Medications to Manage Heart Rhythm & Coagulation
It's Hard to Tell the Poison from the Cure
Drug therapy (also known as medical management) has long been the standard of medical care for patients with atrial fibrillation. Rhythm management (antiarrhythmics) or rate management drugs are combined with anticoagulants to address the symptoms of AF. Medications do not cure AF nor do they affect the causes of AF. In many cases, the drugs used are highly toxic and have side effects that are as dangerous, if not more dangerous and fatal, than AF.
For decades patients with atrial fibrillation have been subjected to extremely restrictive drug regimens that carry the risk of toxicity, loss of bone density leading to serious fracture, fatal hemorrhaging and death. Today you have a choice. With the mini-maze minimally invasive closed chest surgery, Dr. Affleck is able to restructure and remodel the pathways of irregular electrical impulses in the heart that cause atrial fibrillation. Mini-maze does more than alleviate the symptoms of atrial fibrillation; it can restore normal sinus rhythm in most patients - freeing you from life long drug regimens that considerably reduce your quality of life. Whether you live in Salt Lake City, Ogden, or Utah Valley, or anywhere in the country, contact Western Cardiovascular Associates online or call us at 801-743-4750 today to discuss your options for mini-maze surgery.
Rhythm Management Drugs
Rhythm management drugs, called antiarrhythmics, affect the electrophysiology of cardiac conduction in different ways and are meant to bring the heart into sinus rhythm. Antiarrhythmics are broken down into 4 standard classifications and 1 miscellaneous classification based on how each drug affects the flow of electrolytes (sodium, potassium, calcium, etc) across electrically susceptible cells. The risk of mortality from the toxicity of antiarrhythmics is significant, and proarrhythmias (an increase or worsening of an already existing arrhythmia) are common.
Many patients are unable to tolerate antiarrhythmics and many must have their prescription adjusted many times before finding a satisfactory dosage. If you have any underlying heart disease, antiarrhythmics can be very dangerous, and the American Heart Association recommends doctors follow a "safety first" protocol when prescribing these drugs. Sinus rhythm is maintained 60% of the time in patients that have been on rhythm management drugs for ONLY one year.
Rate Management Drugs
Rate management drugs are generally used to slow the heart rate and the conduction of irregular electrical impulses from the atria to the ventricles. The reduced electrical activity can alleviate symptoms of rapid heart beats associated with atrial fibrillation. Rate management is meant to keep the heart below 100 bpm but is not intended to bring the heart into sinus rhythm. This drug therapy only targets the symptoms of erratic impulses and is a life long drug regimen.
Rate management drugs include:
- Beta Blockers: reduce the reception of epinephrine (adrenaline) during episodes of physical exertion or excitement, which in turn reduces the rate of cardiac conduction.
- Cardiac Glycosides: increase the AV node's resistance to electrical stimulus from the atria, reducing the number of impulses reaching the ventricles, which increases cardiac output.
- Calcium Channel Blockers: reduce the rate of electrical conduction in the cardiac conduction cycle.
Though rate management drugs are preferable to antiarrhythmics (in most cases because they are less toxic) they carry their own risks including a new risk associating beta blockers with type 2 diabetes when taken with diuretics. Additional rate management side effects include fatigue, dizziness, impotence, depression, slow heart rate, and shortness of breath.
Anticoagulation
The most significant risk associated with atrial fibrillation is stroke. The type of stroke associated with AF is cause by thromboembolism (a blocked blood vessel caused by a piece of a blood clot that is carried through the blood stream).
When the heart's muscles can't contract with sufficient force to pump blood from the atria into the ventricles, blood tends to pool in the left atrial appendage and clot. The clot forms because of coagulating agents in the blood. Anticoagulants, which are prescribed with both rate and rhythm management drugs, thin the blood and reduce the risk of clots. Anticoagulants can reduce the risk of stroke by as much as 68%.
Your blood thickens and clots naturally to protect you from bleeding to death. When anticoagulants (such as warfarin) are taken in pill form (such as Coumadin) or injected (such as heparin), your risk of bleeding is significantly increased. If you are currently on a regimen of Coumadin, you already know that you must not shave, use sharp knives, use gardening tools or engage in any activity that might result in being scratched or cut. You probably deal with significant bruises all over you body, which can be more than embarrassing if your face tends to bruise often.
Coumadin is a life long drug therapy that requires you to stay on a strict diet to maintain a consistent level of vitamin K in your system. Since vitamin K helps in the production of blood clotting proteins, a balance must be maintained between the amount of vitamin K you ingest and your Coumadin dosage. In order to regulate this balance, frequent blood tests, called International Normalized Ratio (INR) tests are required. INR tests can be required up to twice a week or as infrequently as every 3 to 6 months depending on your eating and drinking habits. Since vitamin K is required to maintain adequate bone density, eliminating or reducing this essential vitamin from your diet seriously increases your risk of disabling bone fractures.
An Alternative to Medical Management
A lifelong dependency on debilitating drug therapies will reduce your quality of life.
Mini-maze surgery will require a 2 to 4 day hospital stay, and a week of recovery. Drug regimens require strict dietary monitoring, frequent INR tests, and constant medical attention for the rest of your life.
Mini-maze surgery may prolong a life free from atrial fibrillation symptoms, AF recurrence, congestive heart failure and the possibility of stroke.
Medical management doesn't address the causes of atrial fibrillation or the risk associated with stroke.
Mini-maze surgery:
- restructures the electrical pathways of the heart
- electrically isolates the pulmonary veins where some irregular electrical impulses initiate
- removes or excises the left atrial appendage where blood clots form
You have a choice. You have a life. Dr. Affleck has a cure. Contact Western Cardiovascular Associates online or call us at 801-743-4750 today.