Journal of Atrial Fibrillation

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I am a 56 yr old male diagnosed with lone AFib in July 2003. I have NO other health issues. EF is normal and NO coronary artery disease. I have been converted 3 times in Sept 03, Oct 04, and Feb 08. I have been on three Rhythm drugs . Rhytmol SR has been the best. I started on this at a dosage of 225 mg 2x per day in Nov 04 but have been on 325 mg 2x per day since my last conversion this past Feb. This higher dosage drove me to a pulse rate of about 45 but also brought me back to sinus rhythm in April. I was out of rhythm for about 48 hours.To counter the bradycardia I was given a pacemaker on May 29th 2008. I feel much better! I chose not to have an AFib ablation beacause of the higher probabilities of complications from the procedure and due to the fact that the side effects from Afib other than the 04 episode have not been severly disabling although my wife might feel differently(bad moods from feeling tired).I also take 25 mg toprol XL, 10 mg Lipitor, and Coumadin. Would you still anticipate that the AFib episodes will increase with age and what are the possible directions my treatment might take if the Afib does get worse?
2008-08-26 Answered By : Dr. Andrea Natale

AF is known to get worse with age. Your options could be other medications or ablation.

Dear Dr. Natale: My a-fib is being controlled right now by 80 mg. Sotolol 2x a day. I also take 7 mg. Warfarin a day, and I do not like taking it as it seems to sap my stamina to say nothing of the huge bruises I now accumulate at the slightest bump. When the a-fib seemed beyond my previous medications, I was ready to do ablation. My question is twofold: Should I continue w/plans for ablation or be satisfied with the improvements I now have? Also, I understand there are many physicians who allow their patients to go off Warfarin when they have achieved 6 mos. without an episode (which I have)--what could make this an option for me? Thank you--Eileen Graham
2008-08-26 Answered By : Dr. Andrea Natale

Eileen, since I have no knowledge of your age or any other health issues you might have, I am not able to advise on the Coumadin issue. I recommend ablation for those patients who believe that either AF or the meds are causing them to have symptoms or when AF is a factor in the quality of their lives.

Re. totally vagal paroxysmal LAF: are other drugs helpful? During Dr. Natale's spring web cast from San Francisco, one of your associates briefly mentioned Norpace, without elaboration. Why might that be more effective against the vagal type, and has its use shown promise? Or are there any other meds that moderate or suppress the vagal response that can be taken along with the more usual antiarrythmics, like flecainide?
2008-08-26 Answered By : Dr. Andrea Natale

Norpace has anticholinergic effects or vagolytic effects and is believed to have better results with vagal AF. However, Norpace comes with pro-arrhythmic side effects and usually can not be prescribed on outpatient basis.

Can it be accurate to associate the term "longstanding" with paroxysmal LAF (for example, having had it 10, 20 or more years prior to diagnosis), or just with persistent and permanent? If paroxysmal LAF is "longstanding", what effect would that have on the probability of success - defined as a long term "cure" - of a first catheter ablation? Is that probability of success reduced by amounts similar to those seen with longstanding persistent or permanent AF?
2008-08-26 Answered By : Dr. Andrea Natale

Long standing AF is AF that is continuous for a period of time, usually for one year or more. Success of the ablation depends on the degree of left atrial size. Being in AF for an extended amount of time can cause the left atrium to enlarge which makes attaining success from one procedure slightly difficult.

A fib came first for me after valve surgery. Then 3 months later tachycardia. If a fib is fixed by cardiversion or ablation etc, will tachycardia go away?
2008-08-26 Answered By : Dr. Andrea Natale

Usually tachycardia after valve surgery is flutter or atrial tachycardia. Unfortunately cardioversion is not likely to resolve the problem.

Hi, I have afib and also an autoimmune disease that they haven't dx yet. I'm on prednisone, so I'm getting a fat around the middle. I'm afraid to do to much exercise because of the afib and my legs hurt so I couldn't anyway. I've been lifting 2 lb. weights.(use to lift 12 lbs) Is there some kind of exercise that I shouldn't do because of the Afib? If I didn't hurt so when I walked I could do that, I know that would be good.. Thank you so much, I've heard so many good things about you, I wish I wasn't in Ca..My deepest regards.......Nel
2008-08-26 Answered By : Dr. Andrea Natale

Any exercise is good as long as you keep listening to your body. The perceived level of exertion should be your guide. Do not push yourself when you are in pain or out of breath. You should be fine. Best wishes.

Thank you for doing this! I'm a 57 YO male in permanent Afib,for 10 years. I am on 240Mg of Cardizem, Coumadin and various other non-heart meds. I have been previously diagnosed with hyperthyroidism as well as sleep apnea. Both are relatively well controlled. Have been cardioverted twice, but normal SR only lasted a day. Amiodarone was used for two years but I believe it damaged my thyroid. I tolerate Afib and can exercise acceptably, though my heart rate will sometimes spike to 190 BPM for a few seconds. It mostly stays in the 140-160 range during strenuos exercise. I'm concerned that I'm going to "wear out" my heart by being in constant AFIB. Seems like many or most have only sporadic episodes of AFIB, but I am in it 100% of the time. My question is this: what factors should I consider in decisions about staying in AFIB as is, considering ablation or maze, or other drug treatments. How do I balance the risks and rewards going forward and what questions should I consider? Thanks so much for your help. Paul Thank
2008-08-26 Answered By : Dr. Andrea Natale

Paul, it is difficult for me give you an accurate response without having an echocardiogram results to guide me. I do not advise you to exercise beyond a heart rate of 140 beat/min. I am glad that the sleep apnea is under control since there is a strong correlation between AF and sleep apnea. I will be very happy to have a look at your echo if you wish to do so.

Dear Dr. Natale, First let me say "Thank You" for taking the time to help us with this battle with afib. My question is as follows: My afib seems to be tied 90% of the time to GERD. Whenever I have acid reflux I will have irregular heart beats. Right before I burp, I will have an irregular heart beat. Many times when the acid reflux is the worst is when I will go into full blown afib. Is this normal and why would acid reflux have any affect on my heart? Thank you for your response. Question 2: I am now on 325 MG of Rhythmol twice a day. Is it true that over time Rhythmol will cease to work as well. Because being on this dose, I have been afib for two months and have very few irregular beats. I have always been able to get the afib to stop within 7 hrs. with the a rhythmol and topral. I don't want to take rhythmol for too long on a regular basis and it not work when I go into afib. Thank you so very much for your help.
2008-08-26 Answered By : Dr. Andrea Natale

It is very true that AF can be triggered by GERD. And yes it is true that at Rhythmol may stop working after a while. Have you thought of the ablation route?

I am a 60 year old female who was diagnosed with AFIB in July 2006. I have since had three left atrial ablations and have a dual chamber pacemaker implant. I am currently on Tikosyn, atenolol, and diltiazem. Subsequent to the last ablation in May, I started dofetilide (Tikosyn) and seen to be holding my own and have been in NSR. When treating AFIB, what is more important: RATE or RHYTHM?
2008-08-26 Answered By : Dr. Andrea Natale

There is no right answer for this question unfortunately. I myself prefer NSR.

I was diagnosed with RAFlutter in 2005 and AFib after an ablation for the flutter. Medication did not help the AFib so in March of 2006, I had an ablation for the AFib. Unfortunately the AFib ablation left me in persistent 2:1 LAFlutter with periods of SVT. It was a rough time with several ambulance rides, 10 or so cardioversions and two additional ablations. After the last ablation in August of 2006, my forth, the LAFlutter recurred twice and was vanquished with cardioversion. It has been 18 months since the last episode of LAFlutter and besides occasional short runs of what I�d guess is AFib, I�ve been healthy. My question is, how unusual was my experience? I was very frustrated with my EP because he took all this so matter of fact and never really seemed to have a plan.
2008-08-26 Answered By : Dr. Andrea Natale

Your case unfortunately is not uncommon. I am glad you finally are free from the flutter and the SVT. Being in tachycardia for a long time may lead to heart failure and stroke. Please monitor yourself and consult with your physician if you have any prolonged episodes of those occasional arrhythmia's.

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