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AFIB after CABG
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AFIB after CABG

I'm a male, 58 years old who had a 5 graft bypass in October of 2006. No MI but apparently came close. On the second day after surgery, I went into AFIB. I had several other episodes over the next few days that always converted. Was placed on Rytemal, digoxin and Toporal and sent home. About a month later I went back into what I thought was AFIB, but when I went to the ER they told me it was A Flutter and electrically converted me. I went home and was back in flutter the next day. To make a long story shorter, I ended up getting a flutter ablation and a pacemaker. Over the last months, I've been on amiodarone and digoxin, but I went off because of side effects. I'm afraid that the problem will come back.

My questions are these:
1. What are the odds that my AFIB and fluter will go away on their own now that my heart in healing?
2. If it does come back, what are my options now?
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Hi Duplix,

Glad to hear that you are doing well after your bypass surgery.  Atrial fibrillation is a common problem after any surgery, especially open heart procedures.  Some estimate that as many as 1 in 5 people after CABG will have atrial fib.

1. What are the odds that my AFIB and fluter will go away on their own now that my heart in healing?

It is possible.  The longer you continue to have intermitten atrial fib/flutter after surgery, the more likely it is going to be a lasting problem.  If you continue having it after 6 months to a year, I imagine that it will likely be a persistent problem.

2. If it does come back, what are my options now?

Now that you have a pacemaker, you don't have to worry about heart rate issues with beta blockers and calcium channel blockers.

If you are having symptomatic atrial fibrillation --

one option is medical therapy.  For people with coronary artery disease, your options are sotalol, dofetilide and amiodarone.  I use amiodarone for short periods of time after surgery and do not like to use it for long periods of time for atrial fibrillation.  I usually start with dofetilide and use sotalol second.

the other option is a percutaneous atrial fibrillation ablation. If you decide to persue an ablation, make sure that it is done by a team that does a lot of ablations and is trained to do so.  Do not be someones first 20 cases.  Don't be afraid to ask.

If you are not having symptoms with atrial fibrillation, then coumadin and rate control is appropriate therapy.

I hope this helps.  Good luck and thanks for posting.
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