PVC's and PAC's after by-pass surgery and cryoablation

[skywalker3]

I am a 54 year old male and in generally good health.  In April 2006 I had a single episode of atrial fibrillation.  After various tests it was concluded that I had normal left ventricular systolic function and three vessel coronary artery disease.  My ejection fraction was 70%.  On June 22, 2006 I had a quadruple CABG and cryoablation.  Daily I am on 10 mg. Altace, 325 mg. Aspirin, 100 mg. Toprol XL, 20 mg. Zocor, and 2,000 mg. Niacin.  My total cholesterol is 134, Trislycerides 146, LDL 76, and HDL 31.  I follow a low-fat, low-sodium, and low-sugar diet.  I do approximately 1.5 hours of cardio and resistance training daily.  I am 5'10" in height and weigh 169 lbs.  For over twenty years, including post CABG, I have experienced periods of PVC's and PAC's.  Somedays very few or none at all, and other days up to 3 to 4 per minute, and infrequently with bigeminy or couplets.  The frequency is significantly diminished during exercise.  My cardiologist has recommended that because of the PVC's and PAC's I should take Amiodarone.  I don't want to take this medication because of efficacy concerns and potential significant side effects.  What do you think?  Secondly, since my physicians believe that my CAD is largely attributable to a genetic predisposition, do you have any suggestions for additional lifestyle modifications or other drug or related therapies?  

[Forum-M.D.-MJM]

Hi Skywalker,
It sounds like you are recovering well from your CABG and I admire your efforts to stay fit.

My cardiologist has recommended that because of the PVC's and PAC's I should take Amiodarone. I don't want to take this medication because of efficacy concerns and potential significant side effects. What do you think?

I think if the PACs'/PVC's don't bother you, I would leave them alone.  I take the side effects of amiodarone very seriously.  There are true indications where amiodarone is the best and only medications, but I do not believe that PAC/PVCs with normal heart function would benefit from amiodarone more than the potential for side effects.  There is no study that shows that amiodarone would prolong life under the conditions that you describe.  I beta blocker or increasing the current dose of beta blocker is a good option.

Secondly, since my physicians believe that my CAD is largely attributable to a genetic predisposition, do you have any suggestions for additional lifestyle modifications or other drug or related therapies?

Unfortunately family history is a big risk factor for CAD.  It sounds like you are taking care of the diet and exercise component.  Otherwise, blood pressure control (ACE inhibitor is probably my first choice, beta blocker my second choice unless you have had a previous heart attack, then I would use both).  Aspirin 81 mg once per day.  It is not currently something that a great deal of data supports but there is some evidence that a glass of red wine per day may decrease your risk.

It sounds like you are well treated.  I hope this answers your questions.  Good luck and thanks for posting.