Atrial Fibrillation

[John18]

Hi,I am new here and hope I can get some help.This is a little long.

My Mom is 71,she has HBP,some cardiomyopathy and is a Diabetic,has been since 1993.She has A-Fib and was diagnosed in 1999 with it.

She was put on Betapace in 99 and then got a pacemaker 2002.Her heart was pausing and she passed out.

She did reasonably well on the Betapace and the pacer for several years.

She began having longer and very frequent spells of A-Fib she has the kind that comes and goes on its own.Her heart goes back to normal without being shocked.The bouts got more and more frequent and her heart doctor kept saying that ablation may be something to think about.He then added Metoprolol to her Betapace.

She kept getting worse,she was having fast heart rates,sometimes as high as 120-130 bpm.The doctor added Rythmol to the Betapace/Met. but her heart rate went up.He took her off of the Rythmol.

She went back later and her doctor took her off of the Betapace and wanted her to take Amiodarone.She has already been told by a former doctor that it is dangerous and I did some research on the internet and found out that it can be very dangerous.

After that,we went to a different heart doctor and he was trying to do rate control instead of rythm control with Verapamil and the Metoprolol.

Her rate did come down but not enough.He did an echo and her heart function was at 40%,he took her off of the Verapamil and replaced it with Digoxin.He also upped her Metoprolol.

The Digoxin and Metoprolol helped some but at her last EKG her heart rate was still quite above 100bpm.He is now wanting to do a Complete AV Node Ablation and install a Biventricular Pacemaker

The ablation runs a risk of Sudden Cardiac Death which usually happens 2 days after the ablation but can happen for up to 2-3 months after.

I would like to know if there are any other medications that she could take.She has only taken Betapace,Metoprolol,Rythmol(a week or two),Verapamil and Digoxin.

Is there anything else that she could try,other than the Amiodarone?

If the ablation is the only option,we at least want to be sure that there are no meds. that could be used.

We are confused and dont know what to do,we have been told different things and we need some help.

Thanks for any help.

[Jerry_NJ]

The decisions may already be made, but seeing nor responses I offer the following. I am new to this "blog".

There is a scale of strength/risk arrhythmic drugs. My reference says the following.

Amiodarone is at the top of the list, choice of "last resort".

Then under Class III
Sotalol (trade names Betapace)
TIKOSYN® (Dofetilide Capsules)

And then Class IC
Flecainide acetate
--- every thing below Flecainide are frequently prescribed for "home" implementation, everything at Flecainide (some variation her) and up is implemented in a hospital environment, in my experience.

Antidysrhythmic (Class IC)
Rythmol SR
Propafenone

I have used both Propafenone and Rythmol SR, in high dose levels - neither could convert me to sinus rhythm, but they helped hold me there for a year+ following electrocardioversion.

This said, I would expect a trial of Flecainide as the next step up in drug strength/risk.

Is there any enlargement or valve problems with her heart?

Given she converts to NSR on her own, an electrocardioverion may not offer any benefits. They have given me temporary relief from AFib.

Best.

[John18]

We got a third opinion.My Mom went to her internist and he sent her to a cardiologist that he said he would go to if he needed a heart doctor.She stopped going to the EP that wanted to do the AV Node Ablation.

She went and what he(the cardiologist) told us was quite different than what the other doctor(the EP) had told us.

First,the echo that she had done showed her heart function at between 45-50%,not the 40% that the EP had said.It seems that the EP was trying to scare my Mom into haveing the ablation.The EP also told us that the Toprol that she was taking couldnt be upped any more because it could bring her blood pressure down to much.

The cardiologist told us that the Toprol doesnt really have that much effect on blood pressure and he added 50mg. to her dose,she takes it at night.He blood pressure seems to be running around a normal pressure.

It seems that the EP was really trying to push her into having the AV Node Ablation.He told her that if she didnt get her heart rate down that she would go to bed one night and not wake back up.From the research that I have done is that AV Node Ablation is really something that is old school and a last resort thing and more for those that are more advanced in age than my Mom.

The AV Ablation makes a person depend on a pacemaker for a heart beat,this gives the doctor a patient for the rest of the persons life.

The other ablations are curative and are usually done up to the age of 75 or 80 if I remember correctly.

Sometimes you need a third opinion.