Atrial Fibrillation in 86 year old

[shoshy]

My otherwise healthy 86 yo. mom was diagnised with Atrial Fibrillation and was admitted to the hospital for seven days. She is otherwise very healthy and was only on Hyzaar for blood pressure prior.
She was told her heart was strong and showed minimal damage, chest Xray proved negative, stress test was passed with exceptional results, but was kept hospitalized until her heart rate stopped spiking. She is now on 5.0 mill. of coumedin, Lopressor, 260mg of cardizam, and 40 mill of lasix because of severe swelling in fingers, legs and ankles, all of which she never had prior. She went from yearly checkups to lab and office visits every few days.

My question is, considering her good health overall, do you think she may be better off with less potent meds which seem to be placing her in more peril. She had a five pound wieght gain last week! Also, do all patients with this malady, get the same treatment plan instead of one that is more individualized?
Thank you in advance,
Allison

[kat4]

I am a little surprised that the doctor suggested a pacemaker associated with an AV node ablation.

I am only a layperson, but I had the impression that for younger people, that was a last resort procedure, as it leaves the heart in atrial fibrillation, although it slows the ventricles.  It used to be the treatment, but that was before less drastic measures were available.

My impression was that first, a different class of meds than your Mom is on would be tried - Flecainide, Tikosyn, among others.  If those didn't work, possibly an ablation for afib, but not the kind that zaps the AV node, rather the kind that gets rid of the electrical impulse places in the heart that originate afib.  The latter is a more subtle operation, however, more difficult for the doc and may take longer, I think.
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I am particularly surprised because D. McWilliams has mentioned before that he studied with Dr. Andrea Natale, probably the best doctor in the U.S. for the kind of ablation I am talking about.

Perhaps your Mom's age rule out these other possibilities, but I would ask explicitly about that, if this were my Mom or myself.

[Michael J. McWilliams, M.D.]

The issue is often one of controlling the heart rate.  We will first try to control the heart rate with one medication.  If that does not work,  a second medication is added.  Sometimes even a third medication is needed.  Cardizem (diltiazem) is known to cause swelling at higher doses, it seems elderly women are common group to have this problem.  One option is to use a medication called digoxin to help slow down the rate and decrease the dose of diltiazem.

It is an individualized treatment plan, but there are only a few options available to help slow down heart rates.  If people have side effects to the medications, sometimes the best option is to place a pacemaker and do a simple procedure (AV node ablation) that makes you pacemaker dependent.  That why the pacemaker is in full control of the heart rate and the medication doses can be decreased.  I have noticed that older women are often the ones that have the most medications side effects with atrial fibrillation and are more frequently the patients that end up with a pacemaker.

I hope this helps and wish you well.