Operation cancellations - corona effect and Amiodarone

[Goosebumps]

I am due to start a 6 week course of Amiodarone prior to a second cardioversion attempt then for 6 weeks afterwards ( yep, I fully appreciate the Amiodarone history, but apparently I need the strongest drug available due to the size of my left atria according to my EP.)

I saw my GP today and we discussed this. She said that in 3 weeks time the NHS will be in full corona virus mode, possibly overrun and all non essential operations will be pushed back, even cardiac ones. Staff will simply be moved to help on the wards.

So we agreed I wouldn't start the Amiodarone until the situation was clear as I want to be on it for as little time as possible.

I asked her about her view of Amiodarone. She said it's an auditable drug and she has to report on it every month so she knows exactly how many patients she has on it 16, and as far as she was aware they were all doing OK on it with no complications.

This was the first time I had heard that Amiodarone was monitored so closely by GP's, reassuring in a way, but I guess this is old news to many of you out there.

[Hidden]

I’m pleased to say that I have no personal experience of Amiodarone but I am aware that it is recognised as being the most effective rhythm control drug available. However, it also has a reputation for having some unpleasant side effects but the benefits it offers for short term use by supporting CV’s and ablations can be valuable and make it worth taking for a limited period. It’s great that you have such a supportive GP.

Hope it all works out for you.

[Jalia]

Good to hear that you will be monitored closely. You will only be on it for a few weeks so should be fine.

I have taken this drug several times in the past , 18 months being my longest spell and more recently for several weeks for support before my 3rd ablation. ( Crikey!.....just realised that was 7 years ago). It is of course a very powerful drug...cardiac Domestos..kills 99% of all household rhythm disturbances !

Here's hoping you dont have to wait too long.

[CDreamer]

Sounds like you have a good, on the ball GP! I think in your position that seems a sensible delay.

My husband has regular blood tests for thyroid, liver and kidney functions - about every 6 weeks.

We have now changed our response to COVID-19 and are limiting our social contact in confined spaces.

Take care everyone.

[seasider18]

I have twice been prescribed it ( 2011 and 2015) for about five months at a time. I discussed it a lot with my GP and cardiology but never hear that.

If you are taking Warfarin it should be reduced when Amiodarone is prescribed.

[Maagaa]

Hi Goosebumps Amiodarone has kept my in steady sinus ryythem until it left my tissues after 18 months. It has a very long life in the body. As soon as it wore off I've had numerous short AFIB episodes. Neuropathy has me using a cane and balance issues that will never be corrected. If I knew how bad this drug was there would have been no way I would have taken it. I would have opted for an ablation. Good Luck

[Goosebumps in reply to Maagaa]

Ah, well this is my conundrum, they won't do an ablation until they know that me being in NSR will solve my symptoms. Hence the cardioversion and Amiodarone first as a test. The words rock and a hard place come to mind.

[Hidden]

I'm glad you have a proactive GP.

Mine pretty much washed his hands of anything to do with me when I was on amiodarone

[LPE44]

This is the first time I've ever heard that doctors are suppose to audit Amiordarone use. Mine never said a word about that. (grr)

Anyway, I was put on it after my ablation - which solved my Afib but caused a heart attack and the insertion of a pacemaker. I have/had Sick Sinus syndrome. That was at the end of April, 2019.

I had a horrible cough since my surgery and am exhausted and intermittently dizzy. By the end of July, my previous EP had become less than kind. When asked what he thought could be causing these symptoms, he said it must be the low-dose antidepressant. Ugh.

I've since moved and started seeing a new EP/Cardiologist in December. He reduced my diltiazem scrip from 360 mg to 120 mg per day. I did see some small improvement in energy levels but then got bronchitis for six weeks. Then when I saw him again in early February, he took me off Amiodarone and Eliquis (my CHADD score is low so he said I can take baby aspirin instead - thankfully since my HI doesn't cover most of the $500/month cost). He had no idea why the cough was persisting or why I was still so tired.

It's obviously the middle of March and I've been off Amiodarone for about a month/six weeks. I was still feeling dizzy, coughing and tired... until this week. Amiodarone has a really long half-life in the human body, I've read. So I've begun exercising now that I feel somewhat better and my cough is getting so much better. Plus the dizziness is greatly reduced.

While I cannot definitively state that amiodarone caused my symptoms, the fact that it's been almost a year and that I am only now beginning to feel better indicates that the listed side-effects of amiodarone are the likely culprit.

Listen, it's a great drug if you need it but it has some truly bad side-effects. If you have to chose between taking it and staying alive versus not taking it - well I'd rather suffer the side-effects. However, I think my original EP failed in his monitoring and follow-up. I don't think I needed to be on it for nine months. ~shrugs - that's on me not finding a new doctor sooner~

As to postponing your cardioversion due to COVID-19, if your doc thinks you're going to be ok until the summer (when hopefully this outbreak dies down), then I'd definitely wait. With my lung issues, I am definitely cutting back on all of my medical and social outings.

[Goosebumps in reply to LPE44]

That's one hell of a tale. I'm so sorry that you have suffered so much. We all have tough decisions to make and it seems so much depends on the skill integrity of our medical advisors, how are we to know best enough to contradict them. It may be that I just have to look in the mirror on the fateful morning and say to myself, 'Do you feel lucky , punk'

[LPE44 in reply to Goosebumps]

Well it is better than the alternative! <weg> Listen, life is one huge crapshoot. You do what you can to mitigate risk and then go for it.

I guess my takeaways are 1) just because someone became a doctor does not mean they know everything - even about their specialty, 2) I have to be an active participant which means reading and learning everything I can and 3) People make mistakes - in my case, the PA who was supposed to help me get a heart morphology at least ten days in advance of my surgery did not. I had it two days before and the dye along with the anesthesiologist allowing my BP to drop too low during surgery likely caused my kidneys to fail. (this was something I had no idea I should be looking into).

Good luck to you! I pray all goes well and that you are in the pink really soon

[Gowers]

My cardiologist has said that if I go into af/permanent af (following 2nd ablation 5 weeks ago.)then he will suggest Amiodarone but only for a short while due to side effects. I am not keen and He doesn't like to prescribe it for young patients. My query is if it is only for a short while will the effects only last a short time? Thank you for sharing the information you have been given

[Hidden in reply to Gowers]

That is a difficult one to answer. If the amiodorone does any damage it may not be reversible.

Amiodorone damaged my thyroid function which thankfully returned to normal but took 18 months to do so after stopping the Ami.

Other people have not been so lucky.

If you are put on it then monitor side effect (or as BobD tells us Amiodorone has effects, not side effects) very closely

[Maril1]

I was on amiodarone back in 2007/8 as the drug of last resort for atrial flutter which I found out later it did more harm than good ( bradycardia) and like most drugs is pretty useless for flutter. I would ask the question why not an ablation? As cardioversion is only a stop gap that is give it a go see if it works or for less serious cases .

[Hidden in reply to Maril1]

Successful cardioversion, even if that is NSR for a few seconds shows that the heart is capable of sustaining NSR, Not much point in carrying out an expensive ablation if it's definitely not going to work.

Agreed a DCV is only a stop gap, but a cheaper than gambling on an ablation

[Goosebumps in reply to Maril1]

I was in NSR for 90 minutes after my cardioversion in December. The cardiologist and EP aren't sure if my symptoms ( chest pains, dizziness, tiredness)are caused by the AFib or another issue, hence the reluctance to go straight for an ablation. I don't take beta blockers, my heart rate rarely above 100, so the symptoms I show are easier to attribute to health rather than meds. It's a tough call.

[Maril1 in reply to Goosebumps]

My HR in proxy afib was over 150 and 130 but in permanent flutter no matter what they tried hence the amiodarone before an ablation did the trick back in 2008 . The Ep took me off the amiodarone a few months before the ablation as he said it was ineffective and he rarely used it only in extreme cases and just kept me on thinners and betablockers .It was another cardiac consultant who had put me on it.

I

[Desanthony]

I had the same as you for my second cardioversion last year. I had no side effects that I noticed from the amiodorone other than a slightly off thyroid reading at the first check post the CV which was when I was told to come off the amiodorone and happened to be at the 6 week mark anyway. The thyroid righted itself within 3 months of coming off the amiodorone and my next 2 blood tests showed all clear.