my dad's atrial fib

[page-borger]

  My Dad is 61 and was diagnosed with atrial fib about 20 years ago. This has been kept under control up until one month ago with quinidine, digoxin, and coumadin. The latter was discontinued 2 years ago due to a bleeding episode. One month ago on a routine physical his doctor noted the atrial fib was back. He was seen by a cardiologist who recommended new therapy: hospitalization for electrical cardioversion and starting on Cordarone. This was done early this week. Things went well, he went home, and last night he went into atrial fib again. His cardiologist said this is not unusual and he is going to be seen Monday 8/3 for medication adjustments. (He is back on Coumadin for now too).
  Being that I am a veterinarian I would like for someone to be honest with me about this condition and what I have relayed above. What concerns me is that for so long everything seemed to be fine and now it has become a problem again.
                                        Sincerely, Page Borger, DVM

[CCF CARDIO MD APS]

Dear Page,
I am not really sure what your question is other than what could possibly make the
a.fib return after 20 years time.  This rhythm is the most common sustained arrythmia
in humans.  The mechanism believed to be in effect is random rentry within the
atrial tissue.  There are a variety of medical conditions associated with a.fib.,these
include hypertension, coronary artery disease, and valvular heart disease.  The therapy
encompasses restoration of sinus rhythm, control of the ventricular rate (in response to
the 300beats per minute in the atrium), and prevention of thromboembolism.  The therapies
are mostly pharmocologic (like what your father was on for 20 years) along with cardioversion as needed.  Sometimes non-
pharmacologic methods are used to treat a.fib. and these include atrial pacing, radiofrequency
catheter ablation, and surgery (that is in attempt to restore and maintain sinus rhythm.)
Even given that the prevalence of a.fib in the population increases significantly with age, most
impressive after 60 years of age, there are multiple factors involved in each individual case.
For instance, the appearance (size) of the atrium on echocardiography can help to predict the likelihood
that sinus rhythm will be maintained.  Sometimes a medication will maintain sinus rhythm for a number of
years but then fails as may be the case with your father.  Sometimes the patient takes another medicine for another
condition and that medication effects the level of antiarrythmic medication to maintain sinus rhythm.  You need to ask
your father's physician about the findings on the echocardiogram,about what are his/her thoughts on why the a.fib returned
and about what factors made him decide on amiodarone as the current anti-arrythmic to use.  As well you might ask him if s/he has
a guess as to the likelihood that your father will maintain sinus rhythm.  
As you may already know, the risk for stroke in a.fib is lowered when coumadin is used for anticoagulation.  Good Luck.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment
can only be made by your physician(s).