About 2 years ago my OH was in a catch 22 situation. At 85 he was in persistent AF with aortic stenosis with an EF of 35% and quite symptomatic with deteriorating QOL. After angiogram established there were no blockages a cardioversion was arranged to see if NSR was possible and Amiodarone started 2 weeks prior to the CV - which failed to establish NSR after 3 attempts. Well one attempt did work - for 7 seconds.
So the options came down to possible ablation which given age and the failed CV seemed an unlikely option to be of benefit or Amiodarone.
2 years on and he has been on Amiodarone with no side affects but like many, doesn’t want to continue to take this drug because of the side affects. An echocardiogram should have been performed 12 months ago, but COVID and lockdowns put paid to that.
QOL improved quite dramatically after a few months of taking Amiodarone as gradually, and it was a gradual process, NSR became sustained after about 3 months of taking Amiodarone at the maximum dose. After 12 months OH decided to try reducing the dose and GP agreed, wrote to EP who also agreed and so gradually, very gradually dose is now down to 100mg - maintenance dose.
Now OH wants to stop Amiodarone so has been in discussion with GP. He has had no affects from the drug, Thyroid function is monitored every 3 months as are kidney & liver and he isn’t symptomatic.
So - given the circumstances what would you do?
How do you calculate the risk of both staying on the drug whilst showing no sign of toxicity against risk of stopping and AF returning in which case the risk of aortic stenosis and heart failure with increasing symptoms would be quite high?