Amiodarone question

[Emmaj]

F age 50 I had a mitral valve replacement in July. The surgeon did not do concurrent maze procedure as it would've added to risk, this being a 2nd surgery. Before the surgery I was having episodic brief a-fib (showed up on Holter, don't know for how long). I was taking Toprol and Verapamil to control SVT. Following the surgery, the drs stabilized my rhythm with Amiodarone, their second choice of meds - first choice (not sure what) didn't work. In the hospital (maybe because I had a can and a half of caffeinated soda to perk up), I went into very, very rapid afib. I felt extemely unsteady, unable to sleep really. The drs. upped the dose of Amio, I started Digitek,and after 48 hrs., had a successful cardioversion. Recently, due to my fear of Amio side effects, my cardio agreed to reduce the dose to 100 mg and said I could really go off it and try another med. He also said some people live with chronic a-fib... I know I could not function if it were rapid a-fib and I would not be very happy really with even chronic, slow a-fib, so I am a little nervous. What meds might be a good alternative to Amio in my case? (I would like to do a little research on them.) Any idea how much a person can "fool around" with meds/cardioversion before a-fib becomes a "going thing" or is everybody different? Thank you so much for this wonderful service.

[Emmaj]

Lung problems can be bad too! A person can develop pulmonary fibrosis, which can be fatal, but usually only develops in people who have underlying lung problems. There is also a risk of some sort of (?corneal) lesions developing on the eye too - scary! I'm not sure if the eye problems are reversable or not. There is also a risk of thyroid trouble, but not sure how much risk or how bad the trouble. I read drs advice, I think in this forum within last month or so, that a person should have a pulmonary function test when starting this med, regular eye exams (once a year or even more often during the first year), and other baseline studies. The worst problems seem to be associated with the highest dosages. Hope your mom can find another med soon! None are without side effects, but everytime I read about Amiodarone, I read the cautionary words too, and that is not true when I read about many other meds... so it's not really reassurring.

[DonJose]

My mother is taking amiodarone right now, and I'm going to ask her MD tomorrow what alternatives might work as well.  She's 71, has CHF, developed arrhythmia last November.  I'm wondering which side effect worried you the most.  The LIVER FAILURE possibility got my attention real quick, as well as the possibility of developing new arrhythmias.  Good Luck in your search for a less lethal medication.

DonJose

[Emmaj]

Thank you so much for your answer. Oh, I actually do have coronary disease. I should have mentioned, but I didn't know it would make a difference in the answer. If you read this post and have time, would you possibly tell me of some anti-arrythmics that I could look into given the coronary disease? I just have a fear of being stuck in a-fib. Maybe I can go off meds though - your answer gave me some courage to try after I check with my cardio next.

[Cleveland Clinic]

emma,

A few comments.

You may not need long term amiodarone if you went into fibrillation immediately post operation. Afib is common, especially post valve surgery. A large number of people do not need long term anti arryhtmic maintanence.

You are relatively young. In the absence of coronary disease other antiarryhtmics include sotolol, ibutilide, mexilitine to name a few. You need to realize all antiarrythmic medications can actually case arryhtmias, so the risk and benefits must be weighed carefully.

There is no set time to 'fool' around. If you are in persistant atrial fibrillation it may be worth while to be evaluated at a referral center that specializes in atrial fibrillation to explore all of your options.

hope this is a start.