Did A-Fib cause Cardiomyopathy?

My husband, at a routine blood pressure check in August 2007, was diagnosed with a-fib and was treated by cardiologist #1 with coumadin, atenolol, lisinopril (for his continuing high blood pressure). After EKGs and Holter monitors in the ensuing months showed no improvement in the a-fib, he was started on flecainide.  Doctor #1 then recommended cardiac cath...but I wanted my husband to get another opinion first.  We went to Doctor #2, who said that he indeed needed cardiac cath, but that flecainide was the absolute wrong choice of medicine, as it could have proven "lethal" to my husband.  He immediately stopped the flecainide, substituted amniodarone, and sent him for cardiac cath by his partner, Doctor #3.  Doc 3 did the cath, and reported back that my husband has no arterial blockages, but has cardiomyopathy...30% EF.  Next day TEE procedure was performed, followed by EP with ablation for newly discovered atrial flutter.  The TEE procedure revealed no clots.  The question now is what to do next? The a-fib is continuing despite the amniodarone, and, with the heart being weak, the doctors are talking about the threat of "sudden death" arrhythmias, and are considering implanting an internal defibrillator...or waiting to see if the a-fib gets under control with the amniodarone.  What is the best course of action at this time?  What is his risk of sudden death?  He is 55 years old, and aside from the high blood pressure that he has taken meds for for the past approx 10 years, he's a very healthy, active man.  Low cholesterol, low triglycerides, never sick.  What is happening, and why??

[Michael J. McWilliams, M.D.]

1. Atrial fib.
If he does not have symptoms from the afib, stop the amiodarone and control the heart rate. If the he has symptoms from afib and his heart rates are not controlled, control the heart rate with beta blocker and then reassess for symptoms.  If he has symptomatic afib despite rate control, trying to cardiovert and continuing amiodarone is a reasonable option.  if he continues to afib despite amiodarone, stop the amiodarone.  Amiodarone has side effects and should be stopped if it is not helping.  Two other  medications used for atrial fib with reduced heart function are sotalol and tikosyn, but again if the afib is rate controlled and not causing symptoms, allow the afib to continue.  It might sound complicated but it really isn't. It might take a few months to tease out all the details.

2. cardiomyopathy or low ejection fraction
If someone has symptoms of heart failure and has an ejection fraction less than 36%, an ICD is an option.  In non ischemic (no blockages) related cardiomyopathy, medical therapy maximum dose beta blockers, ace inhibitors should be tried for 3 months and the heart function should be reassessed.  If it remains less than 35% and there are symptoms of heart failure, an ICD should be considered.

In non ischemic cardiomyopathies, the number of people needed to treat for 3.5 years to save one life is about 1 in 16-17 people.

I can't really answer the why it is happening question -- sometimes there is no specific answers, others there is a clear cause.  It can be complicated.  You probably want to ask your doctor this one.

I hope this helps and good luck.

[Kathy314]

thank you for taking the time to answer my questions.  He is still experiencing a-fib but has only been on the amiodarone for 2 weeks.  I understand it may take approx 3 months to be effective in controlling the a-fib.  In the interim, doctor says he's at increased risk of sudden death and suggest implanting ICD.  My husband is a machinist...working with heavy industrial equipment in a factory.  Would this mean he had to retire from work?  If not, what is the recuperation like after the ICD is implanted?  If he is forced to retire, is he then eligible for Social Security disability ?  He is only 55 years old.  Without his salary, we are in BIG trouble financially.  But of course his health and well being are paramount.  Is the ICD a permanent thing, or, if his myopathy is reduced/cured once the a-fib is controlled/eliminated, is the ICD then removed?  thank you again for your kind concern.