Atrial fib/flutter advice

[sweetsue]

I am a 63 year old female with a 30 year history of A-fib/flutter. It began when I had a mitral valvulotomy at the age of 32 and was fairly well controlled with quinidine, lanoxin, inderal and coumadin. About eight years later the mitral valve was replaced with a Carpentier-Edwards porcine implant and I was released with the same medications. The porcine valve lasted about 13 years then was replaced with a St. Jude Medical prosthesis, same medications.

I had about an 18 month period prior to Feb 1998 with no meds except for coumadin (Divine healing). Then I had a rate increase to 160bpm with angina occurrences and was diagnosed (heart cath) with a blocked descending anterior circumflex artery (blood flow is apparently via secondary paths). Angina was controlled by nitro patches and sublinguals until Sept 1998 when Divine intervention stopped angina during a healing service. A month or so later I was placed on Cordarone and a cardioversion performed. This worked for a year or more, but breathing became difficult. The tests did not reveal fibrosis of the lungs, but breathing was impaired. The Cordarone was stopped and several meds tried without success including Dofetelide. My cardiologist did not think going back to quinidine and lanoxin would work..

At present I am on Cardizem CD 240mg and coumadin. the Cardizem holds the rate to about 100bpm with bouts of irregularity which drop the count to about 83bpm due to skipped beats. The 100bpm leaves me very tired, but the skipped beat occurences really get me down as the heart feels like it is doing flip flops. It seems t

[antida]

A related discussion, new diagnosis was started.

[bombshell]

In 1981 I had an ASD repair.  Prior to the surgery I was not feeling well, but have felt progressively worse since.  I began having runs of a-fib/flutter for 3 days approx once a year right after the surgery.  As the years have gone by I have had increasing and longer-lasting episodes, at present being about every 4 months for five days with a rate of 170-200.  10 years ago the symptoms were noticeable but I was able to function.  Now I cannot do the simplest tasks without having to lie down on the floor to keep from passing out.  During the spells I get swelling in my legs but not my feet or hands.  At the end of the last bout I developed abdominal pain and swelling and went to the ER.  When they put me on the monitor my HR was in the mid to high 30s.  I am currently on Flecainide 150mg  BID, Toprol 12mg QDay and Coumadin 7.5mg QDay.  I am 48 and feeling 80.  I can walk on flat surfaces or even hike downhill, but anything uphill does me in instantly--I get SOB and feel like I'm going to pass out.  My Cardiologist states that their are other meds we can try and I am not a candidate for ablation because of the repair. I know that the meds have side effects, and fatigue is one of them, but some days I go from the bed to the couch and I am sick and tired of feeling sick and tired.  Are there any other options?  At this point I want to feel good or just die.  I don't want to just exist.  Is there anything else or am I going to feel like this for the rest of my life?

[stubble]

I could not get into the questions area, so this is a question disguised as a comment.

I'm almost 69 and I run (jog) most days.  Up till July last year (2002) I was running in long x-country races (up to 30 miles) and ostensibly very fit with a resting pulse rate of about 55.  Up to the age of 60 I could run a mile in well under six minutes and the marathon in about 180 minutes but anno domnini was gradually slowing me down.

Then in July last year I suddenly developed atrial fibrillation.  My resting pulse rate is now anything between 60 and 80 depending on the mood of my ticker.

Cardioversion has failed and the cardiologist thinks that ablation and some of the drastic drugs that are available are not appropriate at this stage.  I'm still alowed to jog but not to race.

When running my pulse can be anything between 120 and 210.  The "safe" limit at my age is about 130 (depending on which book you read).  Today, at 210, I felt no discomfort and was only mildly out of breath.

Nevertheless, according to numerous sources, anything above 130 is "dangerous," though the nature of the danger is never explained.

I am on digoxin, warfarin and calcium channel blockers,

With drugs my BP is about normal except for first thing in the morning, when it is too high.

My questions are:

What is the risk from pushing a pulse rate to way over the "safe" limit for my age?  Am I causing more damage to my heart?  (I already have a slightly enlarged left atrium.)  Am I risking a heart attack?

Staying below 130 bpm would require stopping or walking every time the monitor went too high.  That would be very, very frustrating.

I feel fine but apprehensive because I can't get any advice from fellow runners who also have AF.  I don't know any. Are there any?

After a run I quickly recover to around 80 bpm.

My pulse is never steady.  When running it can hop around from 130 to 210 to 170 to 150 etc.  Resting (inert in front of TV)it can hop from 50 to 60 to 70, so I take several readings and average them.

[sweetsue]

I didn't have space in original post to say that an arrythmia specialist (DUMC) thought secondary path ablation might not be feasible as his experience has been that the path needing ablation often lies in the area where tissue was rolled for stitching in the prosthetic valve (the microwave energy wouldn't penetrate). I guess one could go for mapping and secondary path ablation with AV node ablation as a fallback. He felt that dofetelide should be tried first and we tried that route (the monitored interval showed risk and no conversion had occurred).

[Cleveland Clinic]

An AV node ablation may not be the answer. I suggest you seek referral to a center that specializes in atrial fibrillation including non-pharmocologic therapies, for possible ablation or pharmacologic evaluation.

We have a center for atrial fibrillation at the clinic. Two options to see here would be be Dr. Andrea Natale or Dr. Nassir Marouche.

[sweetsue]

Sorry, this was my first post and didn't realize i would get only one chance to edit here's the rest of my post . . .
It seems that meds won't do the job and my only recourse is AV node ablation and a pacemaker. I am not excited about going this route, but am not able to live a quality life with my present symptoms. I would appreciate your thoughts on all this.

[Cleveland Clinic]

Sue,

I think your post was cut off.  I will try to answer the best possible.  

Codarone can have a variety of effects on the lungs. PFTs whould help discern if you have any damage. Also, as you age effects of tobbacco both first and second hand can have some deleterious consequences. You said you had some impairment. I'm not sure if you mean subjectively or objectively with PFTs. It would be worth know this answer as some types of impairment can respond to medication.

The next question to know would be if your heart function is impaired. You mention you had a blockage in one of the main vessels of the heart. This can lead to damage of the muscle. It would be important for you to know your heart fuction and weather any blockages of the arteries are causing you to have ischmia leadin to your symtoms. Echocardiography and stress testing would help to answer these quesitons.

Rate and rhythm control in atrial fibrillation is a difficult subject. You need anticoagulation for your valve so the main issue if the above questions were negative is weather your symptoms are from your fibrillation. In this case it may be useful to be evaluated for more aggressive maintance of your atrial rhythm either pharmocologically or through intervention.

As for the palpitations, those are a major annoyance. You might try to change to another medication like a beta blocker, but given your fatigue it may not benefit you. However, they have no negative long term implications to your health.


hope this helps.