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.