Treatment options for Atrial Fibrillation

[bundleblocker]

I am curious. My doctor has prescribed Metopropol for my Afibs. Why is a beta blocker prescribed instead of a drug which will actually treat the Afibs?  The beta blocker will lower my heart rate, but I get the Afibs at night usually when my heart rate is low anyway.  I have only once gotten them while jogging.

So it seems to me that the Metopropol will not avoid the Afibs, just control them.  Is that correct?

Thanks!

Greta

[bundleblocker]

Yes, I do have a cardiologist but he is hard to get a hold of. My internist is much easier (although not this holiday week, I have left several "non urgent" messages which haven't been returned, I figure he took the week off)

The low potassium was discovered in the ER. Previously it had been fine. The ER  doc just gave me a pill.  The cardiologist said to get  it re-checked by a lab next week sometime Then we'll take it from there. Hopefully it is just a temporary thing and has resolved itself.

Thanks for the positive thought at the golden years!.

[Brooke_38]

I'm glad to have answered some of your questions. Yes, your Systolic BP is a little on the low side. Maybe your Dr can discontinue the Diovan, keep the Metoprolol as is or increase that a tad and let's not forget the addition of the blood thinner:)

Regarding the Potassium of 3.1, you weren't given a supplement? When my levels drop, I am put on a Supp.

You mention Primary Dr...Do you have a cardiologist? They would be the best source for treating heart related issues.

Don't feel down about the golden years...look at this as just another speed bump. It'll slow you down momentarily but you'll pick up speed in a flash:)

[bundleblocker]

Thanks Brooke and Jerry:

I will ask the doc about the blood thinner when I see him in a couple of weeks for an echo/stress.

I also need a follow-up blood test for low potassium (3.1) which will be done next week.

I am 72 and pretty healthy except for the BP. Which, oddly enough, has been low lately after running. Top figures of 95, and 101.  Of course this is just after stopping the run so maybe normal.

But it is another thing I will mention, as I may be able to go off the Diovan. Seems to me I don't need both the Diovan and the Metopropol, right?

I will call my primary doc on Monday and ask his advice.  I am not used to having all these health concerns and am not dealing with it very well. And they call this the golden age?  Hmph!!

Thanks a lot to both of you for your comments.

[Jerry_NJ]

My experience supports Brooke_38 on blood thinner.  My cardiologist kept me on a blood thinner when I was in NSR following electrocardioversion.  Two of these lasted over 18 months each, and each time he said not to go off warfarin as with AFib there was no telling when I might slip in/out of AFib.  To the best of my knowledge when I slip into AFib, it sticks.  In any case, my cardiologist was concerned that I might have short periods of AFib and not even be aware of them, and even that justified the minimal sided effects of taking warfarin.  I tolerate the drug well, and maintain a stable desired clotting range.

[Brooke_38]

Greta...

I won't say that I'm shocked that he didn't prescribe a blood thinner. Many times this is overlooked and it isn't until disaster strikes that they take a look. I'm not trying to scare you but this needs to be addressed.


Assess Risk of stroke with Atrial Fibrillation using CHADS scoring system...if you have at least 1 point as a risk factor then a blood thinner (Coumadin) is critical to reduce your chance of suffering a stroke.

Congestive Heart Failure (1 point)
Hypertension (1 point)
Age over 75 years (1 point)
Diabetes Mellitus (1 point)
Stroke or TIA history (2 points)
Mitral Stenosis or prosthetic heart valve carry similar risk and also indicate Warfarin

I see that you definitely meet criteria with 1 point for HTN. Please call your Dr regarding this.  

[bundleblocker]

Thanks Mike!  It is comforting to know other people have these kinds of things too  I hope you continue to be without the Afibs.

[bundleblocker]

Thanks for the information. I really appreciate it.  The doctor has not prescribed a blood thinner with the Metoprolol; I will ask him why.  (Not that I want any more medications!)

I am also on Diovan for high BP and will ask my internist if I should remain on this too along with the Meto.

[Mike85281]

I was started on Metoprolol back in 2004 after my first bout with Afib. I was told it would help prevent it from happening again. While still taking the Metoprolol, I went into Afib at least 6 to 7 more times since 2004, each requiring a hospital stay to get me back in a normal rhythm. The Metoprolol only slowed my heart rate, nothing more. My Afib doesn't last more than 12 hours. Usually by morning my heart is normal again, with or without medication. I think it's a panic attack that causes mine. However, in July of this year, I had Afib again and went to the ER and was put on Amiodarone. Since then, my heart rate has slowed even more, around 55 bpm, and I've had no more Afib. I'm not celebrating yet, as I've gone over a year before without Afib before being on Amiodarone. In three years, if I'm still without an Afib attack, I will believe the Amio did the trick. I've had no side effects from it at all either.

[Brooke_38]

The first step in managing atrial fibrillation is typically to treat it with medications, starting with a rate control drug to slow the heart rate in combination with anticoagulation by a blood thinner to reduce the risk of stroke.

There are three types of medications used in treating and managing atrial fibrillation:

Rate control medication to control the heart rate
Rhythm control medication, sometimes called drug cardioversion, to put the heart back into normal sinus rhythm

Your doctor will decide which rhythm control drug is best for you based on the type of atrial fibrillation you have and your medical history, including the presence or absence of other existing heart disease. Here are the types of drugs used for rhythm control:

Sodium channel blockers, which improve the heart's rhythm by slowing the heart's electrical conduction. Examples include Flecainide (Tambocor), Propafenone (Rythmol), and Quinidine (Various).
Potassium channel blockers, which relax the heart muscle and slow the electrical signals that cause afib. Examples include Amiodarone (Cordarone, Pacerone) and Sotalol (Betapace).
These medications are not considered to be highly effective and many have major side effects. For example, quinidine is only about 50 percent effective in maintaining a normal sinus rhythm over the long term, and flecainide, propafenone and sotalol are not much better.

Amiodarone is considered superior to these other medications in attaining and maintaining normal sinus rhythm, but may be the medication of last resort due to its lung toxicity and potential for long-term adverse effects.  Some people who took amiodarone mentioned that it can make you to turn blue like a "Smurf." Who wants to turn blue!

Many people that were on rhythm control drugs said that those medications just left them feeling badly and persistently tired. For most, these medications worked at first, and in some cases controlled their afib for years, but eventually just stopped working.


Anticoagulant medication, such as warfarin or Coumadin, to control blood thickness and avoid blood clots and stroke
The latest clinical trials have changed the thinking of doctors about how to manage and treat atrial fibrillation by discovering that it's less important than originally thought to get afib patients into normal sinus rhythm. Afib patients, however, should always be anticoagulated. The newest strategy for doctors in managing atrial fibrillation is:

Control heart rate and anticoagulate, and if there are no symptoms and the heart rate is controlled, then leave the patient in afib
Cardioversion for patients who still have symptoms and the heart rate can't be controlled, or for whom normal sinus rhythm is preferred .

I hope this helps explain your Dr's thinking...