3 options given by cardiologist

Hi all,

I had a cardioversion in April it was successful for 8 days then I went back into AF.

I have just seen a cardiologist for a follow up consultation and was given 3 options.

1# stay on my medication bisoprolol 5mg and rivaroxaban 20mg and hopefully my heart will go back into sinus rhythm eventually.

2# Have another cardioversion and take amiodarone after procedure.

3# An ablation.

I chose option 2# but I am now horrified to read about the awful effects of amiodarone and I'm considering just staying on the drugs I've been on for 7 months.

Has anyone out there had these options thrown at them I don't know if I've made the right decision it was all so quick and what would you suggest I am bamboozled now?

Thanks guys

23 Replies

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  • Don't take the Amiodarone option. I took it for about a year and it damaged my thyroid. Having to take thyroid medication now which I'm really not happy about.

    What about taking Flecainide after your next cardioversion?

    Jean

  • Hi Jean,

    I wasn't given that option and I really don't want to consider amiodarone now. I will have to call and cancel the procedure but I'll look into flecainide I've not heard of it though?

  • I gather flecanide can cause kidney damage long term.

  • Hi Ad1980, I do understand how difficult it must be for you if you haven't had enough time or information to make a good decision about something that will affect you for the future.

    I wonder, did you have the cardioversion at your local hospital and did you then see a cardiologist or was your follow up with an EP (electrophysiologist, who is a specialist in all things arrhythmia based)? The suggestion that if you stay on Bisoprolol you may go back into sinus rhythm is a bit tenuous, to my mind, and you might want to query that possibility.

    It does sound like you need time to consider all your options, and I can totally understand your reluctance to take Amiodarone, although there are some people on this forum who have had no problems with it, so I trust someone else will repond to your post and tell you how it's been for them. Also, I want to say if you haven't already, ask to be referred to an EP, it may be a bit of a wait on the NHS but if you have the resources once you have a copy of the referral letter you are entitled to see one privately. You can be then referred back into the NHS system for any further treatment and consultations if you need to.

    Do keep coming back and asking questions, we are not medically qualified so can't diagnose or give medical advice but can support you in your search to make the right choice based on our experiences and also the information from the excellent volunteers on this site.

    I wish you all the best and hope you get the answers you need. Kate

  • Hi Kate,

    Thanks for your reply.

    Yes it was a senior cardiologist and I thought him suggesting just staying on my current medications was rather odd.

  • I did choose to go with the second option of cardioversion and amiodarone which will take place within 3 weeks time or so. I am confused as of what to do I am okay on my current medications and I can't help thinking AF is here to stay whatever route I take.

  • How about having a cardioversion and stay supported on Amiodarone for perhaps 6 months and see how you go from there. Doubtless you will still have to take Rivoraxaban in any case. You can always go back onto rate control ie Bisoprolol if you don't stay in NSR.

    I've been on Amiodarone for varying lengths of time and while I didn't like the drug and it was not working properly for me long term, I didn't find taking the drug a big deal.

    Sandra

  • Hi yatsura,

    Yes that was what I decided at the time now I'm wondering if it was the right decision and wonder if staying on my current medications is right for me? Confused.

  • hi i was put on amioderone for 1month before cardioversion and 1month after but my thyroid is still affected. they did warn me this drug can affect other organs and i had it done at kings collge hospital and i was carefully monitered.

  • OK firstly ask yourself what is the purpose of a cardioversion? Are you hoping it will cure your AF as it won't. You have AF so will will get AF. Cardioversion may well return you to NSR as it has once already but for how long? A day a week, a month- who knows?

    Bisoprolol is a rate control drug which slows your heart when in AF but tends to turn one into something of a zombie for many people. It does nothing to stop AF If it helps you fine but do remember that all treatment for AF is only about improving quality of life so if it doesn't then try something different.

    I agree that you need to see a specialist such as an EP but I would seriously consider all options including ablation. It sounds scary I know but many here have had successful ablations which have kept them AF free for many years. Remember good news seldom sells so what you read here about ablation may not be a balanced view.

  • Good post Bob and very true. It is all about finding out what suits you and your quality of life, there are in fact lots of options drug wise and as you say many people have benefitted from ablation and some even cured so always worth a chance.

  • Hi Ad1980,

    Like you I was not happy about being pushed down the Amiodarone road but as Biproprosol and Ablations had failed to control my AF, it was all that was offered.

    So far (3 weeks) it hasn't been as bad as I thought it would be and has, to a certain degree, given me back my life.

    Having said that, I see my EP in July and will want to have a plan for getting me off Amiodarone asap!

  • My first cardio version didn't work at all. I was then "loaded" with amiodarone and had a second cardio version. This worked but lasted for 4 weeks. I then moved house, and got a new e.p. He has just completed all tests and is saying ablation, which I will go with. He took me off the amiodarone about 6 months ago for which I am grateful .

  • I have persistent AF and had a cardioversion in July last year and was put on Flecainide & Bisoprolol. This combo worked well for a couple of months until I had a reaction to the Flecainide, stopped taking it and went back into AF. I had another cardioversion in January this year, this time taking Dronedarone ( a cousin of Amiodarone) but was only in NSR for 8 days. I'm now taking Bisoprolol again along with Apixaban and waiting to have an Ablation.

    I was told by my EP that Amiodarone was only for short term use and he didn't recommend it my case. I suggest you ask about Flecainide as it may work for you.

  • Think long and hard and research the options given. Be calm and get your head straight as it's a lot of information thrown your way by the cardiologist. You can't make a decision on the hoof so please take some time out to consider.

    You will then make the best decision for you. Did he suggest rhythm control drug like flecainide as an example.

    Take care and time to reflect. X

  • Eveyone's story is different. Different levels of distress when in AF, different needs of medication and/or surgery.

    My suggestion is (also) to see an EP cardiologist. Look at all the options, pluses and minuses and then make a decision.

    If have been on amiodorone twice for 3 month periods on each occasion without any side effects. On one occasion following an ablation and then following a modified maze procedure. In both cases gave my heart time to recover from the surgery.

  • Yes. - I would go ablation every time. The fact that you went into NSR after cardioversion, means that there is a very good chance an ablaltion will work.

    My options given last week were

    Flecainide, Digitoxin, Amiodarone

    A 3rd ablation

    Pace & Ablate.

    I have had over 10 years of AF with a 2 year period free of AF after 2 ablations.

    My view is that the drugs - all toxic - cause more problems long term.

    I am seriously considering Pace & Ablate which will leave me pacemaker dependant and still in AF but hopefully with a better quality of life.

    Best wishes

  • PS - download the treatment options from the AFA site and research, research, research before you make your mind up. I have changed my mind over the years over several things after reading the research and understanding the reasoning.

  • Be aware that some EPs have long waiting lists for ablations. Should you decide that it might be a route you want to go down, once your name is on the list, you are likely to have plenty of time for the study of options and contemplation that wisely are being suggested. The time to make a decision whether ablation is appropriate for you is when you get to the top of the list. You can always say thank you but no.

  • AFA have a great little booklet on AF drug information. It gives a run down on the drugs used (not anticoagulants). Worth reading to get an idea what each drug can do. I have to add, that the data on Amiodarone scared me a little but like all drugs, what suits one may not suit another. I think I would want a sit down with a good EP and sort something out.

  • I am surprised you were offered electrical cardioversion *then* Amiodarone.

    1. My doctor tried me on Amiodarone first, doing something called "Chemical Cardioversion". See healthunlocked.com/afassoci...

    2. Being loaded with Amiodarone is supposed to help the Cardioversion 'stick'.

    I am very wary of Amiodarone. But, having experienced Chemical Cardioversion, i would be willing to try it again, especially when the PIP failed.

    3. There is an argument for Amiodarone for Cardioversion (+ Electrical if need be) then using Flecainide instead of Amiodarone to keep the lid on things.

    4. I presume you are on anticoagulants.

  • I had an ablation in February. As often happens following ablation, my heart went a little nutsy, i.e. a fib and lots of it. I was placed on amiodarone, short term, 3 months. I was told amiodarone would put me into NSR and it did. I had a difficult time with this drug and took right under 3 M. Now 3 weeks later, I am in aib on and off every day. Seems while on it, I was mostly NSR.

    It is a drug with many frightening side effects that potentially could become long term permanent health problems.

    I question if it was worth taking at all. I also have mitral valve regurgitation, moderate. EP now thinks the afib is coming from there. THis might effect other outcomes on amiodarone that do not involve valve issues.

    Don't know if this has helped or not. Good luck! Don't fear ablation!Judy

  • i had cardioversion 4 years ago and was given amioderone before and after but cardioversion didnt work. the amioderone had an adverse effect on my thyroid i put on a huge amount of weight felt tired and generally awful im now on levothyroxene for life. i was prescribed bisoprolol i always felt tired and breathless it didnt occur to me it was drug related. i moved house and my new gp changed my prescription from beta blockers to calcium channel blockers my heart rate is well controlled and i feel 20yrs younger.....i would not recommend amioderone to anyone unless absolutely necessary x

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