slows down the heart rate using medications such as beta blockers (metoprolol is a common example). The other is rhythm control, which uses anti-arrhythmic drugs such as dofetilide (Tikosyn) or flecainide (Tambocor). They help restore and maintain a steady heart rhythm.

Because afib stems from an abnormal heart rhythm, it might seem logical that rhythm control would be the best treatment option. But that’s not necessarily true. Anti-arrhythmic drugs have potentially serious side effects, including a higher risk of a dangerous heart rhythm involving the heart’s lower chambers, or ventricles. That risk, and the need for close supervision while taking these drugs, could cancel out any quality-of-life boost you might get from having a normal heart rhythm.

As a result, rhythm control is recommended primarily for people with frequent, bothersome afib symptoms. In addition, relatively young, active people with afib may consider rhythm control even if they don’t have such symptoms. The potential benefit in this case is preventing the afib from getting worse, which could bring symptoms later and possibly damage the heart.

However, in a typical older person with afib who doesn’t have bothersome symptoms, rate control is a reasonable and safe option. If your heart is racing because of afib, taking drugs to slow down your heart rate will make you feel better. And rate control medications pose fewer risks and side effects than anti-arrhythmic drugs.

Note that most people who have afib should also be taking anti-clotting medications to prevent stroke. These drugs include warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), and rivaroxaban (Xarelto). During a bout of afib, the erratic heartbeat causes blood to pool inside the heart when it should be pumping through the body. A stroke can occur when the stagnant blood forms clots that travel to the brain.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Philippians 4:4-9 ESV Rejoice in the Lord always; again I will say, Rejoice. Let your reasonableness be known to everyone. The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things. …

2 Timothy 1:7 ESV For God gave us a spirit not of fear but of power and love and self-control.

Proverbs 4:23 ESV Keep your heart with all vigilance, for from it flow the springs of life.

Romans 12:1-2 ESV I appeal to you therefore, brothers, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Romans 7:23 ESV But I see in my members another law waging war against the law of my mind and making me captive to the law of sin that dwells in my members.

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