My dear Dad (88 years old) has AF which is getting increasingly worse. Despite the fact he has Crohn's Disease and has had Prostate Cancer in the past, he's in pretty good health. He takes exceptionally good care of himself - and is an inspiration to me in that regard. 😊
His AF is most certainly his most bothersome concern, and he has been advised to take amiodarone. He is quite skeptical about it, as his specialist prescribed it during a very rushed and hasty 10 minute consultation. His is, like many, concerned about the side effects; specifically the fact that it can lower blood pressure and heart rate and can have a deleterious impact on the lungs.
My father already has very low BP and a very low resting heart rate and is prone to fainting. He is also still recovering from a respiratory virus contracted last year and has mild COPC.
I would like to help him make a decision on this, and was wondering if there is anyone on this forum who also has low BP/heart rate and existing respiratory issues and has taken this drug? If so, did you suffer any consequences? I know everyone is different, but just having a sense of other peoples experiences might help us decide one way or the other.
Any thoughts would be most welcome!
Jane
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Amiodarone is the drug of last resort, when all else has failed and ablation is not appropriate. It is a toxic drug but it also the most effective antiarrythmic available in the UK.
My husband, aged 90, has been taking Amiodarone since 2018, originally 200mg/daily, now down to 100mg/daily. His Thyroid was mildly affected so he take Thyroxine to compensate about x2 weekly but no other major affects. In older age one has to consider quality of life over longevity and Amiodarone has given my husband a quality of life I doubt he would have had without as all other options had been ruled out - and that’s the rub - what other options has he?
Amiodarone is worth considering if your father would like to regain/maintain NSR but maybe ask questions first? Have other antiarrythmic drugs been ruled out, if so why? Has cardioversion been considered or offered?
Given that your father also has COPD this will restrict choice of possibly effective drugs, many of which will exacerbate COPD, the only other I believe could be Digoxin in the UK as a possible option? How symptomatic is your father in AF? You say it’s his most bothersome concern - exactly why? Some people tolerate AF without meds whilst others find it very difficult to do everyday activities.
My father’s AF was not treated because other conditions, kidney failure meant he could not tolerate any drugs however apart from some breathlessness and feeling uncomfortable from high resting heart rate at times, he lived with paroxsymal AF. Sometimes with multiple conditions it is really hard to determine which symptoms result from which condition or even the drugs taken.
Has Thyroid function been checked? If not, ensure it is before starting Amiodarone along with usual bloods FBC, Liver and kidney. Ensure a regime of regular testing - every 6 months is set up with GP surgery. It’s very easy for things to be missed by GP unless you are on their case.
I am not medically trained but been around enough AF in the elderly to have a bit of experience which I hope may help inform you to at least ask the questions of your doctor. I would suggest that you ask for another consultation when you are present with your father to discuss.
Thank you so much CDreamer! This is all incredibly helpful. I'm going to have a chat with my Father today, and will put your questions to him. Am curious why ablation has not been recommended to him. Or perhaps it has and has been ruled out. In any event, this has given us food for thought. Really appreciate it!
I am on Amiadarone. In my case it has triggered osteoporosis and caused corneal deposits, photosensitivity, kidney issues, quite bad hypothyroidism, and has also contributed to my cholesterol going up. I have an ICD fitted which covers off a bit of the risk and have just been told that as an alternative to Amiadarone, though it’s viewed as less than ideal, I could double my beta blockers. Amiadarone is a hard one to decide on as it certainly helps with the AF but seems to put wrong as many things as it fixes. I wish there had been a proper discussion with me before I was started on it.
So sorry to hear of your struggles with this drug Jishuang44! That sounds pretty intense and I hope you are finding your way through. The fact it helps with AF is great, but one has to question if the side effects really make it worth it!
I saw my cardiologist on Friday. He said I can stop the Amiadarone if I want but it has to be my decision as it might lead to my having another cardiac arrest so he can’t advise me to do it, though he appreciates that it is making the rest of me very sick. I have cardiomyopathy and the other AF drugs are apparently unsuitable for me. I really have no idea what to do now.
As he has a low resting HR I would have thought a pacemaker would have been suggested with the option of ablation of the AV node. I would investigate all options before taking Amiodarone because it seems a bit of a gamble taking it - for some people it’s a success, for others a disaster with life changing results.
Amiodarone works fabulously well. It gave me 19 months of my life back after constant cardioversions. I'm now off it after having a fourth ablation as I was too young to stay on it long term. Yes, it has myriad side effects but at modern lower doses is less risky. It lowered my HR a little -3bpm. For older folks the dose can be as low as 50 if it works. For the record I'm 30 years younger than your dad.
I was nearly given it but my ablation came before it was needed. I gather the drug offers a rather uniquely useful set of benefits, and a few, occasionally important, downsides. However, if you search online for "low dose amiodarone safety", you'll find a major study that showed - against many accounts you will read here and online - that it can be, when properly used and monitored, a safe and extremely useful drug.
Care is needed to check on various bodily processes and organs during the taking of it, and other drugs are generally likely preferred, but at 88, I would think, with required supervision, it might be, as they say "life changing" (for the better)!
Amiodarone got me back into rhythm after my major dissection surgery (age 63), and within the loading period. A surprise to all, most of all me, considering my prior significant AF history (8 years of, then an ablation). I also tend towards a low HR but a high BP. In the end (5-1/2 years) I had to come off it. I became increasingly sure that it was the cause of my general deterioration (tiredness and lack of energy), it did not tackle the ectopics which were getting worse, and the thing that got me to stop was that I became concerned abotu my lung function (difficult to tell whether it was my asthma or something like this making that worse). All my standard 6-monthly tests were ok, save one time when my TSH went to zero, but it came back next test. Once off it, 6 months later I went into A-flutter.
I'm not sure there's any way to tell which bracket anyone will be in - toleraating it, or not tolerating. Best of luck.
Yes...it's does seem like it's a try and see how it goes for you. The lung function issue is quite a concern I think, and something to watch out for. Thank you for sharing your feedback.
Given your father’s age they should be doing pulmonary function test to establish a baseline before starting amiodarone. Also, he should be maintained on the lowest effective dose possible after his loading dose and this should be started in a controlled setting to monitor him for potential side effects. Amiodarone works but it carries significant baggage and in most cases should only be used short term.
I have low blood pressure and was given Amiodarone once in hospital and my pulse went down to 40bpm for weeks I'm on flecainide now 50mg pill in the pocket and that seems to work
I've been taking it for about 14 years, since 2010, I take a flecainide 50mg tablet when my heart goes into A/F and about a hour or so later it goes back to a normal heartbeat
I've been amiodarone 200mg once daily for about 5 years now and other than a false scare I had a couple of years ago and shaking like a scared puppy but no real problems. My base line HR is 50 and blood pressure anywhere from 85/62 but without any side effects and my EP refuses to take me off of it. My HR before taking amiodarone was as high as 260 BPM. It was either amiodarone or become a human guinea pig. I was on Tikosyn (dofetilide) for 25 years which worked very well until it started not working that good and was put on amiodarone while in the hospital without my consent or knowledge. I sincerely Hope and Pray the Dr's. find the right combination for your father. By the way I'm 78 years young. Best Wishes.
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