a-fib

I am 70 years old and have had a-fib 7 times over the last 18 years.  I have converted on my own or with cardioversion. In the last two months, however, I have had 3 episodes, two terminating on their own and this last one has not.  Spoke with my cardiologist and he suggested being cardioverted with IV heparin or going on coumadin and see how I do in a-fib and either remain in a-fib as it is now occuring with more frequency or be cardioverted in 4 weeks.  My question is this.  Will cardioversion be as successful after  4 weeks?  And, is staying in a-fib with good rate control at my age the better option rather than rythem control  and being in an our of the hospital every month or two?  I am presently on lanoxin, lopressor and coumadin.  Thank you!

[va_tony]

"And, is staying in a-fib with good rate control at my age the better option rather than rythem control  and being in an our of the hospital every month or two? "

I'm 65 and that's exactly the question I'm struggling with - rate or rhythm control. The answer depends on how the afib affects your quality of life and the viability of other options. I've been on rhythm control for the last five years (taking rythmol). That worked well until this past year when I unfortunately started going back into and out of afib a month at a time.  I've currently been in afib for the last 5 weeks and have been talking with my cardiologist about switching meds (to sotalol) and another hospital cardioversion. The other option is rate control and just living with afib. In my case, I'm a good candidate for rate control because I tolerate (hardly notice actually) the afib.  While in afib my heart rate is typically 55 to 75 bpm and I function normally. Also because I have an enlarged atria, I'm a poor candidate for an ablation. So rate or rhythm control are my only options.

"Will cardioversion be as successful after 4 weeks".

Yes, it's been my experience that it will.  I have been in afib as long as 6 months (about 5 years ago) and have had hospital cardioversions that worked when used in conjunction with an antiarrhythmic like rythmol.

You need to consider how symptomatic you are during afib.  If you feel weak and dizzy all the time and are annoyed by the palps, then you should instead consider alternatives such as rhythm control or an ablation. If you tolerate afib well, then rate control is worth considering.  In fact, a large clinical study called AFFIRM showed that rate control patients actually lived longer and had an equal quality of life (assuming they were largely asymptomatic) as those on rhythm control.

I've been opting for rhythm control because I feel instinctively that it's best to stay in normal sinus rhythm (even though the AFFIRM study seems to contradict that belief).  For one thing, when in NSR there is less chance of a stroke (I do take coumadin also in any event). Also, the heart is slowly damaged by the afib -- ventricles thicken and atria enlarge with time. So that has to be considered as well. On the other hand, the use of strong antiarrhythmics such as rythmol, flecanide, sotalol for rhythm control is itself inherently dangerous (chance of a deadly proarrhythmic effect especially if you have some CAD).

Tough decision.

Good luck

Tony

[SwanSong]

[SwanSong]

That last post didn't quite work.

I am on Flecainide and Digoxin for atrial fibrillation which is caused by Perimyocarditis. I can't tolerate anticoagulants because they cause internal bleeding. So I am limited in the medications I can receive.

Before the A Fib, my heart rate was a steady 50 - 60 bpm. During A Fib my heart rate is between 78 to 154 bpm. I have tachycardia with the A Fib.