AFib: Hope for the Future

I'm a 57 yom.  I'v had AFib since 1987.  I'm refractory to most meds.  Amiodarone and Rythmol alone don't help and Tikosyn lengthens my QT interval too much.  I've had an ablation but left the hospital worse than when I entered.  Right now I'm on Amioadrone 300 mg daily and Rythmol 225 mg bid.  This has kept me AFib free for 1.5 years.  But I don't like the side effects.  [Q1]  is there any guidance concerning tapering off amiodarone when in combo with Rythmol?  [Q2]   What experimental treatments or drugs  look most promising and how long do you think it will be before they are available?  Thanks for this forum

[Cleveland Clinic]

1.  Amidarone and rythmol are two separte classes of medications and you have already been on them, therefore, tapering really isn't an issue unless your are planning on being started back on the Tikosyn.  Amiodarone stays in the system for a very long time, sometimes longer than 6 months, therefore, tapering doesn't really work very well.  You just have to stop the medication and then wait until it is out of the system.  For that same reason, we always wait 3-6 months after amiodarone discontinuation and check amiodarone levels before starting a patient on Tikosyn.  If your doctor is planning on stopping the amiodarone, there really aren't any precautions, other than the fact that your atrial fibrillation may recur.  Since rhythmol has some beta blocking effects you may be ok being on it alone, however, younger patients and those with atrial flutter are at increased risk of rapid conduction in the heart.  For that reason, we typically start patient on beta blocking agents while on rythmol.  

2.  There are some newer derivatives of amiodarone (dronedarone) which are supposedly as effective, however, with a signifiantly improved side-effect profile.  The trials are being conducted currently.  The drug has to go thru FDA for approval.  It will probably be quite some time before it comes out, if it does at all.  You should really consider having another afib ablation procedure.  The techniques and the risk profile have improved considerably.  Given that you have no structural heart disease and your atrial fibrillation is well controlled, the success rate is very good, and the complication rate is very low.    

[bob1267]

A related discussion, new procedure for af was started.