Brief Answer:
Rate control; anticoagulation

Detailed Answer:
Greetings, sir! My name is Dr. Meriton. Thank you for your question and welcome to HCM. I carefully read your query.

As a general information, atrial fibrillation is a supraventricular arrhythmia, with atrial rate from 400-600 beats per minute. The signal then propagates through the atrioventricular (AV) node to stimulate the ventricles. If this kind of "firing" rate goes to the ventricles, it would produce a serious, malignant, life-threatening ventricular arrhythmia. Therefore, the main strategy in rate control is trying to prolong the impulse propagation through the AV node. For this purpose, we can use beta-blockers, calcium channel blockers (verapamil, as in your case) and digoxin (for chronic rate control), and adenosine (in acute settings. Also, for this purpose, various antiarrhythmic drugs can be used as well. If you were my patient, I would recommend one of these classes of drugs for rate control, therefore, my opinion is that verapamil is a good choice.

Another important concept in atrial fibrillation is anticoagulation (blood thinning), which is achieved by using oral anticoagulants, such as acenocoumarol or warfarin, with a targeted international normalized ratio (INR) at 2.0-3.5, and anti-Xa drugs, which do not necessitate periodically measured INR. This is because a fibrillating atrium (instead of normally contracting and performing to help propagate the blood during cardiac cycle, atria contract without control and are non-functional) tends to pool the blood and this predisposes the formation of little blood clots (thrombi), which can be pumped elsewhere from the heart, and produce minimal or massive ischemic strokes in end-organs.

With these two components controlled well, atrial fibrillation is a totally benign arrhythmia.

I hope I was helpful with my answer. If you have follow-up questions, I would be happy to help you. I wish you a good health.

Best regards,
Dr. Meriton

---

Brief Answer:
No weight gain

Detailed Answer:
Thank you for your follow-up question, sir!

There is no known by evidence that Verapamil results in weight gain. There are certain side effects of verapamil, which, I assume, you discussed with your cardiologist, but no weight gain whatsoever. Even if it may result, while using verapamil, my opinion is that there could be other factors.

I hope I was helpful. If you have no further clarifications, please close the discussion and rate the answers.

Take care. Wish you a good health.

Kind regards,
Dr. Meriton

---