Re: Atrial Fibrillation

Posted By CCF CARDIO MD - DLB on January 23, 1999 at 16:26:33:

In Reply to: Atrial Fibrillation posted by Allan on January 22, 1999 at 21:17:52:






Dear Doctor,
   A couple of years ago, I was finally diagnosed as having bouts of A-Fib...as a matter of fact, I'm in A-fib now as I write this. This particular episode began about 10 am this morning. My doctor has started me on Digoxin today, along with Coumadin. I have been taking Betapace
(160 mg daily) for a little over a month now...but today he told me to up it to 320 mg a day. Before the betapace I had been taking Atenolol for quite some time, but a little over a month ago I went into a-fib, and was in it for 3 weeks before he cardioverted me. He had to HIT me 3 or 4 times, using up to 360 joules, before I verted to NSR. After that, he switched me from atenolol to the betapace. That had been my 3rd cardioversion in 2 years, and when I see him this Monday, I may be having my 4th cardioversion. I am getting tired of this, and so frustrated. The drugs dont seem to help, and it's as if the doctors are'nt trying to find-out whats causing it.
They just keep cardioverting me, changing meds, and sending me on my way! They have done blood work, numerous ECG's, echocardiogram, and Holter monitors...but, they keep saying it's probably "Idiopathic"! They have said that I have some valve leakage, and a slightly enlarged atrium, but that neither is the cause. When my heart goes into a-fib, it always starts-out really violent...but, that usually only lasts for a few secs to a few mins, then it will be in A-fib (which is alot less violent and somewhat tolerable). Sorry for blabbing on, but here are some questions:
1.) Why is the start of my a-fib so violent?...could it be SVT leading into a-fib?
2.) What tests should I demand to find-out what's causing my a-fib?...maybe a EP Study?
3.) Could I have W.P.W., or a AV Node conduction problem?
4.) Do you recommend a BETTER drug for preventing a-fib?
Or one to help it convert back to NSR?
5.) Will my a-fib continue to worsen?...increase in frequency?
6.) Could it be the valve leakage or the enlarged atrium that's causing it?
  Well, I have SO many more questions, but I have taken-up enough of your time. Thanx alot for any and all help you can give me...Sincerely, Allan
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Dear Allan
1.  You are probably most aware of the afib when your heart makes the transition from normal to abnormal.
2.  You should not demand anything. I am sure your doctors have looked for underlying causes of the atrial fibrillation. An EP study would not add much if you already have a diagnosis of atrial fib.
3.  You could, but your cardiologist would have probably looked for WPW.
4.  Drugs must be individualized for atrial fibrillation. You are on good drugs now. There are many other potential drugs. You may consider seeing a cardiac electrophysiologist (a cardiologist who specializes in things like afib) for other options, including less often used medications or special procedures.
5.  Possibly. The longer you are in atrial fibrillation, the more difficult it is to convert you back.
6.  The valve leakage could be the cause, but only if it is substantial in amount. If this is the case, valve surgery may be indicated. The enlarged atrium could be due to valve leakage or the result of atrial fibrillation itself.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.