Saw my EP today

Saw my EP today: I asked about another Cardioversion, he said that it probably would not take and has advised against it. He wants to try drugs especially Aminodorine (sp) I said I didn't want that drug, he did mention tikosyn, I would have to spend 3 days in the hospital but he seemed to feel that as long as I am not in a high heart rate or huffing and puffing that I should just take my Xeralto and that's it. I asked about an Ablation and he said not recommended because of my age. I am 85 and am still in good shape except for this dang AF, everything checks out ok. I am very disappointed.

Liz

Tikosyn is usually pretty effective but I would check Tikosyn prices and what your Medicare drug plan will pay. It tends to be pretty expensive.

A lot of EPs will advise against ablations for someone your age as a kneejerk response,. but the top guys usually don't.

Maybe you should get a second opinion.

Quote
allofus
Maybe you should get a second opinion.

Ditto

I was on Tikosyn for a while when my ablation inf January of 2018 did not hold. This was after flecanide failed to work for me. It did not work as well as I thought it would in the beginning but the longer I was on it the better it did work. I had no ill affects from it. The three day hospital stay was a bit of a pain but as I was limited to the floor I was on.

Hi Liz
Something of interest

**********-
Safety of catheter ablation for atrial fibrillation in the octogenarian population
Jorge Romero MD Gbolahan Ogunbayo MD Samy C. Elayi MD Yousef Darrat MD Saul A. Rios MD Juan C. Diaz MD Isabella Alviz MD … See all authors
First published:10 September 2019 [doi.org] Citations: 1
Disclosure:: Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel support from Medtronic, Atricure, EPiEP, and Biotronik.
Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and St Jude Medical.
Natale received speaker honoraria/travel from Medtronic, Atricure, EPiEP Biotronik, and Janssen. The remaining authors have no disclosures.

I wonder if this the Natale often recommended on this site?

Abstract

Introduction
Catheter ablation (CA) has been shown to be an effective treatment for atrial fibrillation (AF). The complication rates and outcomes among octogenarians remain poorly studied. We aimed to compare trends, morbidity, and mortality associated with CA for AF among octogenarians versus those less than 80 years old.

Methods
Using weighted sampling from the National Inpatient Sample database, we identified patients with a primary diagnosis of AF and a primary procedure of CA (2004‐2013). Our primary outcome was mortality. Secondary outcomes included incidence of major and minor complications.

Results
Among 86,119 patients who underwent CA for AF, 3,482 were 80 years old or older. Complications were significantly more frequent in octogenarians; [16.2% (564 of 3,482) versus 9.8% (8,092 of 82,637), P < 0.001]. Of note, there was no significant difference for the composite of major complications; [3.6% (124 of 3482) in octogenarians versus 2.8% (2286 of 82637), P = 0.20]. The total mortality rate was not significant in a multivariate regression analysis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.35‐2.64; P = .94). The presence of chronic renal failure (OR, 4.19; 95% CI, 2.75‐6.36; P < 0.001), anemia (OR, 1.75; 95% CI, 1.03‐2.97; P = .04), and chronic pulmonary disease (OR, 1.75; 95% CI, 1.11‐2.62; P = .015) were predictors of major complications in octogenarians.

Conclusion
Catheter ablation for AF in octogenarians does not confer a higher mortality risk than in those less than 80 years old. The procedure is associated with a higher rate of overall complications but there was no difference in terms of major complications or death. The presence of anemia, CKD or pulmonary disease were predictors of major complications in octogenarians.

I'm considering one myself, I've just been through another horrendous episode 28 hours....where my HR was >160 and <50. Sick as a dog!
Had to stay in bed ....something I've never done.

Like Rocketritch indicated while on the Tikosyn initially, you would probably be able to move somewhat freely around the Hospital floor, not stuck in bed for 3 days.



Edited 2 time(s). Last edit at 02/14/2020 09:41AM by The Anti-Fib.

Unless something else is going on there shouldn't be any bed restriction. I was allowed to wander around and do anything I wanted as long as I stayed within range of the monitoring system. That gave me access to the entire cardiology ward, the hallways within a few hundred feet, and the family waiting room that had vending machines. It was a boring 3 days but otherwise no big deal.

Carey said --- Tikosyn is usually pretty effective but I would check Tikosyn prices and what your Medicare drug plan will pay. It tends to be pretty expensive.


I checked with my Ins. and they said that the 100-150 mcg. would cost around 73.00 for 20 pills, then when the donut hole is reached the cost would be 48.00. I paid around 58.00 for my propafenone and it didn't do any good, so Tikosyn isn't that much more.

Liz

I have an appointment with a new cardio/EP, I am dropping my EP that I have gone to for almost 20 years, he disappointed me when he said that another Cardioversion would probably not hold, he could have tried one more time. Also, his drug of choice for me is Aminodormine, I don't think he likes it that I refuse to take it. He asked how I am feeling as to the extent that the AF is affecting me, right now, it isn't bad, but it is winter time and I don't have as much work. Just my house and cooking, this is not bothering me, but when Spring and summer come I will be outside doing yard work and in my garden. So he says well lets wait and see how you are then. Well, he can kiss my you know what, I am getting another Cardio/EP and they are near where I live.

Liz

You have a good drug plan. I've heard of people paying $200+ for Tikosyn.

I have been an avid reader of this forum since 2014, which coincides with my first real afib episode. This is my first post. Initially, a low dose of metoprolol kept me in nsr. However, my afib episodes were increasing, from 2-4hrs every few months to 6-10hrs one or two times each month. I have always converted on my own.

In December 2018 an episode landed me in the ER, diagnosed flutter, confirmed(?) with an EKG. I was put on Amiodarone- 200mg 1x day and sent home. A few hours on google reading about the dangers of the drug caused a bit of anxiety- understatement! But I stuck with it and after 3 months, cut the daily dose to 175mg. after 5 weeks, cut the daily dose to 150, then further to 125. No afib. Emboldened, I dropped to 100mg. Turned out to be too far. After 10 days @ 100mg, I had my first afib episode. I retreated back to the full 200mg dose for two weeks, dropped back to 125mg and have been in NSR since. Blood tests at 3,6, and 12mo. show a low amiodarone levels.
I’m 6’ 190. A friend who weighs 140 is on the 200mg dose- which I understand to be the smallest tablet made. My understanding is most of the issues with this drug occurred back when the standard dosage was 400mg 1-2x day. Not sure why there is no 100mg tablet?

Back to the flutter diagnosis. A famous EP looked at the EKG. Agreed, it was flutter. Another EP who is the dept head at a large respected university hospital, said it was not flutter. That seems consistent with my medical journey.

JP

JP

You say you are in NSR and have no issues with the drug, I am on thyroid meds and I have read that Amiodarone can cause problems with the thyroid, it can either make you hypo or hyper. The EP that I have been seeing said that he would put me on the lowest dose, I have always read bad things about this drug, you are the first person that has posted about your good experience with Amiodarone, I thank you for that.

Are you on any anti-coagulant drugs or since you are in NSR for quite a while you probably don't need to be.

Liz

Liz,

I was prescribed xarelto- 25mg 1x day. An anticoagulant of some flavor seems to be standard procedure. My plan was to remain on X until I was confident the Amiodarone was keeping me in nsr. I have an early alivecor unit and an Apple watch 4 to confirm my suspicions. After 3 weeks I discontinued the Xarelto- which I have stayed on if I was not confident I was could detect rhythm issues. 14 months, 1 afib event- which was the result of my experimenting with the dosage.

I share your concerns. I was very frustrated to be prescribed what seems to be regarded as poison- Lungs, eyes, thyroid will all be destroyed! The loading dose alone is a challenge to get through 1200mg day. This drug requires monitoring via blood tests, which I am doing. If I start to have issues, I will have to consider other options. In the end, I had to trust my cardiologist.

Of the 2 EPs I met with, one expressed concern. The other still prescribed the drug to his patients and is interested in my dosage experiment. I now copy him with my lab results.

JP