Morning, can someone explain to me why I should remain on certain AF meds if I am in Persistent AF anyway?
The meds to which I refer are Amiodarone 100mg & Digoxin 125mg which, each taken once a day.
You views on this topic would be appreciated.
Many thanks
Interesting question and one you really need to discuss with your treating doctors.
The difference between persistent and permanent AF is merely an agreement. An agreement between patient and doctor that no further attempts to obtains NSR will be made and rate control (plus of course anticoaguation) will be the way forward.
Amiodarone is a rhythm control drug so obviously you have not had that conversation yet with your doctors.
Rate control plus anticoagulation where appropriate should be the minimum treatment for normal life.
I agree with Bob but checked your history to see if this would help but this is your first post since joining back in 2016. The only thing which occurs to me is that it’s often suggested to patients with persistent AF to have a cardioversion to see if they can be reverted back to regular rhythm. If it’s thought that might be difficult to achieve, then Amiodarone is sometimes prescribed for a limited period before and after the CV. It’s not the best drug to be on for the long term as it can have serious and long lasting side effects so echoing Bobs comments, you are best advised to speak to your Doctor as soon as possible……..
Thanks for your replies (BobD & Flapjack), I tend to agree with your suggestions but guess I was after the assurance it was the right thing to do. The question actually relates to my 91yo mother who was put on Amiodarone some time ago & given she hasn't had a cardioversion, or has one planned, thought I'd ask the question before raising with her/her consultant.
I'll (try) make the appointment & get some answers!
Advise putting in writing in some form as well as/ instead of phone call.
Wow, hope she is coping OK. I would think it’s unlikely they would try any form of procedure to get her back into rhythm and if the Amiodarone isn’t working, I expect they will stop that and focus on trying to keep the rate low with Digoxin and maybe a calcium channel or beta blocker. Hope it makes her more comfortable……
As previously mentioned, the only reasons I can think of continuing amiodarone if someone is in afib is: (1) to convert them to sinus rhythm; (2) Optimize for a cardioversion, before and after; (3) Optimize for an ablation (before and after).
Sounds like your Mom doesn't fall into any of these categories. I don't have to tell you how potentially toxic this drug is, so only taken when rewards are greater than the risks.
Ask your doctor, sooner than later, to justify the drug. If the answer doesn't sit well, get a second opinion. Doctors make mistakes all the time. Hopefully, your mom is under the care of an electrophysiologist,(ep) as they know these types of drugs the best.
Also, has she been offered an ablation? At her age, it would really depend on her health, but if she didn't qualify for a catheter ablation, she might for what is termed Pace and Ablate. It's a much smaller procedure than an afib ablation, that would not necessarily resolve her afib, but would allow her to get off some of the afib medications and may offer her a better quality of life.
Jim
If you have accepted AF and drugs & cardioversion prove you cannot gain NSR and therefore make no difference my reaction would be why continue? If me I would say no. Entirely personal and a discussion for you with your doctors but remember that you can refuse a treatment.
See Bob’s & FJ’s replies for caveats.
Surely when you are in permanent (or persistent) AF then that is the time when you need anti AF medications most? I am in permanent AF and my BP monitor picks it up every single day, with breathlessness and fatigue when walking and making any kind of real effort. But I take Sotalol (and of course anticoagulants) because it is a rhythm control drug and reduces heart rate. Without it, my heart would be racing irregularly with tachycardia whereas now it is just irregular permanently but not dangerous beyond the constant risk of blood clots.
Sotalol is mainly a rate-control drug, and has little effect on rhythm.
As I said several times, it controls my rate and avoids tachycardia. It doesn't control rhythm now with me as my AF is permanent, but it certainly did for most of the time I took it when my AF was principally paroxysmal.
Hi. I’m just thinking that the doctor’s decision will in part rest on the level of activity your mother hopes to maintain and how much the AF is affecting her quality of life. I have recently been put on amiodorone and after a week have already noticed an improvement in energy and less breathlessness. For me the drug is a stop gap following a CV that only kept me in nsr for a week before returning to persistent AF. I’m on the waiting list for catheter ablation, but maybe the doctor is prescribing amiodorone as a chemical form of cardioversion? Just another question or two for your mums GP - I’m not a medic!
I’m aware that amiodorone is toxic in the longer term. My mum in law was on any number of toxic medications into her 100s but chose risk over reduced QOL.
The aspect of arrhythmias such as AF that seem most to matter is the high ventricular pulse rate they can cause. Getting that to below 100, and to normal, if possible, is said to be far more important that achieving normal rhythm (i.e. NSR). This rate reduction is attempted with drugs such as beta- and calcium channel blockers as well as digoxin. Amiodarone is different as it is an anti-arrhythmic drug and with a potential in higher doses and in the long term, some potential for severe toxicity.
An elderly friend has been in permanent AF for many years and is treated only with warfarin, an anti-coagulant, and remains entirely well.
The next step, if I were you, would be to talk with my GP, as others have also suggested.
Steve
HI Dolderson. I will relate some of my personal experiences but remember we are all different. Amiodarone gave me lung problems, but brought me back to sinus rhythm. Flecainide at the 150mg dose caused dizziness, and I fainted once, but it got me back into sinus rhythm. Bisoprolol at 5mg meant that trying to move quickly caused breathlessness, and sometimes resulted in a heart rate in the 40’s.
I am one of the lucky ones and AF/Flutter does not impact on me significantly.
A few years ago I talked to my G. P. about reducing my bisoprolol dose and eventually I settled on 2.5mg ( I am now lightening fast over 5 yards!). In the last 18 months an Electrophysiologist wanted to increase the dose back to 5mg, but I debated down to 3.75mg. This week I saw a Cardiologist and he was happy to reduce the dose to 2.5mg. He noted that my resting heart rate based on my readings over the last 12 months averaged 60bpm.
Shortly after Bisoprolol I raised the question of stopping Flecainide. After two Cardiologist agreed (later confirmed by an Electrophysiologist) I stopped it over three years ago. My only request was to have an annual Echocardiogram to keep an eye on any changes to structure of my heart.
I would never stop Apixaban. I am also on Perindopril. Another decision that I have made is not to have invasive surgery unless it is really necessary.
I am 80 years old, and this is the first time that I have felt age catching up on me. Once a week I still swim 28 lengths of crawl-slow but steady! I walk 4 to 5 miles aiming to reach 3.25 m.p.h. over mixed terrain. I have decided to grow old disgracefully. I tell the women in the U3A (over 50’s Group) that as a man I am an endangered species, and should be treasured and nurtured!
I am in continuous AF and Flutter. One nagging thought is the statement, ”That AF begats AF” At my age when I get tired, or the odd breathing problem, is it age, drugs, or AF? I can control breathing and pulse rate through YOGA breathing techniques.
,I think that we all have some responsibility for our own health and wellbeing. There is nothing wrong in challenging medical professionals with polite questions. Be persistent because as I have recently found out seeing different professionals at an appointment can result in different opinions. What is the best quality of life decision that can be made for a person? TerryW.
Don't know about the Amiodorone but I would think that the Digoxin is to control the heart rate and help keep it down to a safe level.
My wife has long standing AF. Her heart rate got out of control at one point. Bisoprolol was prescribed to reduce the rate. That was not sufficient but addition of Digoxin did the trick.
Hi
I am in rapid and persistent H/R with AF.
I am controlled since being stabilized on
AM Diltiazem 120mg. best for H/R reduction - went down to 62-88 within 2 hours.
2.5 Bisoprolol BB Beta Blocker PM better for hypertension.
Both are for stablizing rhythmn.
Also PRADAXA 110mg x twice - an anti-coagu;ant.
Apart from my 125mg thyroxin Synthroid daily fasting around food. Thyroid surgically removed with 12 lymph nodes (2 affected) papillary thyroid Low Risk so no RAI or suppression of TSH. Keep 1-2 TSH.
I wil have these for life unless AF disappears! But always the thyroxin.
cheri JOY. 74. (NZ)
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