Todd
You have researched well and Dr Morady is your man .Three weeks ago
I was fortunate to sit in on an hour lecture given by Dr Morady here in the Tampa Area .I came away saying how lucky the Michigan people are to have such a Doctor .
He was introduced as someone that has written over 500 papers on this subject and was involved with the development of the Swan Ganz catheter .
His brief lecture included his thoughts on the French and Italian approach to catheter abalation of atrial fib. and why he favors the Pappone procedure .
He also discussed anticoagulation and the need to keep the plasma levels between the therapeutic INR (2-3) when taking coumadin and why these levels are difficult to maintain .
Fixed -dose Ximelagatran 36 mg twice daily is, or will soon be available but may be an expensive substitute .
He discussed the mechanism by which obstructive sleep apnea may predispose to AFib .Hypoxemia- hypercapnia-sympathetic surges-acute increases in BP->activation of strech receptors and electrophysiological effects; and the benefit of using CPAP following cardioversion in sleep apneic patients .
I had been seriously thinking about the use of ACE ihibitors even though my blood pressure is not an issue .Migraine headaches had been a major concern of mine before they were replaced by episodes of afib .I knew if I could dilate blood vessels that were responsible for my headache I would get relief .Now I'm thinking this is what I have to do to get back in sinus .
My life long problem is how to control the constriction and dilatation of my blood vessels .Hot and cold receptors in my brain not in sink .
I also observed the three -five pound weight swing during and after Afib episodes and wondered what part my kidneys were playing .I assume Atrial Fib. results in the accumulation of fluid and conversion back to sinus heralds an out- pouring of fluid .
As if on cue Dr Morady discussed the use of Irbesartan to maintain sinus rhythm after cardioversion .Irbesartan/Avapro lowers blood pressure by stopping angiotensin working which results in dilated blood vessels .
His lecture hand-out also included the renin-angiotensin system in Atrial Fibrillation .From what I can see during the prolonged rapid atrial pacing while in atrial fib .Angiotesin II->activation of extracellular signal-related protein->firoblast proliferation->atrial fibrosis .The use of Angiotensin II antagonists and ACE inhibitors blunt acute electrical remodeling .
Amiodarone he discussed and added that along with the many known side effects .Amiodarone did effect gonadal function and was 60% more responsible for atrophy of the testes than other drugs .A sure reason to look to other treatments for AFib .
Also the surgical Maze procedure could be attempted in patients undergoing open heart surgery but the other forms of LA Ablation were more favored .
Pacemakers were not seen as necesssary as with the improving success of the LA Ablation .
On demand approach to taking medication .'It benefits the patients to take meds. this way .I would suggest they take Propafenone 300mg every 6 hours until they convert as well as Irbesartan .'Irbesartan 150/300mg daily .
You have to be brave to start taking your meds. on demand .I can remember asking my cardiologist if I could take my meds. this way and he dismissed it as being totally irrational .He always favored the pacemaker approach .Well I have started, and in the past four weeks I have had my usual two episodes of AFib weekly but have converted after 300mg of Propafenone each time except once when I converted after the second dose .Perhaps in the future I will add Avapro 75mg daily as well, to see if this benefits me .Then sometime in the future if I still have PAF I will decide on a third LA Ablation . I supplement with Magnesium and take Coumadin as well .
Above is an account of what I interpreted from the lecture others may have seen it differently .I hope that Atrial Fibbers will have an opportunity to discuss their concerns with Dr Morady in the future .
The 12 pages of his lecture has file no.232 on it so I guess can be obtained from Michigan State University Hospital .