What Medications Help Treat Heart Arrhythmias?
Medically reviewed by Mary Choy, PharmDMedically reviewed by Mary Choy, PharmDA heart arrhythmia is an irregular heartbeat, which means it can be too quick, slow, or beat with an abnormal rhythm.Medications play a crucial role in controlling and preventing arrhythmias and ensuring the heart maintains a steady and effective rhythm. Among the most prescribed drugs for this purpose are beta blockers, calcium channel blockers, and a variety of antiarrhythmic agents.Antiarrhythmic drugs are categorized into four main classes (Class I, II, III, and IV) based on the Vaughan-Williams classification system.
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How Are Heart Arrhythmias Treated?Heart arrhythmias are treated with various medications to restore normal heart rhythm, control heart rate, and prevent complications. The choice of medication depends on the type of arrhythmia, its severity, and the person’s condition.Classes of medications used for heart arrhythmias include the following.
Uses
Examples
Beta-blockers
Atrial fibrillation and atrial flutter, ventricular tachycardia, supraventricular tachycardia (SVT)
Tenormin (atenolol), Lopressor (metoprolol)
Calcium channel blockers
Atrial fibrillation and atrial flutter, SVT
Cardizem (diltiazem), Verelan (verapamil)
Antiarrhythmic agents
Atrial fibrillation and atrial flutter, ventricular tachycardia, SVT
Sodium channel blockers such as flecainide; potassium channel blockers such as Pacerone (amiodarone) and Betapace (sotalol)
Anticoagulants
Atrial fibrillation in those at higher risk for stroke
Lovenox (enoxaparin), Jantoven (warfarin)
Cardiac glycosides
Atrial fibrillation
Lanoxin (digoxin)
Types of ArrhythmiasAtrial fibrillation (most common): A "quivering" or irregular heart rhythm, which can lead to complications such as a stroke.Bradycardia (slow heart rate): A heart rate of less than 60 beats per minute.Tachycardia (fast heart rate): A heart rate greater than 100 beats per minute.Ventricular fibrillation: The most serious abnormal heart rhythm that can lead to sudden cardiac death. Supraventricular tachycardia (SVT): A rapid heart rate originating above the heart's ventricles that is usually greater than 150 beats per minute.
Antiarrhythmic DrugsAntiarrhythmic drugs treat abnormal heart rhythms (arrhythmias) by slowing down the heart rate or changing the electrical impulse (flow of electricity generated by a cell) in the heart.The term "arrhythmia" refers to any change from the heart's normal electrical impulses.Sodium Channel Blockers (Class I)Sodium channel blockers work by blocking sodium from entering the heart cells. Sodium is one of the electrically charged particles that flows into the cell when a heartbeat occurs. Blocking sodium from entering the heart slows the heart rate and reduces the heart cell's excitability and conduction (squeeze).Sodium channel blockers are used to treat ventricular arrhythmia. Class I antiarrhythmics should not be used in people with heart failure.Examples:Norpace (disopyramide)MexiletineDilantin (phenytoin)FlecainidePropafenoneSide effects include:Tachycardia (fast heart rate)Dry mouthUrinary retentionBlurred visionConstipationPotassium Channel Blockers (Class III)Potassium channel blockers work by blocking potassium channels, preventing potassium from leaving the heart cells. This prolongs the repolarization phase (a phase where the cell becomes more negatively charged). Prolonging this phase increases the refractory period (a "pause" between heartbeats) without affecting the sodium channels, helping maintain normal rhythm.Examples:Pacerone (amiodarone)Betapace (sotalol)Tikosyn (dofetilide)Corvert (ibutilide)Side effects include:Amiodarone: Stomach issues, sensitivity to light, lung toxicity, liver toxicity, slow heart rateSotalol: Slow heart rate, fatigue, dizziness, proarrhythmia (a drug's ability to cause or worsen an irregular heartbeat)Dofetilide: Headache, dizziness, proarrhythmiaIbutilide: Nausea, headache, proarrhythmiaBeta-Blockers (Class II)Beta-blockers are classified as Class II under the Vaughan Williams classification system. Beta-blockers are used for several conditions, including but not limited to:TachycardiaMyocardial infarction (heart attack)Atrial fibrillationBeta-blockers are more effective at heart rate control than other antiarrhythmic drugs. In other words, they are better at slowing down the heart than changing the electrical impulses.They work by blocking beta-adrenergic receptors. This blocks the release of the stress hormones adrenaline and noradrenaline in certain parts of the body, slowing down the heart rate.Examples of beta-blockers include:Tenormin (atenolol)BisoprololCoreg (carvedilol)Lopressor (metoprolol tartrate)Toprol XL (metoprolol succinate)NadololInderal LA (propranolol)Side effects may include:FatigueSlow heart rateLow blood pressureWeight gainDizzinessCold hands and feetCalcium Channel Blockers (Class IV)Calcium channel blockers (CCBs), also classified as Class IV using Vaughan Williams classification, work by blocking the movement of calcium through calcium channels. They primarily treat high blood pressure, angina (chest pain), and certain arrhythmias.These drugs cause relaxation and dilation of blood vessels, reducing heart workload and oxygen demand.CCBs are divided into two main categories: dihydropyridines (DHPs) and non-dihydropyridines (non-DHPs).Examples of DHPs include:Norvasc (amlodipine)Procardia (nifedipine)FelodipineNon-DHPs include Verelan (verapamil) and Cardizem (diltiazem).Side effects may include:For DHPs: Swelling of the legs and feet, headache, dizziness, palpitations, and low blood pressureFor non-DHPs: Constipation, dizziness, fatigue, and low heart rateAnticoagulantsWhile not used for treating arrhythmias, anticoagulants prevent blood clots that can form because of certain arrhythmias, such as atrial fibrillation. They are also used in other conditions at risk for a thrombosis (blood clot), deep vein thrombosis, and in people with mechanical heart valves.Anticoagulants interfere with the clotting cascade, a series of events involving factors that lead to clotting. There are different types of anticoagulants based on their mechanism of action:Vitamin K antagonists: Block vitamin K-dependent clotting factors (II, VII, IX, and X).Direct oral anticoagulants (DOACs): Directly block specific clotting factors known as thrombin or factor Xa (pronounced Factor 10a)Heparin: Block the clothing factors known as thrombin and factor Xa.Examples of each includeVitamin K antagonists: WarfarinDOACs: Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), Savaysa (edoxaban)Heparin: Unfractionated heparin, low-molecular-weight heparin (e.g., enoxaparin)Bleeding is the most common side effect. This can occur in your gastrointestinal tract, nose, and skin (bruising).For those on warfarin, it is recommended to eat a consistent diet involving a similar amount of vitamin K-containing foods regularly.Warfarin interferes with the blood clotting process by blocking an enzyme that uses vitamin K. Adding too much vitamin K to your diet can reduce its effects. It is best to keep vitamin K amounts within a normal range and avoid any large variations in consumption.Cardiac GlycosidesCardiac glycosides are a class of medications used primarily to treat heart failure and certain types of arrhythmias, such as atrial fibrillation. They are made from the foxglove plant (Digitalis) and work by increasing the force of heart contractions (squeezing) and regulating heart rate.Digoxin is an example of a cardiac glycoside. It may cause some stomach-related side effects, such as nausea or vomiting. Other side effects can include:HeadacheWeaknessDizzinessConfusionGynecomastia (enlarged breast tissue in males)Other Treatments for Heart ArrhythmiasElectrophysiology Study (EPS) and AblationEPS and ablation are used to diagnose and treat arrhythmias, such as recurrent arrhythmias like atrial fibrillation, atrial flutter, and ventricular tachycardia.Catheters are inserted into the heart to map electrical activity. If an abnormal pathway is found, it can be ablated (destroyed) using radiofrequency energy or cryotherapy.Implantable DevicesPacemakers are small devices implanted under the skin to help control abnormal heart rhythms. They send electrical impulses to stimulate the heart to beat at a normal rate.Pacemakers are typically used to treat bradycardia (slow heart rate) and heart block.Implantable cardioverter-defibrillators (ICDs) are devices implanted under the skin. They monitor heart rhythms and deliver shocks if a dangerous rhythm is detected to restore normal rhythm. ICDs are used to treat ventricular fibrillation and ventricular tachycardia.SummaryHeart arrhythmias are managed with medications to restore normal rhythm, control heart rate, and prevent complications. The choice of drugs depends on the type and severity of the arrhythmia.Commonly used drug classes include beta-blockers (e.g., atenolol, metoprolol) and calcium channel blockers (e.g., diltiazem, verapamil) for atrial fibrillation, flutter, and SVT.Antiarrhythmics, such as sodium and potassium channel blockers (e.g., quinidine, amiodarone), treat a broader range of arrhythmias, including ventricular tachycardia. Other important medications used include digoxin and anticoagulants (e.g., warfarin) in those with atrial fibrillation who are at high risk of stroke.The author would like to recognize and thank Norma Ponce, PharmD, for contributing to this article. Read the original article on Verywell Health.
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