New choices to make

Hello everyone,
I just had an appointment with my new EP. My cardiologist wanted me to see him because amiodarone wasn't working. She says that my previous heart surgery (mitral valve repair) is causing me to be extra resistant to treatment.

The EP is very considerate and nice and wants me to decide among three options. Those are: 1) staying in a-fib, 2) taking Tikosyn (after three days of hospital monitoring), and 3) getting a pulse field ablation, which he seems to be in favor of. I've tentatively opted for Tikosyn, which I don't know anything about other than what I see on Google. I'm tolerating a-fib reasonably well, but I hope I won't stay in it because of possible long-term problems.

I'd be glad for opinions. Also, I have a question. I read that Tikosyn might "improve" a-fib, but since I've got the persistent kind, rather than the paroxsysmal, what would an improvement consist of? Could it possibly be a shift from persistent to paroxsysmal?

Thanks all.

An improvement would be less or no afib, or milder symptoms. How long have you been in persistent afib? What drugs are you on now and what are your symptoms like?

The choices you face are the choices everyone with afib faces and they're not simple ones. Any of those three choices could be the right one but Tikosyn (or any drug) is unlikely to be a viable choice for the rest of your life. And, frankly, if amiodarone hasn't worked for you, I'm skeptical that Tikosyn will. It could, but amio is the hardest hitter of all the antiarrhythmic drugs.

But back to your symptoms. How difficult is it for you to live with afib?

For what my opinion is worth, I agree with everything Carey has stated. The drugs are unlikely to work well enough for you to be happy about taking them....at all. Maybe for a few months, two years, but I wouldn't bet on any one of them. Amiodarone is known as the 'big hammer', the AAD of last resort (anti-arrhythmic drug). It is the most toxic one that I know of and the most potent. Tikosyn might work, even really well, but the drugs, all of them, just don't have a long-term record of success in almost every patient. (Still, if you're loath to try an ablation, I would certainly recommend giving Tikosyn a try...the goal, as Carey says, is to stay out of AF for every minute that you can).

For me and many AF sufferers, the worst part about it is the anxiety and quality of life, mostly due to really intrusive symptoms. Any ethical EP will admit that, like so many health care specialists, they care most about making their patients 'feel well'. IOW, treating symptoms. If that is managed by stemming the AF, and it works for a few years, it gives the patient happiness and a few more good years off of the 'marching-toward-heart failure' bandwagon. Most of them do a pretty solid job of it, too.

Your question about a shift from persistent to paroxysmal...no, all the resources I have seen, and I have read through scores of literature articles and watched literally hundreds of videos given by EPs, say that AF is a progressive disorder for 'most everyone. The progression is unigrade, or prograde, and that direction is from first paroxysmal, to persistent, to long-standing persistent, and then to permanent. The latest research says that CA (catheter ablation) is now widely held by EPs to be the 'gold standard' treatment, even above the best drugs. EPs caution their patients that the time to manage AF is early...as early as possible, and whether that is to be drugs on highest recommendation or via CA, the best treatment is early treatment. So, once again, no, your retrograde regression, which is what it would be if it were possible, of persistent to paroxysmal is not happening. About all you can hope for is to stall the AF at whatever diagnosed stage it is at the moment. If it stops, it's because of some unforeseen body change, or a lifestyle change, or because the current treatment is keeping it controlled. An alectrically disorderd heart is going to remain electrically disordered.