Back from EP after Cardioversion Failure

[bigking]

Now EP wants to try another Cardioversion in conjunction with amiodarone . I am concerned because I already have neuropathy in feet and fingers and I have read this medicine can worsen that. Anyone with experience with it?

[Hidden]

I’m not able to help but I can empathise with your dilemma. As I understand it, amiodarone is normally prescribed for three months before and after the CV and although there are alternatives, it is considered to be the best option to get a good result. Obviously it will help to hear from others about their experiences but there might not be many who have neuropathy and have subsequently been prescribed Amiodarone. I suggest you contact the AF Association helpline as they should have access to medics well placed to help you. Good luck……..

[rc-k]

I have neuropathy, resulting from chemotherapy two and a half years ago. I have been taking Amiodarone for about eight months and I have not noticed any discernable change.

[bigking in reply to rc-k]

Thank you. As I read more and more about the drug, the more concerned I get. Not sure it will be successful anyway, but even if it does, I assume I will have to take it to remain in rhythm in perpetuity.

[Hidden in reply to bigking]

Not necessarily as I understand it. A cardioversion is often part of a treatment plan to see if a patient with persistent AF can be returned to normal sinus rhythm and a limited dose of amiodarone is often recommended to increase the chances. If normal rhythm occurs, even for a short period, it indicates that the patient might respond well to further treatment such as an ablation.

[BrotherThomas]

The problem is that we're all different and respond in unpredictable ways to drugs. I took 200mg of amiodarone for just over two years and did not experience any adverse effects. I'm off it now because it didn't seem to work for me in terms of maintaining NSR after cardioversion.

[BrotherThomas]

Sorry, should have said 200mg daily.

[Kernowfib]

Yes, bigking , I had an Amiodarone led Cardioversion just 6-months ago after being in persistent A.Fib.. Apparently the Amiodarone dramatically increases the success rate of the procedure but it must be taken for at least 6-months after the procedure; It has certainly worked for me in that I haven’t had any A. Fib. since.

I also suffer from painful Peripheral Neuropathy in fingers and especially toes, which has been my nemesis during the Amiodarone medication. Since my 6-months on maintenance dose of Amiodarone, I can safely say that the neuropathy has been a real “pain in the foot”. I am hoping that when I see the cardiologist shortly, I will be able to drop the Amiodarone, it isn’t a very nice drug for a lot of people, including myself. However, my choice was made for the Amiodarone-led cardioversion as the neuropathy looked like the better option than the consequences of Atrial Fibrillation. - I am learning to control the neuropathy pain.

I hope my experience is helpful to your decision.

[mav7 in reply to Kernowfib]

Great to hear the success, Kernow !

May I ask how long you had been in persistent afib prior to the cardioversion/amiodarone therapy ? And you have been in NSR for 6 months ?

Reason for asking is my cardiologist has offered same procedure except with Sotalol.

Thx !

[Kernowfib in reply to mav7]

Hi Mav7,

I was in continuous persistent A. Fib for 9-months before ablation and I have been in continuous NSR ever since. Amiodarone certainly has been a ‘wonder drug’ for many years, but isn’t a nice drug that I would welcome long term. It has many issues, and I will be extremely glad to be able to come off of it, Quality of life for me hasn’t been good whilst taking it, but, hey, 6-months of Amiodarone’s side-effects has got to be worth a future without A. Fib.

[Kernowfib in reply to Kernowfib]

Sorry, error made there; should read :-

‘I was in continuous, persistent A. Fib. for 9-months before ‘CARDIOVERSION’

[mav7 in reply to Kernowfib]

Appreciate the info !

Best to you in the future.

[bigking in reply to Kernowfib]

Thank you for the information. Your input is exactly what I am worried about. My neuropathy is already awful in my feet and very bothersome in my fingers. Am really leaning towards ruling out the amiodarone plans of my EP. I am going to have to make decision soon. Either live with the very symptomatic AFIB, or keep down this road of seemingly endless cardioversions and different drugs. Not sure why he doesn't think another ablation won't be effective as the last one worked for four years. Maybe time to change EP's.

[Kernowfib in reply to bigking]

Please don’t discount the Amiodarone-led cardioversion, bigking, it has certainly worked for me 100%. - Atrial Fibrillation isn’t a healthy condition and shouldn’t be dismissed with ease, and Amiodarone has been and still is, apparently, the best known anti-arrhythmic drug available. On the other hand, peripheral neuropathy, whilst basically incurable, can be controlled, I have discovered; an holistic treatment that I have been using has reduced the intense pain in my toes that I was receiving to the extent that sleeping at night was impossible, to a minimal degree that allows a good nights sleep with only the odd twinge.

I don’t think that I would be allowed under the rules of this forum to expound on the simple remedy that I have found that dramatically reduces the night time pain of the neuropathy for me, but if you were to contact me by the ‘private ‘ messaging system that I believe is available, I will be only too happy to impart the simple and non-expensive remedy that has unbelievably worked for me.

Kernowfib.

[Hidden in reply to bigking]

Please bear in mind that I’m not medically trained but as you develop your AF history, it makes it a bit easier to understand your EP’s thinking. You say that you had an ablation which lasted for four years which implies you probably had it around 5 years ago and now you cannot understand his reluctance to try another. This is likely to be because your last CV failed which generally means a Cryoablation or Radio Frequency Ablation is also unlikely to work. It is commonly known that AF is a progressive condition, so to be sure, he’s suggesting another CV but supplemented with the strongest and most effective drug available ie Amiodarone. Obviously, the reasons for you not wanting to go down this route are totally understandable, but in his eyes, unless this combination works, conventional ablation therapy is also unlikely to work either and he would be exposing you to associated risks possibly for no benefit. Your theory of continued CV’s and drugs is unlikely to provide any benefit either because they are not likely to risk doing them if they don’t work either.

You talk about consulting an alternative EP and that’s a good idea but it might also help if you research other forms of ablation such as one of the hybrid MiniMaze variants. If you are a regular reader of this forum, you may well have seen many threads where this has been discussed but type Hybrid MiniMaze into the search box top right of this page and that will reveal many posts (and trust me) some of them go on forever! I have also made  MummyLuv aware as she is a member with probably the best knowledge and understanding of these procedures. It is possible that rhythm drugs are sometimes needed but she will know all about that. In the current climate, hybrid MiniMaze procedures are not easy to come by especially on the NHS but it would be worth investigating and possibly talk to an EP who specialises in this area. Hope this helps…….

[bigking]

Thank you very much for taking the time to respond with learned advice. I really appreciate input from anyone who has had to navigate this complicated issue. I trust this EP and therefore should probably follow his advice. My reluctance is purely because of the many side effects of amiodarone, especially the neuropathy issue. Mine is already serious in my feet and hands and mobility would be an issue if it gets worse.