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Heart Disease (Expert Forum)
Drug Therapy for Arrhythmias
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Drug Therapy for Arrhythmias
by DottyCece, Jan 09, 2004 12:00AM
I always want to avoid taking drugs if at all possible. So, your last response about amiodarone to another site visitor was of interest to me. I thought that if the dose was at 200mg/day, that there was little chance of significant side effects. Your response seemed to suggest otherwise. Could you tell me what are the benefits and the downside in taking amiodarone for the long term? Is there a drug available with less side effects that would be as effective?
A second question I have, is can significant peripheraly edema cause irreversible damage?
A second question I have, is can significant peripheraly edema cause irreversible damage?
Doctor's Answer
by CCF-M.D.-RCJ, Jan 09, 2004 12:00AM
DottyCece,
Thanks for the post.
Q1:"Could you tell me what are the benefits and the downside in taking amiodarone for the long term?"
The benefit of the therapy is the possible reduction in the number of arrhythmic events.
The side effects/downsides of even lower dose therapy, such as 200 mg per day, are extensive and include:
lung disorder 2%
thyroid disorder 4%
low heart rate 5%
liver disorder 3%
eye disorder 1%
skin changes 5-20%
neurologic 4%
plus others
Side effects are expected in about 50% of people taking the drug over the long-term.
Q2:"Is there a drug available with less side effects that would be as effective?"
At treating what?
Amiodarone is the most effective drug for most people for treating afib. Other arrythmias respond to other drugs often just as well as to amiodarone.
Q3:"is can significant peripheraly edema cause irreversible damage?"
Do you mean to ask: "can peripheral edema become permanent?"
Yes, it can. But it usually needs to be quite severe to cause irreversible changes.
Hope that helps.
Thanks for the post.
Q1:"Could you tell me what are the benefits and the downside in taking amiodarone for the long term?"
The benefit of the therapy is the possible reduction in the number of arrhythmic events.
The side effects/downsides of even lower dose therapy, such as 200 mg per day, are extensive and include:
lung disorder 2%
thyroid disorder 4%
low heart rate 5%
liver disorder 3%
eye disorder 1%
skin changes 5-20%
neurologic 4%
plus others
Side effects are expected in about 50% of people taking the drug over the long-term.
Q2:"Is there a drug available with less side effects that would be as effective?"
At treating what?
Amiodarone is the most effective drug for most people for treating afib. Other arrythmias respond to other drugs often just as well as to amiodarone.
Q3:"is can significant peripheraly edema cause irreversible damage?"
Do you mean to ask: "can peripheral edema become permanent?"
Yes, it can. But it usually needs to be quite severe to cause irreversible changes.
Hope that helps.
By irreversible damage when there is peripheral edema I mean chronic edema as a result of valve damage in the veins..or is this reversible?
Thanks so very much for your answers and insight. It has been very helpful for me.
This is an answer that was given to a question about Amiodarone on this site last Sept which may answer some of your questions.
I have been on this drug for 14 mo. now. I talked my Doc. down to 100mg. It is the only one I can take because I had a kidney removed a year ago (renal cell ca.) and this is the only drug of this kind that is not filtered through the kidneys. It saturates every cell in your body and takes a very long time to get out of your system when you go off it. But for many people it works very well; you just have to be vigilant in getting tested for side effects. My husband had to go off it because it made him HYPERthyroid; most people whose thyroid is affected by it become HYPOthyroid.
Best wishes in your search for answers, Barb
I am on Tikosyn, and it doesn't keep me out of AFib all the time. Seem to get it about every 2 to 3 weeks. But it has been much better than propafenone. But not everyone can take Tikosyn, and with your kidney issues I doubt you can.
I'm going to Mayo in Feb for a probable ablation. I guess I would think about that before going on Amiodorane.
If you have AFib I would try another drug before Amiodorane.
I have lone paroxysmal atrial fib. Vessels and heart are fine. I'm a 55 yr old formerly ACTIVE, happy, peppy, vibrant, creative female who is now reduced to a slug! I have been having a. fib. episodes for the past year and a half (genesis: stressful situation at work May 2002)and since July of this year have had two episodes of concomitant tach (SVT?) with syncope. I will occasionally go for days (17 is the number to beat) without episodes, only occasional manageable flutters and PVC's, and then my heart will just feel like it EXPLODES! I had a 17 day run of quiet in December and was feeling ecstatic -cuz I was sure I was finally CURED! But four of the six days following Christmas I had such horrible tach/a. fib with near syncopal episodes that I ended up in ER (AGAIN!). I'm getting so tired of this.....My poor little 2 and 4 yr old grandkids have had to learn all about 911 in case Gramma suddenly "falls asleep" when no one else is around. (And in July I fainted when taking my older grandson around a museum for his birthday. He ended up having to drive my big ol' pickup truck thru downtown Oakland to find me at the hospital where the ambulance had taken me. Luckily, he had just completed his driver's ed. course!)
I'm afraid to walk, drive, do my usual chores or exercise. I've had two fender-benders when in a. fib. - one with the grandkids in the car. I can't think or read when in an episode....just watch TV. I can't work full time anymore. I've always had wonderful jobs and miss that. I'm feeling alone, depressed, and hopeless.
Besides my cardiologist, I've seen two EP docs and a cardiac surgeon. I've collected all kinds of data about all the options. I've tried seven different meds with awful results. Am now only able to tolerate 20 mg. nadolol qd. I was even hospitalized for three days to ramp up on Tikosyn, cuz my cardiologist assured me that would be THE CURE! Nope.
I am now considering a new procedure and would like your feedback. What do you think of the new epicardial ablation? My cardiac surgeon has done ONE, but says this is the way to go. He is very confident that it will do the job.
My concern is the risk of stroke when having the usual RF ablation. (I am always the ONE that gets whatever side effects are listed, no matter how rare.) This new procedure is done OUTSIDE of the heart. They enter thru small holes between the ribs on either side of the chest wall and use scopes to ablate the areas around the pulmonary vessels, thus reducing the risk of clot formation to almost zero. (I know they can't say "zero risk".)
I would gladly be a guinea pig if it will bring my life back....and maybe this way I could help others.
What do you think?
And what is your opinion of the cardiac defibrillator insertion?
Thanx so much for your help - C
I am going to Mayo for an ablation in February. I understand your concerns, although my symptoms aren't as bad as yours.
It sounds like you really have two options:
1) An anti-arrythmic.
2) An ablation.
As I talked to my EP he said two things:
1) Long term medication can result in a higher degree of risk than an ablation. He said if I was older medication wouldn't be such a problem, but the younger you are (I'm 48) the higher degree of probability that medication can cause adverse affects. No meds ever work perfectly. The only "cure" is an ablation.
2) An ablation under a qualified specialist is less risky than driving a car. You've already had one accident while driving. When you have an ablation you are on anticoagulants for 3 months to make sure that clots do not develop.
My episodes seem to be about every 2 to 3 weeks, and they last from a few hours to 20 hours. There is a similar degree of risk getting a blod clot from those episodes as there is from an ablation. I don't want to live with the uncertainty that I'm going to have an AFIB attack all the time at some inconvenient time.
Take the risk. Indeed it seems like you are under more risk not doing anything than doing something.
Take care,
Doug
Thanx for your reply. I have more info on that new procedure. It's called a "thoracoscopic Maze procedure". Unlike the open-chest type of Maze procedure, this one is done with the arthroscopic-type little instruments that are inserted between the ribs with a scope. The instruments are manipulated outside the chest wall while the surgeon and EP docs watch on a screen.
There is almost no risk of clots/stroke and I've been quoted a 70-90% success rate vs. the 30-60% success rate for the typical RF ablation procedure. (My surgeon said "watch what happens when you throw a steak on a hot grill....all the blood coagulates!") I am scared of the clot/stroke risk with the RF ablation done inside the heart with all that blood.
I'm scheduled for one next week....and have high hopes. I have been passing out with my A fib/tachycardia episodes lately.... I want my life back.
Will keep y'all posted. My cardiac surgeon had done ONE (successfully) when I scheduled mine. He has done about 8 by now - I'm waiting to hear how they went.