Answers about heart rhythm disturbance

Dear Dr. Roach: I’m writing about atrial fibrillation. Recently, I had a one-time 17-hour stint of it. I was not aware of anything happening at the time. When I had a device check (heart pacemaker), I was told of this occurrence, and it was recommended that I see my heart specialist. As a result, I was given the choice of taking Eliquis. I purchased some, but did not take any because of the warnings on TV saying it “can cause a stroke, bleeding risks,” etc. I also have had an aortic valve replacement, and they recommend I do not take this pill. — P.A.

Atrial fibrillation is a common condition, especially in older people, where the rhythm of the heart is disrupted. This can cause symptoms due to an irregular heart rate (palpitations), exercise intolerance or shortness of breath (especially if the heart rate is too fast), but it doesn’t always cause symptoms.

Even without symptoms, atrial fibrillation is concerning because it increases the risk of blood clots. With medication, such as apixaban (Eliquis) or warfarin (Coumadin), that risk is reduced by about two-thirds.

These medicines work by making it a little harder for the body to form clots. A side effect is that it makes the body a little bit more likely to bleed. Bleeding inside the brain also may cause a stroke, hence the warnings you read and hear for medicines like Eliquis. Still, with medication there is a large net reduction in stroke risk, and the cardiologist has reason to think there is more benefit than harm for you.

People with mechanical heart valves are at risk for developing clots and then strokes. Eliquis and other new treatments are not effective for people with mechanical heart valves, and Coumadin remains their best choice. Since yours is made from pig tissues, you would benefit from treatment of the atrial fibrillation.