A-Fib and Cordarone

  My father has been in A-Fib for almost a year now.  Doctors have tried atenolol etc.with no luck.  He is on Cordarone now and feels horrible! He is very weak, fatigued, and cant sleep. What is this drug really??  I hear  that it is good.  I certainly hope so.  Now his hands are shaking somewhat. How does this drug affect so many functions?  Apparently doctors are going to 'shock' the heart soon.  I am concerned that the condition seems to be winning.  What else can be done/  thank so much.    

[CCF CARDIO MD APS]

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Dear Stan,
Cordarone, otherwise known as amiodarone, is one of the many antiarrhythmics on the market.
It has a few advantages, one being it can be used without further worsening heart failure if that is what the patient has.
I should say well before I speak any further that any drug believed to be causing major side effects as you describe in your father is not worth it.  That is to say alternatives should be given great thought.
Given that any drug can manifest many side effects and that this is dependent on the individual, I will only speak of what is generally accepted in regards to amiodarone.  The main side effects that are seen with this drug are on the liver, thyroid, and lungs.
And these are just the common ones and almost always require discontinuation of the drug or at least consideration as such.  Another important point is that the older the patient the more likely they are to have side effects.  Why all this wishy washiness and no direct answers? Because this is an informational forum and I have yet to tell you that the atrial fibrillation in your father puts him at significant risk for stroke; a stroke is always devastating if not dramatic as you and I both know.
There have been many studies in the past on how to decrease the risk of stroke in patients with atrial fibrillation; although the blood thinner coumadin(warfarin) has been shown to decrease the risk what we now know is that the best situation is to get the patient back in normal sinus rhythm (get rid of the atrial fibrillation).  Unfortunately you often need a drug (antiarrhythmic) to help get the patient and keep the patient out of a fib.  As you may already know the drugs often do not convert the patient and cardioversion is required.
If the patient does cardiovert, he may still need the drug to keep the rhythm normal.  There are many determinants to the likelihood of ever getting and keeping a patient in normal rhythm, however it is now felt that the physician should make absolutely every effort to get the patient in normal rhythm but within reason.  And now we are back to the first point that I made, no one should ever continue a drug that they believe is the sole cause of there suffering.  It is possible as you imply that the afib itself is making your father ill, all the more reason to cardiovert.
Remember that fatigue is a very non-specific symptom with many potential causes, and sleep disturbance in an elderly or just older person is a flag for depression and should be investigated.  If you could have a geriatric physician (if appropriate) evaluate your father, maybe this would help with all the potential drug side effects as well as the other complaints. Also if possible it would help greatly for your father to keep a diary of his symptoms before and after the cardioverion as this may help to sort out the true cause.  I will end with the fact that I know there are many antiarrhythmic available to
physicians in the treatment of afib and they all have potential side effects, but their use needs exquisite tailoring to the individual patient.  Information provided in the Heart Forum is intended for general informational purposes only, any diagnosis or treatment of a specific medical condition can only be made by your physician(s).