Medicines to Prevent Abnormal Heart Rhythm in Heart Failure

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Topic Overview

One of the most frightening aspects about havingheart failureis that it can lead to premature death. The increased death rate among people with heart failure is in part caused by the tendency of those with heart failure to developabnormal heart rhythms.

Some people with heart failure die suddenly from abnormal rapid heart rhythms (called ventricular tachycardia or ventricular fibrillation) that begin in the damaged muscle of the heart. These abnormal rapid heart rhythms are dangerous, because they start without warning and dramatically reduce the heart's ability to pump blood. If the abnormal rhythm does not stop on its own after a short period of time, death results from reduced blood flow to the brain and vital organs.

What antiarrhythmic agents are used?

Beta-blockers have been proved to increase the survival of people with heart failure. It is not entirely clear how this occurs, but it is suspected that a major factor is their ability to prevent ventricular arrhythmias. Beta-blockers can be very effective at preventing single abnormal beats of the heart muscle, called premature ventricular contractions, which experts think are a common trigger of ventricular arrhythmias. These beneficial effects have been observed for essentially all beta-blockers. The ability of beta-blockers to prevent ventricular arrhythmias further emphasizes why all people with heart failure should be taking them.

Of equal importance, beta-blockers do not have any proarrhythmic effects, even in people with very abnormal left ventricular function. When a medicine increases the occurrence of arrhythmias, it is said to have a "proarrhythmic" effect.

Amiodarone is an antiarrhythmic medicine. Amiodarone may not be useful for everyone with heart failure. Although amiodarone may prevent abnormal heart rhythms, it has not been shown to lengthen the lives of people with heart failure.footnote 1Also, amiodarone has many side effects. Your doctor will help you decide whether taking amiodarone is right for you. Your heart rhythm may be monitored continuously for a 24- or 48-hour period using a Holter monitor. If you take amiodarone, you will need to see your doctor periodically to find out whether you are developing any side effects.

You may take amiodarone if you have animplantable cardioverter-defibrillator (ICD), a device that is implanted in your chest to control your heart rhythm. This device is an alternative to or an addition to antiarrhythmic medicines such as amiodarone. Amiodarone is used so that you will need fewer shocks from the ICD to control your heart.

Related Information

References

Citations

  1. Roy D, et al. (2008). Rhythm control versus rate control for atrial fibrillation and heart failure. New England Journal of Medicine, 358(25): 2667-2677.

Other Works Consulted

  • McKelvie R (2011). Heart failure, search date August 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147-e239.

Credits

ByHealthwise Staff

Primary Medical ReviewerRakesh K. Pai, MD - Cardiology, Electrophysiology

Martin J. Gabica, MD - Family Medicine

Adam Husney, MD - Family Medicine

Specialist Medical ReviewerE. Gregory Thompson, MD - Internal Medicine

Current as ofDecember 6, 2017