Treatments for atrial fibrilation

[KLB]

I have been diagnosed with atrial fibrilation. I had a pacemaker implanted about a year ago which controls my heart rate. I take one tablet of Verapamil each day. I find that if I am sedentary I have no discomfort, but if I try to walk over a quarter of a mile or other exercise,I get short of breath andhave to stop and rest. I am 75 years old now and had been treated with Lanoxin for about 15 years prior to 2001 when I was diagnosed with atrial fibrilation. I want to know if there any procedures and or medicines that can help increase my energy level so tht mild exercise is possible. I have had three carioversions but none of them helped.

[CCF-M.D.-CRC]

Dear KLB,
Atrial fibrillation may indeed result in a decreased ability to exercise.  At the Cleveland Clinic we try as best as we can to get the patient back into sinus rhythm and maintain it there.  However, in some individuals this is not always possible and we end up having to use medications to control the heart rate.  

The medical approach to your case would depend upon your other medical conditions and what drugs have been previously tried.  There are many antiarrhytmic drugs such as sotalol (Betapace) and amiodarone (Cordarone) which may be helpful in maintaining sinus rhythm.  If these fail there are other drugs (e.g. Tikosyn) that could be tried as well.

If antiarrhythmic drugs fail then medical rate control is the next option with beta-blockers and calcium-channel blockers (e.g. verampamil) being used for this.  If these drugs do not control heart rate during exercise larger doses may be required.

Lastly, a AV node ablation may be used for rate control when nothing else works. So you can see there are several options here.  Your cardiologist should be able to recommend the best one for you that will hopefully also help you feel better.

[racedriver]

The recent (released March 2002) studies by the National Health Instittutes (AFIRM and RACE)involved several thousand patients over several years, and measured a really critical indicator of health (survival vs. death).  The conclusion was that the half that had just rate control survived a little better than the half that had just rhythum control, but the survival rates were statistically equal.

So the message to doctors is that rate control for a-fib is no longer a secondary treatment, but is a primary treatment with excellent survival rates.