What To Do?

[John18127]

My Mom is 71 and has been told two things.This is a little long but I hope spmeone can give us some information.

She has had Paroxysmal (SP) A-Fib since 1999 and had a pacemaker put in in 2002.She was on Sotalol from around 99 until November of 2008.The doctor (electrophysiologist) she had been going to since 1999 wanted to put her on Amiodarone,she has been told by an Internist that she used to go to that it was dangerous.

She had actually taken it for a short time in 1999.Her then Primary Care Doctor took her off of it and that is when her heart doctor started her on the Sotalol.

She did pretty well on the Sotalol until around the middle of 2007,she started having more trouble.She got worse and the heart doctor she was seeing wanted to start the amio.This was in Oct-Nov.2008.

We decided to go to a different heart doctor (electrophysiologist) and wanted to try rate control and see if it worked.The meds that he tried were Metopralol,which she was already taking and Verapamil.She took Metopralol 50 mg. and 180 mg. ext. release of Verapamil once a day.It helped some but her rates according to him were still running 120-130 bpm.

He then did a dopplar echo and said that her heart was at 40% function and stopped the Verapamil.

He then stopped the Verapamil and went to Digoxin and Metopralol.He upped the Met. from 50 mg. twice a day to 100 mg. ext. release once a day.It helped some but her rates are still around 120 bpm.

He then said that he wanted to do a complete AV Node ablation and replace her dual chamber  pacemaker with a Biventricular pacemaker.

I have done research on this type of ablation and found that there can be a rather high death rate at times.This can happen from 2-90 days after the ablation and is called Sudden Death.

I also found that this type of ablation isnt the first choice and is more of a last resort type of thing.

She is now at the point that she doesnt know what to do.The electro. that she is seeing now has told her that her heart cant keep beating like it is,it will wear out.

He told her that she would go to bed one night and not wake back up if she doesnt do something.That was upsetting.

We dont know what to do.

We dont know if there are any other meds to try or what.

Does anyone have any ideas?

Thanks.


This discussion is related to TAMBOCOR AND A-FIB.

[grendslori]

I can tell you that Amiodarone is a last drug of choice so if your mother was put on it, it was for good reason. I think one of the first things that hit me reading your post was that you have too many chiefs and not enough indians. Everybody's doing all kinds of things and I think that can be more deadly than the A-V Node ablation! Stick with one cardiologist and one EP specialist. Forget the GP and the Internest. My daughter has had several ablations and had SEVERE muscle damage to both ventricles and both sides of the septal wall as well as several types of electrical problems (she later had a heart transplant) and she also had a duel chamber pacemaker implanted;she had several ablations. She was also on Amiodarone for a few years. There is always a risk with a sudden death event where heart disease is concerned, you just do everything in your power to eliminate the risks as best you can. If the doctors are telling your mother that there is that risk, why would you not do the ablation? It could save her life.  

[grendslori]

I forgot to mention that Amiodarone is one of the drugs of choice when dealing with a stubborn arrhythmia which may be hard to control. Why this Internest says it's dangerous, I don't quite understand unless he is referring to the side affects, which the drug does have bad side affects......but so do all drugs.

[John18127]

,Hi,I may not have been as clear as possible.My Mom has only been to two electros in about 10 years.She doesnt have a cardiologist.We went to the second electro to see what he thought,he says the ablation.

While the second electro says ablation,he did not inform us that it could cause sudden cardiac death,a risk after the ablation,he only said that my Mom needed to do something.He said that she would go to bed and not wake back up.The SCD can happen from 2-90 days after the ablation.

One study had several that died in a rather short time after having the AV Node ablation. http://content.onlinejacc.org/cgi/content/full/40/1/105/T2

This site also doesnt recommend the AV Node ablation, http://atrialfibrillationblog.com/av-node-ablation-why-you-shouldnt-have-it/

My Moms health isnt the best,she has HBP and is a diabetic.She also has an enlarged heart,has for many years.

I and her both want to do waht is the safest and best thing to do.

About the amiodarone,I have done research on it and some doctors will not use it,I also read that a university hospital will not use it either.

The internist that told her it was dangerous is quite stubborn and isnt the kind to tell someone this unless he thought it was the right thing to do.The side effects of amiodarone can be deadly and have killed several people,some withing a few weeks.ARDS being the most severe and quick.

The thing with amiodarone is that once the side effects start,there isnt much one can do until the drug gets out of the system,that can take weeks or months.

The AV Node ablation makes the person pacemaker dependent,the heart no longer beats on its own,if it does,it is called a rescue rate,it runs at about 40 beats per minute,if it does that.

We just want to do the right thing and AV Node ablation is a last resort from the info that I have found.

Amiodarone is also a last resort,if there are other drugs that could be used,that may be the best thing to so.The problem is,no one has really tried to see if other drugs will help.
That is what makes it hard to really know what to do.

[John18127]

The second electro has said that it isnt an emergency to have the ablation,it is just something that he said she needs.

The part about him not telling us the risks of the ablation is what makes one not know if he can be trusted.

[rkahn001]

Wow!  Great information!  My 81 year old mother has suffered from CHF for alamost 15 years and in the last 5 yrs been dealing with AFib. They have tried twice in the last two years to start her on Amioderone, but both times have had disasterous effects.. The first time, two years ago, the drug left her extremely dizzy, nauseous and weak. She was only able to tolerate it for approx two weeks and nearly bed-ridden for the entire time. This last time they tried to start amioderone, despite my better judgement (I thought she may have been allergic) and it lasted approx 3 days, when she started having V-Tac events. Two in three days. thankfully she has a AICD impnated and it saved her life. They have since taken her off the Amioderone and have recommended AV Nod Ablation.. scheduled for tomorrow.. we will see