Indomethacin, Gout and Afib

[va_tony]

Thanks for taking my question.

I am 65 and have had atrial fibrillation for over 30 years. I am not considered a good candidate for ablation because I’m asymptomatic while in afib and also have an enlarged left atrium (5.4 cm). The afib had been well controlled using rythmol during the last 5 years but unfortunately about six months ago I began to lapse into weeks long afib episodes.

Perhaps this is a coincidence but about the same time I started having these long afib episodes, I also started to experience painful symptoms of gout.  My uric acid levels have always been high (ca. 10 mg/dl) so gout was perhaps not unexpected.  

1. I’ve read that high uric acid levels may be linked to heart disease.  Do you think there may also be a connection between either uric acid levels or gout and afib?

2. I was prescribed indomethacin over the last few months to take for 5 days at a time to relieve the gout symptoms, which worked well.  I noticed that the last two times I started indomethacin while also in afib, I converted within a day or so.  When I googled indomethacin, I learned it is an anti-inflammatory (NSAID) and sometimes prescribed for infants with ASD to promote defect closure.  Is there a chance that my enlarged atrium temporarily contracted slightly while taking indomethacine, thereby promoting cardioversion? Or is timing of the recent self-conversions just another coincidence?

Thanks in advance

Tony

[PikaPika88]

Tony, I'm not an old lady yet!  My gastro Dr said to me "good girl"!   See!  She reckon I'm still like a "girl"!   If I'm a girl, why all my body accessories are going to fall apart???  You're right, I must be OLD!

[va_tony]

Sorry Pika, it won't work.

While indomethacin is used for to treat ASD in infants, that's very different from being able to repair aging heart valves. There are many different causes of valve regurgitation. For example, regurgitation may result from age-related wear and tear on the valve and it's leaflets. Even IF the drug could shrink the valve, it wouldn't do any good.

Tony

[PikaPika88]

Hi Tony,

Could indomethacin help to close the regurgitation valves?  If it helps infant then it can probably help mine one.  Although mine is not an infant valves but ...........  I want to have a trial.  I don't want a pig valve or mechanical valve.......  I'm not the right candidate for bionic women.

[va_tony]

I thought perhaps my "theory" might be a little farfetched but decided to ask anyway. It seemed to me that there might be an inflammation aspect to a 'dilated' atria (which in turn promotes afib) but as you see Dr. MJM thinks not.  So an anti-imfammatory med would, of course, be ineffective in the absence of inflammation.  Still, what piqued my curiosity, besides the coincidence of self-conversion timings, was the clinical use of indomethacin to help close infant atrial septal defects.  I imagined that the infant's atrium shrunk somewhat and with it the septum and hole, thereby promoting hole closure. Perhaps that too is far fetched. I'll have to do some reading and try to understand the actual mechanism behind the ASD treatment.  Perhaps that will provide a clue.

I found Dr. MJM's remark " It is possible that AF decreased your renal clearance of uric acid and caused the flare -" to sound plausable.  I've long noticed that when I go into afib, I have a tendency to urinate excessively and subsequently lose 3 or so pounds of water.  So it's possible that with less fluid available, it's harder to flush away the uric acid..

I hope all is well with you healthwise.

[tickertock]

AS a sufferer myself of ankylosing spondylitis, more than one cardiologist has discussed with me the possible link between these connective tissue /autoimmune diseases and heart palpitations, though it was limited to sinus tachycardia and ectopics beats, I'm not sure about a-fib, but with systemic inflammation I guess anything possible.

I also have noticed that anti inflammatory medications also reduce my pvcs when i used have a flare of them, even though basically all I take is one 325mg aspirin daily, I avoids NSAIDs as much as possible, though I had to be given an injection of voltaren about 6 months ago for a severe flare up costochondritis , it worked wonders though I dont take tablets cause they dont agree with my stomach, amazingly aspirin doesn't irriate it that much.

I guess all am trying to say though it might not studied well or at all , it might not be so farfetched that indocid did cause a reduction in your atria and thus halted the a-fib. I imagine if NSAID has an effect on tachycardia and ectopics in persons with inflammation then I guess it might be possible to have the same effects on atrial fibrillation. Hope you continue to feel better.

[va_tony]

Thanks again Doctor. I appreciate your taking the time to provide such clear answers to my questions.

BTW, I started allopurinol a week ago to lower uric acid levels to avoid further gout episodes and to remove a risk factor for heart disease.

Tony

[Michael J. McWilliams, M.D.]

Hi Tony,
1. I’ve read that high uric acid levels may be linked to heart disease.  Do you think there may also be a connection between either uric acid levels or gout and afib?

Increased uric acid levels are an independent predictor of cardiovascular risk.  High uric acid levels increase  your risk of gout.  It is often acute changes in uric acid levels that cause the gouty flare.  It is possible that AF decreased your renal clearance of uric acid and caused the flare -- it is also possible that this is a coincidence.  I did not see a direct association of atrial fib and uric acid levels.

2. I was prescribed indomethacin over the last few months to take for 5 days at a time to relieve the gout symptoms, which worked well.  I noticed that the last two times I started indomethacin while also in afib, I converted within a day or so.  When I googled indomethacin, I learned it is an anti-inflammatory (NSAID) and sometimes prescribed for infants with ASD to promote defect closure.  Is there a chance that my enlarged atrium temporarily contracted slightly while taking indomethacine, thereby promoting cardioversion? Or is timing of the recent self-conversions just another coincidence?

Your enlarged atrium is probably scar from years of increased pressure related to atrial fibrillation.  There is no current evidence that inflammation plays a role in chronic AF -- it certainly does in post operative patients.

Hope this helps.  Thanks for posting.