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treatments
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Questions in the Heart Rhythm forum cover topics that include heart rhythm issues, arrhythmia, irregular heartbeat, implanted defibrillators, pacemakers, and tachycardia.

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treatments

I have an AF condition and taking 150 mg Arythmol 3 times daily but still getting AF every one to 2 months for 3 to 6 hours each time and tends to increase with figuores activity, heavy meals, my question is there a time released medication for AF that one can take once daily and the operation where the doctor burns the cells responsible for irregular  heart beat is this a dangerous procedure and what is the success rate as iam 49 years and want to continue exercising without the worry of having the condition and without medication.
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Hello,

1.  my question is there a time released medication for AF that one can take once daily?

Currently the only once daily medication is amiodarone.  I like to avoid amiodarone if I can because of the side effect profile, especially if you are talking about long term use.  There is a twice daily form of rhythmol SR (more expensive than rhythmol), sotalol and tikosyn are also both twice daily.  Once per day medications are rare because people may absorb the medications at different rates, leading to differing drug levels among users. Some of these medications are dangerous at high levels.

2. the operation where the doctor burns the cells responsible for irregular  heart beat is this a dangerous procedure and what is the success rate as iam 49 years and want to continue exercising without the worry of having the condition and without medication.


It is a safe procedure but there are alway risks.  You have to decide when the benefits to the procedure outweighs the risks for you.  This can be a tough decision.

The are variations in risk depending on the type of procedure and the operator.  More experienced operators tend to have fewer complications so it is important to find out how experienced your doctor is.  Training does make a difference.

In general the risk of complications are quoted like this:

Risk of stroke is about 1%.  While devistating strokes are rare, they can happen.  Bleeding risk is 2-4%.  Severe bleeding may require a blood transfusion or surgery, again this is not common, but it can happen.
The risk of bleeding around the heart (cardiac tamponade) is about 1% or less.  This may require drainage with a needle and catheter inserted into the sac around your heart and rarely requires surgery.  There is a risk of death with any procedure, although in general this is very low. Atrial esophageal fistulas are rare but are the most serious complications. If there is damage to your esophagus and an atrial esophageal fistula develops, the risk death is around 70-80%. At this point there are only case reports of AE fistulas so the exact incidence is not known. The risk is decreased by avoiding ablation around the esophagus. This is done by marking the esophagus with contrast, a temperature probe, or several other methods.  

There is about 25% chance of needing a second procedure to achieve the success rates quoted in most trials. There are also case reports about damage to the vagus nerve and problems with digestion related to this.  This is a pretty comprehensive lists, but there are some problems that I did not mention in detail like AV fistulas, pseudoaneurysm, etc.  At some point it is possible to get lost in the details. The cummulative risk of all these events is around 5-6%.  Remember the serious complications are rare events -- the majority of this percentage is bleeding events or surgery.  It is important to discuss this with your doctor before any procedure.

If you have a structurally normal heart and paroxysmal AF, success rates of 70-80% are frequently quoted in the literature. Success rates decrease depending on persistent AF, heart failure, valvular heart disease and other confounding medical problems.

You sound like a reasonable candidate for ablation as long as the risk-benefit profile sounds reasonable to you.

I hope this answers your questions.  Let us know what you decide to do in the end.  Good luck!
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