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AF Association
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Wants to get off drugs

I am now in normal sinus rhythm thanks to a successful internal cardioversion - I feel great now. I would like to stop taking warfarin and having regular blood tests and stop Amiodarone. Is there any merit in doing so?

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Just because you are now in NSR does not mean your AF has gone. It would be unwise to stop anticoagulation (akin to Russian Roulette) as your stroke risk does not miraculously disappear . The amiodarone is probably keeping you in NSR right now but agreed it is not a drug you would want to be on for long so may be changed to a different one. On balance I wouldn't do as you want to. I value the life I have too much but do talk to your EP about a change of drug..

Bob

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Thanks BobD. I thought NSR means no longer in AF? After my op, I was in AF for about 3 months and then had successful cardioversion and was in NSR for about 18 months - Amiodarone was stopped. Then I went back into AF and was diagnosed with Graves Disease (wonky thyroid) which can cause AF. I was put back on Amiodarone and had 2 failed ext cardioversion before success with internal cardio. If no AF then Amiodarone not necessary? If no risk of clotting, then no point in warfarin? But I would not make any changes without GP approval.

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Cardioversion is seldom a cure for AF although you may stay in NSR for some time. Could be a couple of weeks it could be a few years but at present it is being helped by the amiodarone so the bets are off I'm afraid. You should also understand that you have had AF therefore you have a stroke risk. Even though you may now be in NSR does not take that risk away. Many EPs now feel that anticoagulation should be for life if you have AF and that includes post successful ablation as I have had. I would never dream of stopping my warfarin even though I haven't had AF for seven years. Remember that should you go back into AF (which like it or not you will one day) then it takes time to get back into range and you only need one clot to spoil your day. Please don't think I am being negative here. I have your best interests at heart.

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Hi Bob. You and I have been around for a long while. I fully agree with you that you should continue the anti coagulation therapy even if the AF is not present at the moment. You never know when it might return.Always best to be prepared.

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Did you have thyroid issues prior to AF or did your thyroid issues come about after starting Amiodarone? My thyroid was affected by Amiodarone and my AF episodes increased and the duration of them was sometimes days. Coming off amiodarone and responding to the thyroid drugs reduced my AF to the point where my episodes stopped, but I still went through with an ablation.

I had a scan and was tested for graves, but my thyroid issues were down to the Amiodarone. AF can be a secondary condition to thyroid problems.

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I was in NSR prior to the thyroid issues being diagnosed which could be what triggered the most recent AF which I was in for about 14 months. Cheers.

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You might try controlling the carbohydrate in your diet (especially fructose which thickens your blood seven times as much as glucose), and increasing your natural fat intake instead (which lowers the amount of hormones circulating, such as insulin/IGF-1).

Any changes to medication need to be done in consultation with your GP.

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Thanks. I need to lose weight and do more exercise, it's true. I will be seeing my GP of course.

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BobD is the resident expert and his advice is usually the gold standard. Before I knew about Health Unlocked, I stopped taking drugs and what I found was the effect of the drugs wears off very slowly - probably 6 weeks for some drugs. Also, it is better if you wean off the drugs slowly and not stop cold turkey although this is what I did because I could not get any concrete advice from doctors or pharmacists. You can always start the drugs again if this does not work, especially if you are new to AF, as I was, but I did not need cardioversion. For some reason AF started: so if you can do something to eliminate that reason, you may not need drugs, at least for now. While on drugs, I suspect it is more difficult to find triggers that may be the cause that starts an AF episode. And if you need to implement lifestyle changes or have other health challenges that could influence AF, this will make it even more difficult to find a cause or at least will necessitate more effort. As far as I know, the medical community does not seem to know exactly why AF starts, although there are likely many reasons. They do know the electrical issues that take place in the heart. To find the reason and most of the time solution (if there is one) for you will take dogged effort; and you will receive lots of push back from doctors and family. For me, drugs made the AF worse; and I felt lousy so I had more incentive to experiment with stopping them. Being very uninformed, I knew nothing about what to do except to try this. Doctors did not seem to have an answer for me.

Anticoagulants are another issue. Before you stop them, you may wish to research natural products that "thin" the blood. Unfortunately, the natural products do not have double blind studies that verify their actual effectiveness and this is where the Russian Roulette comes in. I suggest you read and read and read before you decide to change something that works now and to decide to commit to dogged effort.

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Thank you for such a full and expert reply. I had not had an AF episode prior to my aortic aneurism and subsequent open heart surgery. After the op I was in AF and had one unsuccessful cardio prior to leaving hospital. After about 3 months I had a repeat cardio which worked this time and I was in NSF for 18 months. Then I was diagnosed with Graves Disease which I am convinced was the trigger for my most recent episode of AF.

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It is not just the electrical issues of the heart but also the rogue issues of the cells in the veins generating electrical signals.

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I spoke to my EP at my 3 month post-ablation follow up. He said he would only warfarinise me for procedures (ie another ablation) so he said he would be happy to stop my warfarin.

When I went through 4/5 cardioversions in as many months I was only on a daily aspirin.

This is because my stroke risk is low.

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I think I am similar to you in that I would like to rid myself of as many drugs as possible ESP. I'm on Metoprolol, Amiodarone, Plavix, Crestor (preventative - my cholesterol has always been good to excellent. Amazing considering my diet lol) and an Aspirin.

I have been a 50 a day smoker now down to 10 a day and my quit day is *gulp* tomorrow. Can't wait to get rid of what is a major contributor to my AF.

I plan to become as healthy as possible and then with GP's help wean myself of most if not all drugs.

I've started magnesium supplementation about 8 weeks ago and feel so much better for it already. Have also started supplements like vitamin C and CoQ10 (plus others) to try to give my poor battered heart a bit more lovin.

I am not sure if you have told us your full plan towards to getting rid of meds - again obviously with your Dr's advice - but it's worth really considering what you need to do before you even consider it.

For me? I have to lose around 25 kilos, be off the cigs for at least 3 months, exercising 30-45 minutes a day for at least 3 months and eating healthy.

Seeing a dietitian next week and booked in to see my cardio to start planning for an ablation.

While I know you do not need to know all this I guess what I am saying is that the best way to get there is make a plan for your health improvement that gives you bite sized chunks instead of just general terms like lose weight.

Good luck with it!

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Good luck with the smoking...it will be ok....we have all (or many) wrestled our way through it......did it eating cheese its ....sometimes on the first night I think ok to have 1 and only one puff......then let it go.....after 3 days it will be over....then be careful in 3 weeks because you might think this is so easy I could smoke one but don't do it

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Hey thanks appreciate the support. I have quit and failed several times.

With the help of a hypnotist I got to 3 months about 5 years ago and as I write that I am giving myself a mental smack in the back of the head lol

3 mnonths! I could have been off them today for over 5 years.

Ahh well - sometimes we have to bang our heads against a brick wall an awful lot before we realise that NOT doing it is probably a better idea :)

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Have you read Alan Carr's book. I did and now off cigs for over two years. It gives a small mind shift and you look at smoking from another angle. Well worth trying.

I was on 30 a day for about 40 years!

Good luck

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I never say I have quit smoking not had one since 1979. I say I have stopped. I still have minor cravings but just would not absolutely give in. During the 36 years I have saved the price of a packet of cigarettes every day into a unit trust. In two weeks we move into our brand new house that my 6 figire investment has helped to ffinance. Incentivise yourself. Good luck. And dont give up the warfarin

I took daily aspirin for over 25 years never missed and then had a TIA.

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I have copied your 'And dont give up the warfarin' Barry and will paste it somewhere I can see it all the time.

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Incentive is everything isn't it Barry. I was a 40 a day Marboro man till 1982.when my dying mother asked me to stop and that was that. Used to have dreams about smoking for years! Odd thing though, my wife who gave up the following year started again in 2007, Doesn't smoke in the house so she has her summer house in the garden complete with gas fire and wine rack where she spends the hour before dinner every evening. . lol In fine weather I sit outside with my wine.

Gibbs Rule 52 We are all different.

Bob

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Great advice and thank you. Good luck to you too.

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There are already several replies about this, so there'snot much I can add. I have a similar experience to you. Amiodarone was was the only thing stopping me from going back into AF once I was in NSR. When I dropped from 200mg/day to 100mg/day because of side effects my AF returned. And when I stopped Amiodarone and switched to Dronedarone because of side effects (deposits in my eye corneas) the AF returned. Everyone's condition is different and maybe an alternative will work for you, but I think you will need something to keep you in NSR.

Hope it goes well

Lance

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Interesting as my cardio told me to discontinue Amiodarone completely after doing a halter and stress test. Offered nothing as an alternative and I negotiated her down from 200 to 100 mg a day.

After 3 weeks on 100 mg I had an AF attack. Which I suspected would happen. I put myself back on 200 mg and things are back to where they should be.

I know I need to get off the Amio and am going to see her in a couple of weeks.

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Dave1961. This may help. I read one time "You do not need to listen to your brain." So when your brain tells you something stupid, tell it to get lost. Or if that doesn't work, use the more emphatic "F" word.

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