atrial fib and lidocaine

hello.  i have been to the dentist to get a upper wisdom tooth pulled .  each time my dentist tries i cant get numb. he uses caines without epinephrine in them.  my heart condition is tachycardia (about 109 beats without meds) i am over wieght 250 pounds . i also have sleep apnea.  i also have atrial fib episodes lasting about 7 seconds each time and i get them about 6 times a year. more if i am stressed. i have high blood pressure . without meds it runs 147/93.  i am on atenolol 25 mg. a day.  my dentist says he will not use epi and doesnt know what else to do.  he sent me to an oral surgeoun who says he will use epi on me.  my question is, is this safe to use epi on me?  my cardiologist says no and gives me no other options to get my tooth pulled.  how do you get a tooth pulled if you cant get numb safely?????...    will the epi kill me or something?  i am at a dead end here. no one has any answers.  help.....

[Michael J. McWilliams, M.D.]

The epinephrine is used to control bleeding, the lidocaine is what should numb your gums/teeth.  If your cardiologist says you can't have epi, I certainly can't second guess that.  They must have a good reason for saying it.  In general, the epi used with lidocaine is in very low does and does not cause problems.  If your cardiologist insists you can't have, it might be worth getting a second opinion.  If you do get a second opinion, don't tell them the your doctor doesn't want you to have epi, wait to see if they come to the same conclusion independently.  That is how I would handle if I saw a similar situation in clinic.

I hope this helps.