Will reducing stress or caffeine help my father’s AFib?

Question

Hello doctor,

My father is 66 and was recently diagnosed with atrial fibrillation. His ECG showed an irregular rhythm, and his HR was 132 beats per minute. He is now on Apixaban and Metoprolol 25 mg twice daily.

How do you usually determine if rhythm control is needed in addition to rate control?
Also, how often should blood work, such as INR or kidney function, be checked with these medications?

He wants to know whether reducing caffeine or stress helps keep episodes under control.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Rhythm control is needed in patients with atrial fibrillation, especially in those in whom the recurrence of atrial fibrillation is not expected and in those patients who remain symptomatic even after better heart rate control. Only rate control is a strategy when atrial fibrillation is permanent.

If your father's heart rate is 132, then his heart rate is not controlled. The target heart rate with atrial fibrillation is between 80 and 100 beats per minute. I would suggest increasing the dose of Metoprolol in order to achieve the target heart rate. Indeed, anxiety, stress, caffeine, nicotine and alcohol intake, dehydration, infection, and inadequate sleep worsen the heart rate control in patients with atrial fibrillation.

Regular INR (international normalized ratio) monitoring is not recommended with Apixaban (anticoagulant). Serum creatinine can be monitored at the beginning of therapy and six months to one year later. Depending upon age, body weight, and serum creatinine, the dose of medication can be adjusted.

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else. I would be happy to answer.