What drugs successfully treat atrial fibrillation?

[codeblue]

My father is 81.  He has recently been diagnosed with a-fib.  He has Type II diabetes, successfully controlled with Avandia, peripheral neuropathy in his legs and feet, for which he takes Neurontin and Ultram without a whole lot of success, and HTN, for which he is on Tenormin.  His IM doctor has put him on Coumadin and Cozaar to help treat the a-fib. In my experience as a health care professional, I have always seen people with a-fib being treated with Lanoxin and Coumadin.  In addition, I have read that those people with diabetes and PN should not be treated with Beta Blockers.  Shouldn't a-fib be treated with an antiarrhythmic, something to control the heart rate, like lanoxin or a calcium channel blocker and a blood thinner? Would it be prudent to have my dad's a-fib managed by a cardiologist rather than his IM doctor, in which I don't have alot of confidence?  With the PN, he is more at risk for falls due to the numbness.  A cardiologist recently told me that for those people at risk for falls, he likes to use Plavix as opposed to Coumadin.  Is that a viable alternative?  I know I have alot of concerns and questions...thank you for your time and expertise.  Sincerely, Codeblue

[Cleveland Clinic]

codeblue,

You ask alot of good questions about fibrillation.

To start, the medications you mention do not really trat atrial fibrillation.  They more or less control the symptoms and the morbidity associated with it..namely rapid heart rate and the risk of stroke.  They mechanisms to treat atrial fibrillation incluse other antiarrythmics such as sotolol, amiodarone and procedures such as ablation and surgical correction.  

Most importantly,  in most patients, especially the elderly...rate control can often have the same results as attempts to maintain sinus rhythm.

To answer your questions:

1) Shouldn't a-fib be treated with an antiarrhythmic, something to control the heart rate, like lanoxin or a calcium channel blocker and a blood thinner?

Digoxin is not an antiarryhtmic. It is a medication that controls heart rate. It is a poor one at that, with poor effects in those patients that are active.  Beta-blockers and calcium channel blockers are better alternatives. I prefer beta blocekrs, even in diabetics as long as they do not have problems with glycemic control.  

2) Would it be prudent to have my dad's a-fib managed by a cardiologist rather than his IM doctor, in which I don't have alot of confidence?

Most internist are perfectly capable handling simple atrial fibrillation. There would be nothing wrong seeking the opinion of a cardiologist if you have questions. If he/she agrees with the management, I would continue on.

3) ith the PN, he is more at risk for falls due to the numbness. A cardiologist recently told me that for those people at risk for falls, he likes to use Plavix as opposed to Coumadin. Is that a viable alternative?

There is currently no data whatsoever, showing benefit of plavix in stroke prevention in atrial fibrillation. The two current standards of care are aspirin and coumadin...with the later being undoubtably more effective in patients that can tolerae it. Alot of people have peripheral neuropathy and do perfectly well without falls. I usually prefer coumadin unless there is a definite risk.  Any regimen that would attempt to use plavix, should at least include aspirin sine it is proven.


good luck

[DottyCece]

In my situation, I was placed on coumadin (though Plavix is effective too) and cardizem for rate control.  After a while, I was loaded on sotolol and cardioverted and did well until open heart surgery.  Then I was placed on amiodarone which has awful side effects...eventually, I had an AV nodal ablation. I see more and more AV node ablations being done with a pacemaker especially if the person doesn't tolerate the rates and has significant side effects or contraindications for taking meds.  I know there are other medications that are used too and need to be considered in context with all else that is going on with the patient.

[I'mallheart]

Atenolol works well also

[Lexicon154]

So does Toprol (metoprolol), which is another beta blocker.  I take Toprol XL 50 mg once a day.  I also take the antiarrhythmic Rythmol 225 mg twice a day.  That combination has kept me out of a-fib for over three years.  I was able to stop the Coumadin within six weeks of starting the Rythmol.

[Paule]

Just a quick update on Plavix being 'proven' with aspirin. A study released today found that plavix with aspirin had no statistical significance over just plavix 'but' had greater rates of bleeding.

[codeblue]

Thank you all for your respones.  I feel better about my father's medications now. Just another thought....once you've been anti-coagulated on Coumadin and you are told to stop it for a week before a dental or surgical procedure, what are the dangers assciated with that?  How long would you have to be off the coumadin to pose a threat (such as a clot)? Thanks again!  Codeblue

[Kristin391]

Regarding coumadin:

I have been on coumadin for 2 years for atrial fib and a prosthetic mitral valve.  I have had to hold it for procedures like cardiac cath, surgery etc.  Basically, there are little consequences for doing that.  Usually I go off for a day or two and then may start Lovenox or Fragmin until the day before the procedure.  After the procedure, I start the coumadin again and continue with Lovenox until my INR is therapeutic.  At first this all made me a bit anxious but I have had no problem with this approach.  The valve is the bigger risk problem I have been told but caution is always a good idea.

[suzyjane]

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[Viv530]

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