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Amiodarone, Emphysema, Warfarin
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Amiodarone, Emphysema, Warfarin

I am a post menopausal woman with serious atrial fibrillation. I have never been on antiarrythmic drugs. I was not able to tolerate beta blockers (difficulty breathing) so I have been on a calcium channel blocker for about 1 1/2 years (Cardizem).
I had an ablation procedure in mid-December (pulmonary vein radio frequency) and since then my a-fib is worse than before. This is presumably because the scar tissue is yet to fully develop and the area was irritated by the procedure. I am now in a-fib about 90% of the time instead of 60-70% of the time and I am still very symptomatic when in a-fib (as I was before the procedure); breathless, very weak, not currently working.
Amiodarone is being suggested for 2-3 months to help the modeling of the heart (For me, a drug that metabolizes in the kidney is contraindicated). I do take Warfarin so I am concerned about interactions with Amiodarone, but also, I have mild emphysema (I quit smoking 2 1/2 years ago):

1. Am I more susceptible to lung toxicity using Amiodarone than a person with healthier lungs?
2. Weighing the risks, how important is it to use an antiarrythmic drug at this point, rather than wait for the heart to reconfigure itself as the scar tissue develops?
3. I tend to be hypersensitive to drugs.
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230125_tn?1193369457
1. Am I more susceptible to lung toxicity using Amiodarone than a person with healthier lungs?

You are not more likely to have it but you have less reserve if you do have it.  The risk of pulmonary toxicity is low but should considered.  I use amiodarone sparingly.  If you don't have coronary disease or a cardiomyopathy, I would try flecainide or propafenone first. Amiodarone is the most effective treatment for atrial fibrillation -- the side effects are more common though.

2. Weighing the risks, how important is it to use an antiarrythmic drug at this point, rather than wait for the heart to reconfigure itself as the scar tissue develops?

The amiodarone will not help the remodeling but might improve your symptoms while you wait to see if the ablation worked.  The decision to use amiodarone depends more on if you can tolerate the symptoms of atrial fibrillation.  If you are rate controlled with a calcium channel blocker and still have significant symptoms, amiodarone may be a good choice for you assuming you are not eligible for flecainide or propafenone.

I hope this helps.  Thanks for posting.
2 Comments
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97628_tn?1204465633
If you choose the Amiodarone for a long peirod of time, keep an eye on your thyroid levels :-)
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