I am 61. Can I manage atrial fibrillation with medications?

Question

Hello doctor,

I am 61 years old and was diagnosed with atrial fibrillation six months ago after experiencing heart palpitations, shortness of breath, and dizziness during my morning walks. My cardiologist started me on Metoprolol to control my heart rate and Apixaban for stroke prevention, but I am still having episodes where my heart feels like it is racing irregularly.

My CHA₂DS₂-VASc score is three due to age, hypertension, and diabetes, so I understand that the blood thinner is important for reducing stroke risk. Should I consider procedures such as cardioversion or ablation to restore normal rhythm, or is rate control with medicines sufficient? What are the long-term risks of staying in atrial fibrillation, and how can I balance stroke prevention with the bleeding risks from anticoagulation?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Metoprolol helps control heart rate and reduces palpitations. Apixaban (an anticoagulant or blood thinner) is very important in your case because your CHA₂DS₂-VASc score is three (due to age, hypertension, and diabetes). This puts you at significant risk of stroke, and anticoagulation reduces that risk substantially.

Rate control with medications is often sufficient if symptoms are mild and heart function remains preserved. However, since you are still experiencing irregular racing heart episodes, you may be a candidate for rhythm control strategies like electrical cardioversion (to reset the heart rhythm) or catheter ablation, which are usually considered when symptoms persist despite good medical therapy or if atrial fibrillation is affecting quality of life.

Atrial fibrillation itself increases the risk of stroke, heart failure, and worsening symptoms if the rate is not well controlled. With proper medicines and anticoagulation, many people remain stable long-term. Anticoagulants do carry some risk of bleeding, but in your case, the stroke risk is significantly higher than the bleeding risk, so continuing anticoagulation is strongly recommended.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.