Hi there ! I ama 67 year old who has had a pacemaker for 7nyears. My PC check shows that I am in afib 97% of the time . This has increased faience last February . My new cardiologist took me off Propafenone then >.I am only taking a beta blocker and a anti coagulant. I am toltally a symptomatic.  I am seeing my cardiologist tomorrow. He is reluctant to start Amiodarone because I am symptom is. Any thoughts ? 


Atrial Fibrillation (AF)

by Gemita - 2021-10-17 13:38:28

I see you are still sitting on the fence about Amiodarone.  From your history I note that I have responded before on this subject, so I won’t repeat what I have already said except to say that Amiodarone is one of the most effective meds out there to try and it often works where others have failed, but it is vital that your doctor monitors you closely while you are on the medication because of the side effects and toxicity (pulmonary and liver) as well as the potential for it to adversely affect thyroid function.

As to your AF, it has clearly become persistent-permanent and in your shoes I would want to find the best possible treatment.  Have you discussed an ablation which is usually more effective than medication?  Although AF is not curable, effective treatment (medication or an ablation) can give us a long period of respite from AF and some lucky folks may even go into remission. 

I note that you are fortunately without symptoms at the moment.  Long may it last.  In extreme cases, persistent AF can lead to heart complications, like heart failure and AF can also hasten a decline in thinking and memory and this could lead to dementia, so even with good symptom control (rate control) and anticoagulation, this may not be enough to fully protect all of us from adverse effects of permanent AF.  I am highly symptomatic when in AF but have a low incidence of the arrhythmia so feel reassured.  With your 97% AF burden I would certainly be looking for better control because once normal sinus rhythm is totally lost due to AF, it becomes harder and harder to revert.  That is the nature of this arrhythmia, but I think you already know this?

I hope you have a successful consultation with your cardiologist tomorrow and that you will receive good advice.


by AgentX86 - 2021-10-17 13:58:28

Since you're asymptomatic, there isn't really any need to treat it aggressively. Keep your heart rate under 100bpm and anticoagulation, then decide what to do (I'd do nothing, in your shoes). At your age I'd  ot go anywhere near ameoderone for anything more than a few months to bridge to a more permanent solution.

Again,  were it me, I'd do nothing but your doctor may have other reasons to treat it so aggressively.  Ask. Ameoderone is nasty stuff.




by Julros - 2021-10-19 01:26:36

I agree with AgentX86 on holding off on amiodorone if you are assymptomatic and your rate is controlled and you are adequately anticoagulated. 

Really, what do you have to gain, other than a prettier ECG? You may lose a little atrial kick, but by your report you don't sense it. And they won't stop the anticoagulation based on your CHA2DS2 score. 

But as Agent says, there are a lot of potential icky side effects. 

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