Proper Drug for My Wife and Efficacy of an Ablation

[Tiburon]

For the past 40 days, my 77-year-old, relatively fit wife has been in and out of AFib — but mostly in. She’s had three trips to the hospital during this period, because her heart rate had been in the 120-150 range for several hours each time. On her first hospital visit, she was given Diltiazem and then Amioderone, which converted her to NSR. She continued taking Diltiazem. Five days later, she was back in AFib. A few days later she was successfully electro cardioverted, but was back in AFib 5 days later Her EP put her on Multaq, and two days later she reverted to NSR, but had to stop taking the drug because of swelling in her ankles and feet. Again, electro cardioversion was attempted, but this time it failed. She was admitted to the hospital to receive Tikosyn. The drug got her out of AFib but caused an unacceptable prolongation of her QT interval and was stopped. She was sent home with a prescription for Amioderone, 200 md/day. She has no ventricular issues and otherwise has a healthy heart. She is now back in AFib with a 90-120 pulse rate. She is reluctant to take Amioderone because of its side effects, particularly those related to lungs (she has a lung issue). Her last episodes of AFib were about a year and a half ago. Are there some other anti-arrhythmic she might try.? The EP at the hospital would not prescribe Flecainide because he said it’s his practice not to prescribe it to patients over 70. The EP suggested an ablation as an option, but she questions the efficacy of a first ablation at her age and objects to the invasive nature of the procedure. What success rate for an ablation could she expect at her age?

[jeanjeannie50]

Hi there, I'm sorry to see that you haven't had any replies to your query. Some forum members here get on really well with Amiodarone. Can you help with this CD CDreamer ?

Jean

[Rainfern]

Hi Tibiron, first I’d just like to say that in my cardio team apparently 70 is considered young and they perform ablations on people in their 80s quite regularly. I was put on amiodarone a few months ago in the hopes that it would back up a second cardioversion. I was back in persistent AF within days. However because my heart can revert to NSR even for just a few days, they consider it worthwhile to give me a catheter ablation. I am now on the very long waiting list! I am hoping at my next appointment with the EP that they will take me off the amiodarone. Touch wood I’ve had no major side-effects, but my lungs have never been a strong point. It’s bad enough having AF without further damage to other organs!

I wonder if it would be possible for your wife to get on the waiting list for ablation and she can always change her mind as a date approaches. That way she can also decide whether she wants to stay on amiodarone. Sometimes we just need time to make these decisions and mull it over with the cardio team.

Best of luck and hope you get all the information you need to make the best decisions.

[Tiburon in reply to Rainfern]

Thank you for your reply. Good luck with the ablation! I hope it’s successful.

[Vonnegut]

I am 79 and have taken Flecainide first as PIP and now regularly for several years so hardly any episodes of AF- just a very few, very short ones. It might have added slightly to the chronic fatigue I have, but at 79, guess I can’t expect to be as fit as I was for all my life until shingles got me with the pain before the rash (and no chance of an appointment or an antiviral from my surgery!) a few years back! I did manage a reasonably long walk with rests recently but most of my friends have less energy than they used to and other medical problems like arthritis etc which I’ve avoided! Remember we are in the “bonus years” being over 70!

[Ppiman]

There are several drugs but all rather similar so far as I can tell, and most somewhat risky if QT interval is an issue. I was told that amiodarone was the only one I could take owing to this but, so far, bisoprolol alone does the trick. It seems as if your wife has tried all of the different classes of anti-arrhythmic drugs.

Low doses of amiodarone have been shown to be very safe (see the link below), and close surveillance is practised these days, also. It has a poor reputation from its historic higher dosage use, I believe and is still a highly regarded heart drug, one that is much safer than others in some important aspects (e.g. it doesn't usually lengthen the QT interval). I would be cautious of it, though, so I understand your wife's reluctance.

An elderly friend has had permanent AF for very many years now with a rate that is generally 90 or lower and he takes no medicines at all apart from an anticoagulant and rarely knows he has it. I would think things would depend upon what symptoms your wife feels when she has it but if her heart rate can be kept below 100, I gather it's unlikely to cause harm in and of itself.

Steve

[Tiburon in reply to Ppiman]

Steve — thank you for your reply. I don’t see the link to which you refer.

[Ppiman in reply to Tiburon]

Sorry - I forgot to add it. Here it is. It’s quite interesting given the often negative comments that are sometimes posted.

ncbi.nlm.nih.gov/pmc/articl...

Steve

[Tiburon in reply to Ppiman]

Many thanks, Steve! The results of the study should cause one concerned about the risks of the drug to take another look at trying it at lower doses for a shorter duration.