AF due to mitral valve regurgitation.

[Nunia]

My husband, age 66, had his mitral valve repaired in 1996.
His last echo showed severe mitral valve regurgitation, and his cardiologist prescribed Atenolol.
A month after taking this drug, my husband began to have atrial fibrillation.
His doctor wants him now to take Coumadin for 4 weeks, then to start taking Amiodarone tablets (at home) for 2 weeks and then to have Electro Cardioversion.
After the Electro Cardioversion, he will have to continue with the Amiodarone.
We are very concerned about the side effects of the Amiodarone.

My questions are:
1. Did the Atenolol initiate the AF? Should he stop taking it?
2. If the reason for the atrial fibrilation is the leaking mitral valve, is there a chance to stop the AF with the Amiodarone and the Electro Cardioversion?
3. What are the chances that in his case (severe mitral regurgitation) the Amiodaron will cause Ventricular Fibrillations?
4. What tests need to be done prior of taking the Amiodarone?
5. Does he need to be in the hospital while starting to take the Amiodarone? And for how long?
6. His doctor says he will have to have a mechanical mitral valve in the near future. Is there still a need to go with the Amiodarore and the Electro Cardioversion or just to continue with the Atenolol and the Coumadin until the surgery?
7. Will the surgery for valve replacement will stop the atrial fibrillation? (His LA=44mm).

[CCF-M.D.-KE]

Sorry to hear about your husband's atrial fibrillation. Atrial fibrillation is a condition where the top chamber of the heart does not contract but quivers. This results in erratic impulse delivery to the lower chambers of the heart and leads to an irregular heart beat. There is an increased risk of stroke associated with atrial fibrillation, therefore blood thinners are recommened.

1. I don't think the atenolol initiated the atrial fibrillation I think it is primarily related to his valve problem and his age.

2. The cardioversion should convert him back to normal rhythm and the amiodarone is used to keep him in a normal rhythm.

3.The incidence of  ventricular fibrillation is  rare with amiodarone.

4. Amiodarone has a number of side effects. The major ones include problems with the thyroid gland,  lungs and  liver. There are other medications one may consider with fewer side effects. I would discuss flecanide(not used in people with heart artery blockages), and sotalol with your doctor.  

5. No he does not need to be in the hospital to start amiodarone.

6. Yes he still needs the cardioversion because as long as he is in atrial fibrillation there is a risk of stroke.

7. The surgery may decrease the likelihood, but may not completely stop the atrial fibrillation. Unfortunately as people age there is an increased risk of atrial fibrillation.

Thanks for your question,


CCF-MD-KE

[debra21784]

Can really sympathize with your husband.Can only say been there ,done that,have the tee shirt to prove it and still trying to recover.My a-fib continued after my valve surgery .What has to be identified here is the A-fib directly rlated to the valve ?If so then another repair or replacement might be the answere.If it is stand alone a-fib ,an EP cardiologist can tell you if an ablatation can be done.Like your husband I was on Atenolol in the past,Flecinide and aminodorone .They aren't too bad ,just more of a nuiance.Never had any side effects or reactions.What is important is to get to the bottom of the a-fib ,see if it can be corrected  but above all remain on the Coumadin even post cardioversion.A-fib will indeed cause a stroke.I had one from it ,not high on my list of experiences I'd want to repeat.The valve repair was a piece of cake in comparison.Wish I would have had the ablation sooner ,maybe even could have prevented the stroke.
If you aren't being seen at a major academic medical center get to one,If there isn't an EP cardiologist and cardiac surgeon on board for an opinion and formation of a team for care ,get them in place.

[Nunia]

Hi Debra,
I am Nunia's husband. I have many questions for you:
Did you have the mitral valve repaired twice? At what hospital?
Did they open your breast bone twice? When did the A-fib started? Did you have electro-cardioversion or did the drugs do the conversion? Did you have the A-fib after the valve was repaired? How long after? Are you still at A-fib or did you go for ablation? At what hospital? Did the ablation stopped the A-fib? Are you still taking amioderone?
Please give us your whole story.
Thanks.

[Jody71572]

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