A bit scared of changing from Bisoprolol to Dronedarone.

[countrygirl1]

After six months of PAF (which started after mastectomy surgery) I have fortnightly PAF lasting 12 - 14 hours and going back to NSR on it's own. I'm on 3.75 Bisoprolol and it keeps the rate down but doesn't stop attacks. All my attacks have started after food or at night when asleep. Now I'm being prescribed Dronedarone and am rather cowardly about starting it. Does anyone have experience of this drug or comments about it please? Thanks, Jane

[SRMGrandma Volunteer]

Hi Jane, I think it is always scary to start a new drug, especially the rhythm control drugs. Once you and your EP have made the decision that the benefits outweigh the risks, then that next step is a leap of faith to actually take it. I understand feeling cowardly about it. You certainly have much to gain if it keeps you in NSR. Have you discussed the possibility of an ablation? I can understand if you want to avoid another surgery right now, as you have already been through a lot. Meanwhile, I hope you are doing everything you can to be as healthy as possible with your diet, exercise, and stress management. Good luck, keep us posted. Be well.

[countrygirl1 in reply to SRMGrandma]

Thanks Grandma, I am very interested in improving my everyday health as much as possible. I don't drink or smoke, and am about 7lbs overweight so would like to reduce that. I am unsure what type of eating plan would be best, and I have difficulty with stress. I'd like to do anything I can to help relieve the AF, with as few drugs as possible - hehe I'm sure everyone else feels the same! Any advice gratefully received, Thanks, Jane

[Deeferdi]

I've been on Dronedarone 400mg twice daily since May 2015 and I've been fine. I was on Bisoprolol 2.5mg before that and just couldn't get along with it. I'm also on Diltiazem 180mg once daily. With the Dronedarone I always take it with food as the Arrythmia nurse said it can cause stomach upsets if not. For the first 6 months I had monthly blood tests with the Arrythmia nurses to check liver function etc and ECGs, then dropped down to three monthly checks. For the first few months I was fine, no AF but then in December I had a bad month with AF but had stuff going on in my life so the tabs didn't seem to have any effect at that time but it all settled down again until the last two days where my heart rate has been back at 200+bpm but think that was tied up with a funeral I attended yesterday. I'm ok with it, the only thing that does seem different and may not be linked to the Dronedarone is that my hair seems thinner than it used to be!

Di

[JonathanPittsCrick]

Dronedarone is a good anti-AF drug and doesn't have bad side-effects - in particular it avoids most of the side-effects of amiodarone (though it's not quite so effective).

One side-effect it does have could be a problem, though. Like most rhythm control drugs (and bisoprolol) it also slows the natural (sinus rhythm) heart rate. And from what you say your AF seems to be triggered by slow heart rate (vagal type). This means that dronedarone may make the problem worse. The ideal drug would be one that speeds up the heart rate, such a disopyramide (Rhythmodan) - though this does have some (mainly mild) side-effects.

I think it would be worthwhile having a 24 hour Holter recording of your heart rate to check that it's not going too slowly (less than 45) already, especially at night – if it is, then a pacemaker might be the most helpful treatment. And if it's not 100% effective, dronedarone could be added later.

[countrygirl1 in reply to JonathanPittsCrick]

Thank you very much for such an informative reply! This is very interesting. I did have a 78 hour Holter monitor a few months ago and it showed a few seconds of AF at night, also occasional nocturnal pauses with dropped beats, and minimum heart rate was 44. I have been taking the Bisoprolol in the evening in order to cope with the side effects of weakness and tiredness but wonder if I have been doing myself no favours! I am keen to learn as much about this whole condition as possible, and thank you for your input. Thanks, Jane

[JonathanPittsCrick in reply to countrygirl1]

It would be extremely interesting to see whether the "few seconds of AF" were triggered by pauses / severe bradycardia - if so a pacemaker would be very likely to help.

So many people get side effects from beta blockers - I really don't understand why (other) doctors prescribe them so much.