Medicines for attack atrial fibrillation

The purpose of drug treatment for attack atrial fibrillation is to slow down the rapid heartbeat during the flicker attack, make the attack go over and, if possible, prevent new attacks. Which drug [s] the doctor chooses depends, among other things, on the problems you have and if you have other diseases, such as heart failure, asthma or COPD.

Treatment of attack atrial fibrillation

There are several different groups of drugs used to treat atrial fibrillation. The drug groups used are as follows:

  • Beta-blocking drugs.
  • Rhythm stabilizers, so-called antiarrhythmics.
  • Calcium channel blockers.
  • Digitalis.
  • Blood thinning drugs.

Beta blocker in the first place

Most often, beta-blocking drugs are used primarily to slow the heartbeat during an attack, and also to prevent new attacks. Beta blockers act much like a protective brake on the heart.

Calcium flow inhibitors slow down an attack

Some calcium flow inhibitors affect the electrical retention system in the heart and can be used to slow the heartbeat during an attack and cause the heart to beat at a slower rate. However, they cannot prevent new attacks.

Rhythm stabilizing drugs prevent new attacks

If the treatment with beta-blockers does not help or cause troublesome side effects, or if you experience problems more often, you may need rhythm-stabilizing drugs, so-called antiarrhythmics.

Rhythm stabilizing drugs reduce the irritability of the heart’s electrical system. This reduces the risk of new flicker attacks.

Rhythm stabilizing drugs do not usually slow the heart rhythm during an attack, but are used to prevent new attacks.

Sometimes beta-blockers and antiarrhythmics are combined

If beta blockers do not produce a sufficiently good effect, it can sometimes help to add rhythm stabilizing drugs.

Digitalis is sometimes used

Digitalis is not used very often against attack atrial fibrillation, and especially not if the purpose is merely to slow the heartbeat. This is because digitalis slows the heart at rest but not as efficiently when exerted. However, if you have congestive heart failure at the same time, it can sometimes also be used to attack atrial fibrillation and often in combination with beta blockers.

Blood thinners may be needed

If you have atrial fibrillation or permanent atrial fibrillation, the risk of getting a blood clot is slightly greater than it usually is. If your doctor believes you have a significantly increased risk, you should be treated with a blood thinning drug that reduces the risk of blood clots and stroke.

Sometimes drugs can cause side effects

All medicines can produce unwanted effects. Some people get side effects from a drug treatment, others do not. Sometimes the side effects decrease after a while. Contact your doctor if you have troublesome side effects. You may need to get a different dose, try a different drug or maybe a completely different type of treatment.

Beta blockers

Adrenaline and norepinephrine are hormones that are released when the body is exposed to stress, for example in physical or mental exertion. As the amount of stress hormones in the blood increases, the blood pressure rises and the load on the heart increases. Then the heart has to work harder and the heart muscle needs more oxygen.

In the body’s blood vessels and in the heart are recipients of the stress hormones, so-called beta-receptors. Beta-blocking drugs block these receptors so that the hormones have less effect on them. Then the blood pressure and the heart rate and the heart work more calmly and efficiently.

In the case of atrial fibrillation, beta blockers can also slow the electrical conduction in the so-called AV node in the heart. The AV node is a special cell accumulation that exists between the atrium and ventricle.

Which beta-blockers are used in attack atrial fibrillation?

The beta-blockers used to attack atrial fibrillation usually contain some of the active substances atenolol, metoprolol, bisoprolol or sotalol. In addition to the beta-blocking effect, Sotalol can also have a certain rhythm-stabilizing effect.

All beta blockers act in much the same way. However, because people work differently, it can still help to switch to another type of beta blocker if the one you are trying at first does not work well enough or if you get troublesome side effects.


Since beta-blockers suppress the activity of the heart and slow down the heartbeat, it is important that the dosage is carefully tested by a doctor.

Never discontinue treatment with beta-blocking drugs on your own. Doing so can increase blood pressure and adversely affect the heart. Treatment with beta-blockers should be completed step by step and in consultation with a physician.

If you have asthma, COPD or other problems with the trachea and lungs, tell your doctor before using beta-blockers.

Consult your doctor if you need to use beta-blockers when you are pregnant or breast-feeding.

Side effects

Beta-blocking drugs, for example, can make you tired, have headaches, feel dizzy, feel sick, vomit or have diarrhea. They can also cause the heartbeat to slow and the hands and feet to become cold. You may also have sleep problems with nightmares.

When you use beta blockers, you may find that you cannot cope as much as before. If you don’t put in a lot of effort, it usually doesn’t matter, but if you do some sports or work out hard, beta blockers can be inappropriate.

Other conditions where beta-blocking drugs are used

Beta blockers have many different uses. They are used, for example, in high blood pressure, angina, congestive heart failure and permanent atrial fibrillation.

Examples of beta blockers used in attack atrial fibrillation

  • Atenolol, containing atenolol
  • Bisoprolol and Emconcor, which contain bisoprolol
  • Propranolol and Inderal, which contain propranolol
  • Carvedilol and Kredex, which contain carvedilol
  • Metoprolol, Seloken and Seloken ZOC, which contain metoprolol.

Rhythm stabilizing drugs

All rhythm-stabilizing drugs reduce the electrical irritability of the heart. The heart rhythm becomes more stable and thus reduces the risk of an attack with atrial fibrillation. Examples of active substances in rhythm-stabilizing drugs are disopyramide, dronedarone, flecainide and amiodarone.

Differences between the different rhythm stabilizing drugs

Most rhythm-stabilizing drugs do not have a slowing effect on the fast heartbeat during an attack, but only prevent new attacks. However, medications containing amiodarone differ slightly from the other rhythm-stabilizing drugs, as they can also function to slow down the heart during an ongoing attack.

When is the drug used?

You can get rhythm-stabilizing drugs if beta-blockers have not had enough effect or if you have had troublesome side effects or if you have frequent problems.

Rhythm stabilizing drugs are mainly used to prevent new flicker attacks, especially if these attacks occur when you rest or sleep.

It should be a heart specialist who handles this type of medication. The treatment may also require you to go for regular blood tests to prevent the occurrence of side effects.


Talk to your doctor if you need to use this medicine while pregnant or breast-feeding.

Side effects

For example, some people who use rhythm-stabilizing drugs may become thirsty, have trouble peeing, become tired, feel unwell, or have blurred vision.

Amiodarone prevents new attacks of atrial fibrillation very effectively. It also slows the heartbeat during an ongoing attack but can cause several different and sometimes very serious side effects. For example, the lungs or thyroid gland may be affected. Therefore, amiodarone should be used with caution and followed up with regular checks.

Examples of rhythm stabilizing drugs

  • Cordarone, which contains amiodarone
  • Durbis Retard, which contains disopyramide
  • Multaq, which contains dronedarone
  • Tambocor, which contains flecainide.

Calcium channel blockers

In order for a muscle cell, for example in the heart or blood vessels, to contract, there must be calcium in the blood. When the muscle cell is activated, calcium from the blood is transported into the muscle cells through special channels. Calcium flow inhibitors reduce the flow of calcium into the muscle cells.

The calcium-flow inhibitors used in attack atrial fibrillation primarily affect the heart’s muscle cells. The drugs slow down the electrical conduction in the so-called AV node in the heart. The AV node is a special cellular accumulation that exists between the atrium and ventricle in the heart. The drugs lower the heart rate and reduce the heart’s work.

When is calcium flow inhibitor used?

The calcium-flow inhibitors used in atrial fibrillation are those containing verapamil or diltiazem. The drugs slow down the heartbeat during an ongoing atrial fibrillation and cause the heart to beat at a slower rate. However, they do not prevent new attacks.

Often calcium flow inhibitors are only used after beta blockers or rhythm stabilizers have been tested.


Never interrupt regular calcium flow inhibitor treatment on your own. A treatment should always be completed step by step and in consultation with a doctor.

Consult your doctor if you need to use this medicine when you are pregnant. There is a risk that the fetus may be affected. Consult your doctor if you need to use this medicine while breast-feeding.

Side effects

Some people who use calcium flow inhibitors can have side effects because the body’s blood vessels widen. Then you can, for example, become red in the face, get swollen ankles, get a headache, get tired or feel sick. The side effects usually go away after a few days, but this does not always apply to the swelling of the feet.

Sometimes you may be constipated by calcium flow inhibitors, especially those containing verapamil. It can be counteracted by eating foods that contain a lot of fiber. You can also use non-prescription medicines containing lactulose. If any of the side effects are serious, contact your doctor.

Other conditions where calcium flow inhibitors are used

Medicines belonging to the calcium-flow inhibitor group are used mainly for high blood pressure and angina.

Examples of calcium flow inhibitors used in atrial fibrillation

  • Verapamil, Isoptin and Isoptin Retard, which contain verapamil


Digitalis is the collective name for some heart-stimulating substances that occur naturally in the thymus flower, digitalis purpurea.

Digitalis strengthens the heart’s pumping capacity and slows the heartbeat at rest. The substance should be used with caution in atrial fibrillation and especially if you have congestive heart failure at the same time and preferably in combination with a beta-blocker.

Digitalis does not prevent new flicker attacks.

When is digitalis used?

Digitalis is mainly used for heart failure and at the same time fast atrial fibrillation.


When you are treated with digitalis, it is especially important to follow the dosing instructions on the medicine package carefully. If you take too low a dose or forget to take a dose, cardiac activity may be impaired. Taking too high or too high doses can quickly lead to poisoning. This, in turn, can interfere with the heart rhythm.

Do not use St. John’s wort when you are treated with digitalis without first talking to a doctor.

You can use this medicine when you are pregnant.

The active substance passes into breast milk, but if you follow the dosing instructions it is unlikely that the baby will be affected. You should still consult a doctor if you need to use this medicine while breast-feeding.

Side effects

For example, if you have too much digitalis in your blood, you may have poor appetite, feel bad, and get visual disturbances such as blurred vision or that everything you see will be colored in a yellow-green tone. Contact your doctor immediately if you experience any such problems.

Examples of digitalis drugs

  • Digoxin BioPhausia.

Blood thinning drugs

Atrial fibrillation increases the risk of getting a blood clot and stroke. Blood thinning drugs significantly reduce the risk, but carry an increased risk of bleeding. To assess whether you need treatment with blood thinners, that is, if the benefit outweighs the risk with the treatment, the doctor may make a so-called risk estimate. Examples of factors that the doctor then considers are gender, age and other concomitant diseases.

When are blood thinners used for atrial fibrillation?

If your doctor determines that you have a significantly increased risk of getting a blood clot, you will be treated with anticoagulants, called anticoagulants. For example, you may be given medicines containing the active substance warfarin, dabigatran, apixaban, rivaroxaban or edoxaban.

The drugs can help you bleed more easily, but are an effective protection against blood clots in atrial fibrillation. Drugs containing warfarin, such as Waran, have been used for many years, the others being newer. The new drugs have in studies been found to be at least equivalent to warfarin, they provide the same protection against blood clots as warfarin and the risk of bleeding complications is the same. Treatment with warfarin requires regular blood test checks to get the right dose. For other blood thinners, regular blood tests are not required as they are taken at a fixed dose once or twice daily. After reviewing the advantages and disadvantages of the various preparations, you can, in consultation with the doctor, choose which drug is most suitable.

Acetylsalicylic acid, found in Thrombyl, is now used to a lesser extent in atrial fibrillation as studies have shown that the drug provides poorer protection against blood clots and strokes than other blood thinning drugs.

This is how blood thinners work

Warfarin counteracts the formation of blood clots by affecting certain substances in the blood that are needed for blood to thrive.

Dabigatran works by blocking a substance in the blood that contributes to the formation of blood clots.

Apixaban, rivaroxaban and edoxaban work by blocking a so-called blood clotting factor that is needed for blood to circulate.

Acetylsalicylic acid reduces the stickiness of platelets, platelets, so that they do not clump easily and form clots.


When you are treated with warfarin, you need to have regular blood tests to make sure you are getting the right dose of the drug.

Do not stop treatment with blood thinners without first consulting your doctor. The risk of severe blood clots may increase if you stop taking the medicine.

Consult a doctor if you are using a blood thinning drug and plan to become pregnant.

Tell your doctor if you use any of the following:

  • Inflammatory and analgesic drugs, so-called cox inhibitors or NSAIDs, for example Treo, Ipren and Diclofenac.
  • Means containing St. John’s wort.

Side effects

Warfarin, dabigatran, apixaban, rivaroxaban and edoxaban increase the risk of bleeding.

In some people using acetylsalicylic acid, the risk of bleeding may increase. Some can get stomach upset such as burning in the stomach or esophagus.

Examples of blood thinners

  • apixaban found in Eliquis
  • dabigatran found in Pradaxa
  • acetylsalicylic acid found in Thrombyl and Acetylsalicylic acid
  • warfarin found in Waran and Warfarin
  • rivaroxaban available in Xarelto
  • edoxaban as found in Lixiana.

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