Atrial Fib. and sleep apnea

[Sidney-McCamond]

  I am a 48 year old man.  Last March after several years of progressivly worsening sleep apnea I ended up in the hospital with a rapid heart beat (189 BPM)  and lowered oxygen levals.  I was severly overweight, much of which was from edema in my legs and stomach area.  Since that time I have lost 70 pounds, had a sleep study and now use a Bipap machine when I sleep.  The sleep apnea is under control. I was diagnosed with atrial fib  and it still remains a problem.  I take a combination of cardizem and lanoxin to control heart rate.  A cardiac conversion was attempted but it did not work.  Before all this  I was diagnosed with mitral valve prolapse.
       My question is ,  Is there any other treatment for atrial fib?  Is there any other way to convert my heart rhythmn back to normal.  Keep in mind that my cardiologist has tried drugs and electro-convertion.  I shouls point out that aside from very mild symptoms the atrial fib does not bother me too much and with the sleep apnea under control I feel better than I have in several years.

[CCF Cardio MD - MTR]

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Dear Sidney, thank you for your question.  The atrial fibrillation may be related to your sleep apnea and increased weight, but now that those problems are under control, you can be treated as most patients with afib are.  When afib first prevents, the heart rate is slowed with medications like cardizem and lanoxin and the blood is thinned with a drug called coumadin.  When the heart is in afib, there is a risk of a blood clot forming in the left atrium and being ejected out to cause a stroke.  Thus, we put most patients with afib on coumadin unless there is a contraindication to using it.  After 4-6 weeks on coumadin, any clots presents should have dissolved so electrical cardioversion is usually the next step.  If afib recurs after cardioversion, then various antiarrhythmic medications can be given and then cardioversion can be tried again.  If cardioversion repeatedly fails on antiarrhythmic medications, then the heart rate is controlled and coumadin is continued indefinitely.  That is the standard way we treat patients with afib at the Cleveland Clinic but practice patterns vary.  Thus, if you are concerned, you should speak with your cardiologist about future management.  However, it is encouraging that you are feeling so well now.  Good luck!
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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