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St. Jude Medical

October 21st, 2014
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Hello doctor, I am Vijay. I am heart stroke patient, I have been taking amiodarone and suffering from this condition for roughly 10 years, it works well, but I do not like the side effects. . I have heard that there is a new medication for atrial fibrillation. Could you please let me know?
2012-05-28 Answered By : Dr. T. Jared Bunch

Thank you for question. There are a number of potential medications for atrial fibrillation. If you heart size and function are normal and you have no evidence of coronary artery disease then we can use all of them. If you have coronary artery disease then we can use Ė dronedarone, dofetilide, sotalol, or amiodarone. If you have heart failure, then we typically need to use amiodarone or dofetilide. The newest medication available is dronedarone. It is like amiodarone (an analog). It is not nearly as strong as amiodarone, but it also does not have the same risk of injury to the lungs and liver. It also does not interact with the thyroid gland like amiodarone. Dronedarone is only safe if you have not had any recent episodes of heart failure and your atrial fibrillation is such that it comes and goes. If you have heart failure or are in atrial fibrillation all the time you should avoid it.

Iam an egyptian pharmasist 25 years old.I had been done MV repair in 1991 in Broussais hospital by Dr. chauvaud for severe cong. MR(4/4) dilated LV( 56mm)-LA(60mm) pulm hypertension P.O on captopril and digoxin with regular follow up with ECHO annually.From 1991To 2002 some episodes of paroxysmal AF.On january and december2003 two episodes of rapid AF reversed to NSR by cardioversion So Amiodarone 200mg once daily +Bisoprolol 2.5mg once daily.On january and november
2012-05-28 Answered By : Dr. T. Jared Bunch

I believe we only have part of your question. It appears that your atrial fibrillation is progressing in severity to a more persistent subtype that requires cardioversion. This pattern is not surprising since you have valvular heart disease with both ventricular and atrial remodeling. Although amiodarone is a relatively cardiac safe medication in the setting of valvular heart disease, your age and pulmonary disease to me would be reasons to consider other options. These options include a washout of amiodarone followed by use of a less toxic medication versus catheter or surgical ablation. With you valvular heart disease and moderate-severe left atrial enlargement, if you are interested in a catheter ablation it should be performed by an operator that is experienced not only in pulmonary vein isolation, but also in mapping both micro- and macroreentrant tachycardias that are often seen in those with a surgically modified heart. The operator should take every possible precaution to minimize your exposure to fluoroscopy during the procedure and rely heavily on a 3D mapping system to avoid placing you at risk for various radiation-relative malignancies over your anticipated long life span. I would consider a percutaneous catheter-based approach before surgery since your prior procedure would preclude a minimally invasive approach.

I have had paroxysmal AF for about five years, and last year I started having 2-3 episodes per week averaging maybe two to four hours each. I asked my cardiologist to put me on an anti-arhythmic medication and he was very reluctant as he strongly favors rate control only. At my insistence he prescribed an AA med - propafenone. (150mg x 3). This drug worked wonders for more than ten months - no episodes ! - until last week when I had two episodes, one of which required a cardioversion. I am on a long waiting list for an ablation, which I am inclined to delay if the meds start working again. My question is whether in the meantime I should increase my dose of propafenone, or maybe try flecainide which seems much more common and maybe more effective for people? When do I know if it is time to have an ablation?
2012-02-28 Answered By : Dr. Pierre Jais, MD

I completely agree with you. Iím not a fan of drugs but when they work, why not using them. We have to keep in mind that the aim is to reduce the impact of AF on quality of life. If rate control doesnít fulfil that goal, AA drugs have to be tried. You can even continue Propafenone at the same dosage. There is no dugs able to cure AF. What we look for is to reduce the number of episodes and their impact on your quality of life. I therefore donít consider the 2 episodes you had as a failure. You can certainly increase the dosage up to 900 mg per day if your kidney function is normal and shift to Flecainide when Propafenone will be inactive. It may or may not work. Ablation is to be considered if at least one drug has failed. In other words, if you consider the present situation not acceptable with Propafenone, you could go for an ablation. I would suggest to wait a little longer with an increased dosage of Propafenone. Donít wait too long as once the AF is permanent, ablation is more difficult and less successful.

I am a 45 yr old who had an ablation 8 months ago. I am in nsr but find when I train on my bike my hr is higher then it was doing the same effort before the ablation. Is this normal?
2012-02-28 Answered By : Dr. Pierre Jais, MD

Yes, this is frequently observed and is probably due changes in the autonomic nervous system by ablation. The interruption of AA drugs may also explain it partly. But keep exercising and training and it will improve.

I have had 5 unsuccessful ablation procedures in the last 3 years. Recently I read an FDA warning about magnesium depletion with long term use of PPIs and replaced the PPI I had been taking for the last 15 years with something else. I have had no problem with AF since then. Could it really be that simple?
2012-02-28 Answered By : Dr. Pierre Jais, MD

This is an interesting observation. However, I donít think it is that simple. I have had many patients with magnesium supplementation with limited efficacyÖ

Has there been any link established between Atrial Fibrillation and Dermatomyositis? I have both and it seems that the occurrence of Afib and PAC's is now alot less now that my DM is in remission. Are there any studies about this? Is it possible that taking Prednisone & Metrotrexate has actually helped lessen my Afib?
2012-02-28 Answered By : Dr. Pierre Jais, MD

No link has been established to the best of my knowledge. Having both conditions is rare and this is why it has not been studied.

I am a 65 y/o male. ablation in 2008. Afib recurrence in 2009 (six months) Afib now under control with rythmol and metoprolol. Few months ago I started having premature atrial contractions and pauses in the rhythm. The wave on ECG is normal just spaced irregularly. Cardiologist said not to worry. The PACs and pauses are annoying and when severe are uncomfortable. How can this be stopped or reduced?
2012-02-28 Answered By : Dr. Pierre Jais, MD

You could consider reablation as this could suppress both the PACs and the pauses. Some physicians could recommend to implant a PM if the pauses are significant but it would make more sense to me to repeat the ablation procedure.

What will the efeeects of passive smoking have on me with regard to AF?
2012-02-28 Answered By : Dr. Pierre Jais, MD

The impact of smoking is limited on AF and there have been very few studies on that. None on passive smoking.

Hi Dr. I may have messed up and sent this twice. Sorry! I'm a 66 year old woman diagnosed with paroxysmal AF in June 2009, although I've been symptomatic for several years. I take 50 mcg Levothyroxine, 12.5 HCTZ, 1 baby aspirin twice a day and 2000 mg fish oil. I was on Multaq for afib for 2 weeks (10/5/11-10/19/11) and still had a-fib breakthroughs. My ECG from 10/5 (in a-fib) shows QT:440, QTcH:461, PR: None recorded. The ECG on 10/19 (NSF) shows QT 524, QTcH:506, PR:148. Is the change in the above numbers a concern? Do I need an ECG to see if they came back down in the last 3 months? I also had a 24 hour Holter monitor test on 10/19/11. It showed minimum heart rate 43, maxiumum heart rate 120 Average heart rate, 62. 1 PVC, wide complex couplets: none, wide complex tachycardia:none, pauses greater than 2 seconds: 3, longest lasting 2.1 seconds. 37,241 PAC's Conclusion: NSR with frequent premature atrial complexes and frequent organized paroxysmal fibrillation suggestive of atrial flutter with variable ventricular response (HR 50s - 100s. That is a change in previous Holter monitors as far as the 37,241 PAC's and the mention of atrial flutter. Never had pauses before Because my heart rate stays elevated uncomfortably when coming out of AF which is a change that occurred during the 2 weeks on Multaq and the changes in the above ECG numbers and Holter monitor test, is it safe for me to take rhythm control drugs? The doctor mentioned Amiodarone. I can't take beta blockers due to rapid drop in BP and heart rate. Thank you so much for the website and your answer.
2012-02-28 Answered By : Dr. Pierre Jais, MD

The values of your ECG parameters have to be validated by a doctor as the automatic measurements by the machine are sometimes wrong. If confirmed, I would suggest to stop Multaq. The change in your arrhythmia is likely to be due to an incomplete effect of the drug that has organized your AF (into atrial flutter) and shortened atrial fibrillation to some episodes that are now not exciding the simplest form: PACs. But this is not improving your quality of life, as frequently observed, AA drugs are not perfect. AMiodarone would be more effective but at 66 years old, you may be too young and the chances for developing significant side effects are high!

I had a 5hr rfa ablation for a fib+aflutter. Catheter did not work during procedue. .5 pericardial effusion/ICE increased to .74 post proceedure. Difficulty w/deep breaths aft ablation, breathing improved when sitting up. 32hrs aft rfa, 7:30pm 166 pulse-afib, 2hrs later(9:20pm) dizzy, nausea, weakness, pain left shoulder/neck to behind/inside scapula, could not breathe...systolic 60(s)&falling.Oxygen full face mask, metoprolol and flecainide iv push. Thought death was imminent. Symptoms improved aft ox and iv push...10:15pm nurse said moving to icu bec heart not stable...afib converted to sinus 12pm. Was this event cardiac tamponade, heart attack, cardiogenic shock? When I asked doc he was not specific stating friction caused by pericardial effusion. I read about pericardisis...symptoms more in line w/above. Please help me ID cardiac event. Thank you.
2012-02-28 Answered By : Dr. Pierre Jais, MD

Your description is the one of a Tamponnade where the hemodynamics was further impaired by the arrhythmia. What surprise me is that you donít mention drainage?

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