Regarding your response to the poster below about his/her 50 day long atrial fib episode - our father is going through something similar. He has a CHADS score of one (only because they suspect a partially clogged artery but it’s one of those arteries in the back of the heart so they are not positive if it’s the artery or something in the diaphragm that’s showing up on the nuclear stress test – you’re right, we are confused also with this).
Here’s the question we are facing now, even though he has no bad symptoms (pulse about 80’ish), he’s approaching his 90th day of being in afib. What do you think of cardioversion or using something like flec to try to get him back to sinus rhythm? The cardiologist said it’s our decision and that he would have no problem with having him stay in afib. Doing nothing doesn’t sound right to us (other than a daily aspirin with metoprolol and a statin). Our father would rather do nothing more. Your opinion?
Converting someone back to sinus rhythm can be done either electrically (DC cardioversion) or by medications (pharmacological). Regardless of the CHADS score, a clot in the left atrium/left atrial appendage needs to be ruled out by TEE or with empiric treatment of anticoagulation for at least 4-weeks +/- confirmation by TEE.
Medications usually used for cardioversion include Class III antiarrhythmics such as amiodarone, sotalol, or dofetilide. Class Ic medications include flecainide or propafenone -- but are contraindicated in those patients who have a history of coronary artery disease of any kind. These medications need to be administered by a licensed physician.
Its your dad's life and thus his decision to make. If he has decided he wants to do nothing more and his cardiologist has discussed his options to him, then I would suggest that you honor your father's decision.
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