Treatment plan for Atrial Fibrillation

  I suffer from Atrial Fibrillation. It seems to be constant. maybe got
  this way within the last few years. Probably not related to heart
  disease.
  I had numerous paroxysmal tachycardia episodes years ago. held in check
  with Lanoxin.
  I took Lanoxin, which slowed pace somewhat
  I then added Amiodarone for 30 days (400) which with Lanoxin brought me
  to a very normal pace but did not cure the AF (surprise!)
  Cardioversion several weeks ago failed. (external) Im a big guy so
  maybe the efficiency of the procedure was diminished.
  the plan is catheter cardioversion.
  Ive been reading about radiofrequency catheter ablation.
  is this in my future?
  also hear about pacemaker benefit .
  By the way, Im 55 and feel fine.
  Could you comment on my situation?
  I would love to dump coumadin and amiodarone someday, (hey! who likes to
  read DEATH every other word in the drug warning ,heh?)
  Im a bit pessimistic about the cardioversion because it doesnt seem
  to deal with my tendency to this malady , it will maybe halt it for
  a while, but will it be back? Is it a good option? Ill give it a try,
  This ablation sounds very delicate but interesting.
  Anything else happening in the field of Atrial Fibrillation management?
  Thanks for listening to me rag on about this.
  Michael G. Kramer

[CCF Cardio MD - MTR]

_
Dear Michael, thank you for your question.  Atrial fibrillation (AF) can be a difficult problem to deal with as you can attest to.  The medications you are being treated with (amiodarone, coumadin, and lanoxin) are all appropriate for AF, but you obviously still remain in AF.  External cardioversion is usually successful at restoring normal sinus rhythm but may not work in larger patients like yourself since the electricity has to travel through more soft tissue to be effective.  Internal catheter cardioversion can be used to convert AF to sinus rhythm but is used only in isolated circumstances.  Cardioversion is usually initially successful, but sinus rhythm is maintained long term only in around 50% of patients.  There are experimental internal cardioversion devices that can be implanted and are self-activated by patients.  These devices are usually for patients with periodic AF and not constant AF. Radiofrequency ablation (RFA) is a procedure similar to the Maze Procedure (see previous questions in the heart forum about the maze procedure) where radio energy is used to "burn" channels into the atria to block the chaotic electrical activity of AF.  In AF, this procedure has had variable success.  However, another rhythm disturbance that is often seen concurrently with AF called atrial flutter can be treated successfully with RFA.  A pacemaker would only be necessary if you developed refractory fast rhythms from AF that could not be controlled with medications.  You do not appear to be in that category.  Since you appear to be asymptomatic with AF now on good medications, you may opt to continue your present treatment with medications alone.  Your risk of a side effect from coumadin, amiodarone, or lanoxin is small and you must understand that all medication package inserts are more dramatic than what is seen in clinical practice.  However, you should speak candidly with your cardiologist about further treatment options.  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.