Atrial Flutter/Fibrilation

Posted By  CCF CARDIO MD-APS on January 19, 1998 at 18:06:26:

In Reply to: Atrial Flutter/Fibrilation posted by Aaron Gaither on January 12, 1998 at 21:48:14:

: I am a 60 year old male.  I had heart bypass surgery 11 years ago and developed Atrial Flutter about 8 years ago.  I was doing well on encaid but was taken off because of CAST study.  I was put on Sotalol which turned me into a zombie with my pulse going to low.  I exercise vigorously 4 times a week and couldn't even walk up the stairs.  My pulse and blood pressure have always been low.  Dr. put me on Amiodarone 200 mg.  I was on that for 2 years at 200 mg but developed thyroid problems.  I was reduced to 100 mg amiodarone and put on .125 of lanoxin.  I am taking 1.50 of synthroid and just about within normal TSH level.  Dr. wants to take me off amiodarone completely but in a quandry as to what med to use because of low pulse and pressure.  Suggestion has been to go to .25 of lanoxin and get a pacemaker installed or go back on sotalol with a pacemaker.
  Not comfortable with that until all medicines and procedures have been explored.  I heard about ablations but understand that you have to disable the sinus node to correct atrial fibrilation and then become totally pacemaker dependent.  I would consider that but don't like the idea of becoming pacemaker dependent.  Also, understand that ablation does not always work and must be redone.  I heard about the maze procedure which requires open-heart surgery but it is effective.
  Last choice is to go into chronic AFIB.  Understand stroke risk with that and possible enlargement of ventricles over time.  I have also been able to mostly exercise myself out of AFlutter by getting on a treadmill for 1/2 hr., however, does not always work.  
  Question: what is the best alternative?  Any new medicines that I could consider?  My heart stayed in rythmn with amiodarone at 200 mg with just one episode of irregularity but at 100 mg, I've had about 4 to 5 in last year.  Only needed one cardio-version and exercised myself out of the others. I'd like to get off medicine completely but don't seem to care for the alternatives.  Currently not doing ablations in this region.  Would be appreciative of any advice or suggestions.

[CCF CARDIO MD APS]

Dear Aaron,
    It seems to me that you have a very good understanding of your potential options as well as the risks you might be taking with each option.  Unfortunately I can not reccomend a particular treatment on the web, as a physician I routinely examine my patients and build
some kind of rapport with them before helping to make this kind of decision.  At this point I think it would be best for you to get a second opinion at a center that does offer ablation therapy with pacemaker backup as these centers tend to be the ones that have availabilty
of the newest drugs available.  I and many other cardiologists feel that remaining in chromic atrial fibrillation is at best a last resort since the risk of stroke is a major one and almost always disabling, even lifestyle cripling- this often represents a greater threat than
say pacer dependency, or even the annual need to be cardioverted.  If you are considering a second opinion at The Cleveland Clinic Foundation, you can call 1-800-CCF-CARE  and ask for an appointment with Drs. Kidwell or Tchou.  
    Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).