Amiodarone or pace and ablate?

[Cara95]

Hi there. I am new to the forum. I was diagnosed with PAF in 2018 and after 18 months of struggling on various medications had a PVI ablation and 6 months later an ablation for AVNRT. Despite these procedures my symptoms increased a lot. I am now on amiodarone and feeling ok. I was told that pace and ablate was the next and last option if the medication did not work. Apart from some insomnia, the meds are fine. However, I am uncomfortable with taking it for a prolonged period. I have been on it now for 4 months. Is this wise, or should I simply go for the pace and ablate. I am seriously conflicted.

[CDreamer]

That was the choice I was given and I chose Pace and Ablate and refused Amiodarone. The Pacemaker alone worked for me so didn’t proceed with the AV node Ablation.

Amiodarone is not recommended long term but I think everyone reacts differently and my husband has been taking it for 2 years now and it’s kept him in NSR with no affects which has meant his Ejection Fraction increased back to acceptable levels and his QOL improved. He is now on a maintenance dose of Amiodarone and you may be interested in a thread I had a few months ago now when several expert opinions from eminent physicians were expressed.

healthunlocked.com/afassoci...

[Cara95 in reply to CDreamer]

Thank you for your reply, CDreamer. I have read through the previous thread and have found much food for thought.How wonderful for you that the PM sorted the problem without having to do the AV node ablation.

Does this mean that the PM only paces when the HR is low? Are you still aware of being in AF?

[CDreamer in reply to Cara95]

No, my PM is pacing 99% of the time - it seems that I still have what they call - ‘good conductivity’ so a little of the pulse is still regulated by my natural PM - AV node.

Pacemaker technology is now advanced so depends on the type of PM & how it’s programmed. Everything is monitored remotely through an App on my phone so I need only go for a physical check annually. The PM clinic gets a regular readout directly from the App.

My pulse rate is now set to 60, it was 70 which was uncomfortably high for me so reduced to 65 and now 60. I haven’t shown a heart rate over 135 now since implant - would go to 180-200 prior.

Since implant I have recorded 2 episodes of AF, both short 30mins to 2 hours & both when I had pneumonia. Nothing since so it eliminated the AF. My EP says that has happened to a dozen or so of his patients. Yes you will still feel AF after Pace & Ablate if you continue to suffer AF.

Hope that helps & please don’t hesitate to ask questions.

[Cara95]

Hi Bill64. I am 75 and the dose is 100mg. I have not had any screening tests yet as I have only been on the meds for 4 months now.I still get daily episodes of AF but only for short periods. Although I can now cope with day to day activities without getting too breathless, I am still excersise intolerant.

I was hoping that if I took the amiodarone it would have had a more dramatic effect.

[TracyAdmin Partner in reply to Cara95]

Dear Cara95 Please check with your doctor before changing any prescribed medication, they have access to your own personal medical records. We strongly discourage any Members offering advise on such medication changes.

[Cara95 in reply to TracyAdmin]

Thank you Tracy. Of course I will act only on the advice of my doctor. I took Bill64’s suggestion as the opinion of a fellow sufferer (with more experience than my own?) but will be consulting my cardiologist or EP before making any changes.

[Cara95]

Thank you so much Bill64. My lungs were checked out thoroughly before starting with the amiodarone, so it seems that the sensible thing to do is stay with the meds and keep a sharp eye on possible side effects.

[Tut7iFru7i]

what is pace and ablate please?

[Visigoth]

Very interested to read your post as I’m 70 and been on amiodarone for two and a half months. It’s done wonders for me so I’m currently trying to decide whether to go for ablation (my EP says pacemaker is not suitable for me). I’m on 200mg daily and my symptoms are well controlled but my EP said it would be an option to try 100mg and then I’d be likely to avoid the worst side effects- but there would be a trade-off in terms of having more symptoms. Like you, apart from some insomnia I appear to have no other side effects as yet.

[Cara95 in reply to Visigoth]

Yip, we seem to be in the same boat. Higher dosage, more relief but also more risk. O dear!

[TracyAdmin Partner]

Hello there, if you would like any support or advice, then please do not hesitate to contact the AFA . You may find information to help you re the Pace & Ablate procedure on our 'Virtual Patients Day 2020' please follow the link to view the agendas heartrhythmalliance.org/afa... you may also wish to register an interest in some of our other upcoming events and view our Patient Resources too .

[TracyAdmin Partner]

Bill64, we strongly advise against any Members of the Forum offering advice on changes to prescribed medications for themselves or other Members. Kind regards, Tracy and the Admin team.

[Eastwick]

Pace and ablate was the best thing I did as my AF was so frequent. My left atrium has developed permanent rather wild af but I don’t feel it at all!

[Cara95 in reply to Eastwick]

That is so encouraging!

[Pilateslady]

I was diagnosed with PAF 15 years ago. I am now 78 yrs old and this Thursday 22nd will undergo pace and ablate. I’m not keen on the idea of amiodarone or it’s side effects. Over the years I’ve had flecanide, bisoprolol, dronedarone plus 2 ablation. I have 7-8 hrs of AF every couple of weeks when he feel really unwell, faint and breathless. So although I’m very anxious I feel this is the better option 🤞

[Cara95 in reply to Pilateslady]

All the best and keep us informed on your progress.

[Pilateslady in reply to Cara95]

I’ll let you know how it goes 🤞

[dedeottie in reply to Pilateslady]

Your situation is nearly identical to mine Pilateslady except I am 65. I am on the waiting list for pace and ablate and using this time to do some research on the subject. Because of my symptoms when in AF I have no doubt it is the right decision for me but that doesn’t stop me looking for reassurance! Good luck with your procedure and I’m looking forward to hearing the nitty gritty details afterwards ( good and bad of course).All the very best to you x

[Pilateslady in reply to dedeottie]

Thank you. Feeling nervous today and will be glad when it’s all over. I’ll keep you posted.

[Alphakiwi]

Some people cant take amiodarone, or anything much else. 10 days on amiodarone put me in hospital. I flat lined in the ambulance. Waiting for pace and ablate

[Cara95 in reply to Alphakiwi]

For you, obviously there was no choice.