Re: Atrial Fibrillation

Posted By CCF CARDIO MD - MTR on April 04, 1998 at 16:33:50:

In Reply to: Atrial Fibrillation posted by Stan on April 02, 1998 at 17:57:39:






: 57 yr old male, previously diagnosed with cardiovascular heart disease including high bp-taking norvasc, zocor, niacin.  An ekg prior to an angiogram on March 10 found atrial fibrillation.(asymptomatic- Heart beat slowed rather than speeded up. I can't feel a thing).  Thyroid tests negative.  Meds added on March 10-Lanoxin, Coumadin, Atenolol. No correction, so Tambocor added March 27.  Plan is to cardiovert electrically in April 7 if not corrected by meds by then.  Question concerns all these meds and their appropriateness or risk used together.  Diagnosis of afib on March 10, today is March 29. Is this the currently most advisable treatment plan-meds, then electric cardioversion?  Should I expect meds to continue long term even if cardioversion is successful?







Dear Stan, thank you for your question.  Atrial fibrillation (Afib) is a common disorder
that is treated as your physicians are doing.  With afib, the heart beats irrregularly
and patients often notice that they have palpitations or skipped heartbeats.  Some patients
have an usually fast rhythym when in afib and quickly become fatigued and short of breath.
In your case, you appear asymptomatic from the afib and are probably wondering why some
much attention is being made for this problem.  The biggest concern we have as physicians
is that clots form in the heart during afib and can be ejected to cause a stroke.  Thus,
we put patients on blood thinners (like coumadin that you're taking) to prevent clots from
forming.  In your case, your doctors could not determine how long you have been in afib
so coumadin was started to dissolve potential clots that may have been present and will
be continued for 3 - 4 weeks until you can have a cardioversion to stimulate your heart
to go back into normal sinus rhythym.  Tambocor, also known as flecainide, is an anti-
arrhythymic drug that is designed to medically convert your heart into normal sinus
rhythym but drugs like this are only about 50% successful on their own.  When they don't
work, electrical cardioversion is used to reorganize the rhythym. Cardioversion is more
successful in the short-term and long-term when anti-arrhythmic drugs are used concurrently.
Once the heart is in normal sinus rhythym, clots in the heart have a greater chance
of being ejected and causing a stroke.  That's why coumadin is continued for 3-4 weeks
before sinus rhythym is restored to dissolve any clots that could be present when afib is
diagnosed.  We know that 3-4 weeks is an adequate duration of therapy to dissolve clots.
The other medications you are taking, lanoxin and atenolol, are designed to slow the
heart rate down during afib to limit the symptoms I mentioned previously.  Given what you
say about your heart rate being well-controlled to begin with, those medications may not
be necessary for the long-term (although atenolol would also help to control your blood
pressure).  After cardioversion, you will probably need to stay on coumadin (because you
will always be at risk for going back into afib), flecainide (for at least a few months
depending on how you do), and atenolol depending upon what your doctor thinks.  Once sinus
rhythym is restored, afib can recur and since you're asymptomatic while in afib, you
may not know when you're in afib.  That may be the reason to continue coumadin long
term to protect you from a stroke if the afib recurs.   I hope you find this information
useful.
Information provided in the heart forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.
    


: Thank you for your response.  Very helpful.  Additionally, are defibrillators or pacemakers in the protocol for this condition and if so when and what circumstances.  If not, why not?  I am very unhappy thinking about all these meds longterm since they make me so tired.  



  _
Deart Stan, implantable defibrillators are being developed for afib but they are still in the experimental stage.  Patients with these devices have to be seen at large cardiac centers that are developing these devices.  We have a program at Cleveland Clinic and if your cardiologist thinks that could be an option for you, the person to contact is Dr. Mina Chung at 1-800-CCF-CARE.   Pacemakers are only used as a last resort for patients who have refractory fast afib that doesn't respond to medications.  The electrical conduction to the ventricles is elminated by radio currents and a pacemaker is inserted to supply the heart with a normal rate.  However, the atria remain in afib (even thought the fast atrial impulses are not conducted to the ventricles) and patients need to continue on coumadin for good.  I doubt a pacemaker would help you since it appears that your heart rate is under good control when you're in afib.