I wanted to know if anyone has been in similar situation to my husband. He is 44 and a couple of months ago found out he has AF. It is all the time he has had 4 ecgs all in AF. He had an echocardiogram 2 weeks ago and we now know he has reduced ef of 42% and enlarged atrium. The GP spoke to him suggesting an anomoly on the echo which sent us into a worry. The arrythmia nurse didnt seem to know about this but having liased with the consultant has now given him the following plan:
2 new drugs rampril and amerdorone (sorry if wrong spelling)
Plus anticoagulant on standby ready 4 weeks before cardio aversion
MRI
Appointment when started new medication for further tests.
Cardio aversion as soon as possible
CT scan after
We are worried theres something going on that they are looking for on scans as we weren't expecting them for cardio aversion and GPs vague information . Anyone had similar? Would be really grateful to hear from you.
Thank you.
Written by
Seaside1005
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Cardioversion is a procedure to shock the heart back into normal sinus rhythm (NSR). It is normal to try this to see if NSR can be attained as this will direct future treatment plans. It is vital that the patient be anticogulated for at least a month prior to cardioversion (DCCV) to prevent the possibility of clots forming in the heart.
Amiodarone is a drug to try and chemical convert the heart to NSR and also to assist with the DCCV. It is not a nice drug and should only be used short term as it has so many other affects.
The enlarged left atrium is normal with people who have AF if their condition has not been managed. It is quite common for this to reuturn to a more normal size when rate is better controlled.
The CT scan will be to look at the heart again to see what may or may not have changed.
All in all it sounds as if a good treatment plan is in place by a team who know what they are doing so be happy. Please understand that GPs seldom understand AF and all its intricacies so don't be alarmed by anything they may say as it is probably wrong. The arrhythmia nurse will know far more.
Thank you so much for that information it really does make me us feel better! Its been a bit of a whirlwind and we were shocked to hear that his heart function was reduced. Hopefully the plan will work and get him feeling better.
Our medical lead Matt Fay once said amiodarone doesn't have side effects, it has effects.
Photosensitivity is one. Don't go out in the sun or you may burn.
Lung problems,(any chest problems seek medical help) crystal deposits in the eyes, attacks the thyroid gland. Oh it really is a great drug. Trouble is it does do what it says on the tin so on occasions, such as prior to cardioversion, short term usage is fine.
If you go to the main AFA website you can look it up.
Amiodarone has a bad press but it is also THE most effective drug to ensure NSR sticks after cardioversion. My husband has been taking Amiodarone for 4 years now with no unpleasant affects but he is now on a low maintenance dose. As PPiman says, it’s benighted history is because of use of high doses over longer periods. Talk to your cardiologist about any concerns.
The dangers of not being able to sustain NSR for your husband may outweigh the small risks of taking the drug.
Treatments are all about balancing associated risks with benefits. Ask your cardiologist to explain what might happen if your husband was unable to sustain NSR and what other treatments might be considered.
Its benighted history is owing to the use of the drug in high dosages, I gather. This study is very important, I believe, not least because amiodarone is still, I gather, the most commonly used anti-arrhythmic worldwide. It seems that all anti-arrhythmic drugs bring their own burden of side effects but, as you say, this one is, rightly, a drug of last resort or for short term, low dose, use.
I was in a similar position with permanent AF but my EF was 27%. After cardioversion I was afib free for 2 years. Now have paroxysmal AF but EF is now around 45% so things can improve.
was diagnosed with AF earlier this year and my EF was 45%. (Normal is only 55% anyway). I had an emergency cardioversion but only stayed in NSR for a few hours. I now take Amiodorone and and Bisoprolol which keeps my HR steady, and have an ablation booked for December. Hopefully ii shall then be able to stop the Amiodirone. I also take Ramipril to help manage my blood pressure but it also relaxes the blood vessels around the heart allowing it to heal the heart failure. I had an MRI 2 months after starting this treatment regime and my atrium was normal and EF back to normal. Sounds like your husbands story is very similar to mine and the hardest thing I've found is the psychological adjustment to what's happening to you. Once your symptoms are well controlled and you learn to relax about it, life returns to almost normal.
Thank you it does sound very similar, thats reassuring that things can return to near normal with treatment. You are right psychologically its hard, husband more inwardly worried which is tough. Obviously Im the sort of person who needs to know all the details! Thanks again feel very reassured by your reply. Good luck with your ablation.
I can add only a little to the other excellent replies, based on my own experiences and from discussions with doctors and studies I have read.
Most important is to say that the fear that heart issues create magnifies the actual problems caused by the heart many fold: lowering the anxiety will help reduce symptoms more than anything else. Here, the knowledge gained from the scans - echo and MRI - will help your doctor to reassure you more than any other single thing - and reassure you they almost certainly will do.
An enlarged atrium appears not to be all that unusual in people with AF but that, in itself, might not be overly important. My elderly friend is 89 and a good example, as is my son's colleague, still teaching at 76, and my cousin, a smoker, too, at 76 and all similar. It's likely that other factors are as, or more, important, than AF, such as increased blood pressure, valvular problems, hardening of the arteries, diabetes and obesity - to name a few. Uncontrolled obstructive sleep apnoea, too, is important, it seems in up to half of people with AF. All of these can be helped by medicines or lifestyle changes.
A reduced EF is a sign that the left ventricle of the heart is pumping less oxygenated blood than the body demands, bringing with it tiredness and a need to breathe more deeply. The weakness is, apparently, caused more by a persistently racing heart rather than by the AF and, once that is brought under control by, for example, bisoprolol or another beta blocker, then the EF will improve, and symptoms diminish.
All-in-all, the chances are very high indeed that the future will be far brighter and much more normal than you currently believe.
Hi Steve. Thank you so much for your message. Thankfully husband isnt an overly anxious person thats me! Can you tell!? I am just much better if I have all the information. We have a 19 year old daughter with autism who needs a lot of support and care, so if feels a little overwhelming to have additional health issues to contemplate too.
I suppose for us his age is a big concern, it seems that alot of people on here are older than him. Because there doesnt seem to be any obvious causes and because he doesnt seem to have high blood pressure or cholesterol or other risk factors and I guess a worry that if they cant stop the af will his heart continue to fail? We are pretty good at coping with what life throws at you but it feels like alot at the moment!
From my reading, there's always a cause to what is otherwise sometimes called "lone AF", but it mostly remains hidden and is perhaps even of little consequence as it might be something genetic or innate. In younger people, it seems that some kind of "imbalance" in the autonomic nervous system might be a cause, but it's ill understood - often the vagus nerve is "blamed". Something that appeals to me as I had this is that some mechanical aspect where the body physically pulls at the heart a little. Body shape, constipation, wind, indigestion and such like can all do this. The irritation of the heart then sets off one or more innocent ectopic beats (i.e. palpitations) and this can, in prone people, trigger AF. The heart isn't floating freely in the chest as we might think, it's tethered to various parts that do move and can even stretch it a little; it actually almost sits on the diaphragm muscle, and presses against the oesophagus, for example, in many people - quite naturally. I much prefer this idea than the commonly considered "irritated vagus" as making a lot of sense.
I see your husband's doctor has prescribed losartan - like me. Even though high blood pressure isn't present, this drug has, I gather, been shown to protect the heart well over the lifetime.
I’ve just been reading your post and also the one from BobD.
I’ve had AF for 1 yr 9 moths and finally got to the top of the cardiology waiting list about ten days ago when I had a consultation. I’ve been put on Amerodarone200 and am having a cardio conversion hopefully in December. I was told I’d only be on it for six months, so a short time. I did n't realise that it was a chemical drug to help put the heart back into NSR as they just told me it was to strengthen my heart prior to the CV, so when I read BobDs post in reply to you, I found that quite encouraging. I have also looked up the link on the research of the drug and I feel a lot more confident now so thank you BobD and Seaside for bringing this to the fore. What would we do without our shared I formation!
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