Pacemakers

My husband is now being told (scare tactic) that if he goes off Amioderone, 100% guarantee he’ll go back into A-fib. He’s had two episodes, two years apart and another ongoing one after an aortic valve replacement surgery, which I felt was poorly executed. He has been in sinus since June 18 after cardioversion.

The only solution, he is told, is to have a pacemaker installed and then he can go off Amioderone. Now he is being told he has pulmonary fibrosis which is making him cough.....incessantly.

I have hand-delivered his records to Mass Gen. for a second opinion, scheduled October 31.

I searched the forum but didn’t find much on pacemakers.

Your feedback will be much appreciated.

There's something missing here. A pacemaker won't keep him out of afib, so are there other arrhythmias they're concerned about that the amio is controlling? What exactly are they saying the purpose of the pacemaker is?

The pulmonary fibrosis is concerning. I would want to stop the amio ASAP if I were him, but first I'd want to make sure I understood the consequences. Can you explain why they want to implant a pacemaker? Is it also a defibrillator?

Welcome Catherine, and sorry to hear of your husband's troubles. Carey asks the key question above regarding why they are recommending a pacemaker to begin with?

Amiodarone is typically the AAR drug of last resort and can be very effective at controlling AFIB, at least for some time, but like most other AAR drugs it too often fails long term and it comes with some very serious side effect complications you are no doubt aware of ... including pulmonary fibrosis, thyroid toxicity and a hoist of other problems that make most informed EPs and Cardiologist willing to use it only when absolutely necessary and for as short a period as possible in the vast majority of cases.

Some cardiologist resort to Amio up front, as you would for a front line therapy anti-arrhythmic med. Even though it rarely, if ever, should be used in such a way, unless other complicating circumstances in your husbands case calls for it. I call it the lazy docs fall-back choice when they resort to it at the drop of a hat up front. For a patient like your husband, using Amio up-front for AFIB may also be inspired by a lack of understanding about other good options to exhaust first, including an expert ablation process by a highly experienced EP operator when it becomes clear the patient is in persistent AFIB in which sustained NSR cannot be achieved via ECV (Electro-cardioversion).

Typically, if Amio is prescribed for something like post-aortic-valve-surgery-induced AFIB, it would be intended for relatively short term use only and not dangled out there up-front as a long term solution for his procedure-induced AFIB.

And as Carey noted as well, we need to know if your husband has had any Ventricular tachycardia (VT) episodes or reduced left ventricular ejection fraction, either of which could make the use of Amio at this stage of your husbands case at least more defensible.

How old is your husband and please let us know if there are any other risk factors or cardiovascular issues that could help explain the care he is receiving now?

And, for sure, just adding in a pacemaker is not a solution for AFIB itself. I trust your doctors are not suggesting a permanent pacemaker to go along with an AV-Node ablation ... are they??

Best wishes,

Shannon

Carey, Shannon, thank you for your response. My husband is 80 years old; two A-fib episodes, two years apart. The second episode occurred two days before a scheduled aeortic valve replacement surgery (open heart),which I suspect occurred due to fear and stress. Nevertheless, they decided to perform the surgery despite the A-fib. He came through the surgery with tachycardia (140/160j for 10 days, whilst fibrilating. Amio infusion, then pills, then infusion were unsuccessful relative to the heart rate and rhythm. The 10th day, cardioversion was unsuccessful...back on amio infusion. Not converting. The 12th day another attemp, by another electrophysicist, which took, heart rate down in the 70’s but still fibrillating. Released with Metoprolol and amio. Two monts later cardioaverted into sinus and has continued, whilst still on amio.

Every time we have gone in for followup and asked to get off amio, we’re told he needs to stay in rhythm longer and to continue on amio or (paraphrading),”If you stop amio, you will revert to fibrillating 100%. However, we can install a pacemaker and then it will be safe to stop the amio”.

He has pulmonary fibrosis, still coughing and discussions of using oxygen at home.

I look at my husband and not too long ago I saw an energetic man and yes, huffed and puffed when stacking wood. Now, he gets out of breath walking across the room.

What happened here?

I apologize for repeating the same info, as I read my original post. But what I am relating here is exactly the events that took place.

No need to apologize. Your second post added details not clear in your first.

I don't know what happened here but it sounds like amio's toxic effects happened. I would want to hear the second opinion. I still don't understand why they think a pacemaker will replace amio. Mass General is generally a good choice so please report back.