Amiodarone after ablation

[Natur]

I am four week post ablation. A week afterward, I had an afib episode that had to be treated with cardioversion even though I was taking 120 mg of TR diltiazem. A second episode began a week later and they told me to start 200 mg of amiodarone, which has big side effects on many and takes six months to clear once it’s stopped. My second episode converted after two doses of amiodarone. They want me to continue both meds for next 5 months, but I’m afraid of it. Any experiences like this?

[CDreamer]

Hi Natur and welcome

For sure that Amiodarone is a very toxic drug - down side - and it is the most affective drug for maintaining NSR.

My husband’s cardioversion failed, persistent AF, so wasn’t a candidate for ablation so was advised to take Amiodarone - that was 3 years ago now. It took about 6-8 weeks to start to have any affect but gradually AF became episodic and eventually after 12 weeks he maintained NSR. He is still on 100 mg Amiodarone and AF has not returned and he has had no affects.

But one person’s experience is no predictor of how you may react. It is a drug of last resort and my husband was at that stage with Aortic Stenosis, Mitral Valve regurgitation and EF of 35%. His quality of life was vastly improved and EF now back up to 55%.

It’s important to get baseline bloods and to have regular checks for Liver, Kidney and Thyroid. Amiodarone for short term use - ie 6 months is considered a reasonable risk, it’s the longer term use which normally causes problems but nearer the end of life one is more concerned with quality of life rather than longevity.

I am assuming you will have read and been told about all of the bad affects of Amiodarone and that’s certainly enough to scare you off it, but also consider the benefits because it’s the biggest gun in the armoury against AF and if not that - what other options would you have and would they be acceptable to you?

You will find people on this forum who have suffered the affects of Amiodarone and now live with AF and find they cope reasonably well so your choices may well be reduced right now. I’m no medic but have dealt with and been around AF for 16 years so seen quite a lot. I refused Amiodarone so was tried with Pacemaker Therapy and that worked for me - brilliant! Medtronic have a Pacemaker now which they say is about 50% affective for AF so that could be an alternative?

You haven’t given much background so where you live, health care system, age, health and fitness, body mass, sleep, stress and exercise are all bound up in this so if you have done ALL of the Lifestyle Changes, tried all the other treatments which have failed it may have to be Amiodarone or AF.

Best wishes

[theohappy in reply to CDreamer]

I think this is a great answer. Consider the individual choices you get to make based upon your circumstances. For me quality of life is important. And, I won't do amioderone due to thyroid issues.

[CDreamer]

I see you already read my post from last year about titrating down, the comment from JonathonPittCrick we found reassuring, if you don’t know he is a top EP in the SW area of England.

[pip_pip]

Hi. I was using amioderone for 6 years without any problems. However I was warned not to go over the 2 year mark in the earlier days. Generally it's unusual for any side effects to show themselves for a year or so. I had a lot more bad issues with flecainide, propofenone and digoxin, so each individual differs on how it goes.

Be well

Phil

[Jajarunner]

I took it for 4-5 months pre and post ablation no.1. heart was steady as a rock. Arrythmia nurse told me "it's a brilliant drug with Side effects for some". Hence importance of monitoring. Hope it goes well for you xx

[RichMert]

OK. I had close to 4 months of Amiodarone prior to first Ablation as this was the only drug in the end which could keep my heartbeat and increasing number of AF episodes down. Naturally the Amiodarone was stopped after the Ablation however, in my case, my AF came back in a bad way after one month and I was put on Amiodarone again until they could complete a second ablation 2 months later. I have since been PAF free for 8 years. My point being that Amiodarone is a last resort and I was told 6 months was the maximum period I could take the drug for. To be honest, I wish I had never taken it as it is likely to have had an impact on other organs within the body. If they need to give it to you by IV, make sure they do not put it into your arms. I ended up with infected arms which needed antibiotics to resolve (it does something to your veins). My advice would be to keep that drug short term knowing that it has a 6 month afterlife. If you need another ablation then pointless suppressing the evidence needed to support one.

[gemma29806]

I’ve been trying to come off Amiodarone for over a year.I’ve been having liver blood tests for eight months. Tablet has affected my walking, my corneas,and the fatigue is some this else.Finally doctor got in touch with cardio and he wants me to keep on it till he sees me plus he’s putting me on another tablet.

[DKBX]

The key thing is to monitor for the side effects. I was on it for a couple of years before having my first ablation.

[etheral]

Ask about Tikosyn (dofe tilide). Downside is you have to be monitored in hospital while being started, upside no long term dangerous side effects. Has kept me in NSR for 4 years. 70 yr old male.

[etheral]

Also ask to be referred to an Electrophysioligist (EP) who would have the most experience in handling your case. Best,etheral