Latest protocol for antiarrhythmic drugs

Hello All ,

Been a while since I've been here. What Carey always says whenever someone asks about people and successful ablations being here is true. When you have a successful ablation and in NSR your visits here become less frequent and I am a guilty party.

Currently I am sitting in the ER with my 79yo mom. She has been in controlled persistent Afib for the better part of 15yrs.

She had rotator cuff surgery scheduled for today but refused her due to her elevated heart rate. It was in the 162 bpm range. She had had an EKG done for pre-op November 15 and the rate was 142 at that time. Of course they never sent the results to her PCP or the surgical center so nobody knew about it until today. So it's hard to say if her rate was constantly over 100 BPM for this entire time. She hasn't personally noticed much of a difference herself.

They are going to do some tests including an echo and keeping her overnight for at least this evening. The ER doc mentioned cardioversion but with long term AFib I doubt that will be an option a cardiologist will consider.

She is currently on 100mg metoprolol a day so if I remember correctly she's maxed out on that. So the laundry list the doc spat out was cartizem then amiodarone which I retorted my objections to that and mentioned flecanide and ticosyn which he sort of shot down stating that they were no longer in favor and that amiodrone was the preferred way to go.

So what are everyone's thoughts?

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rocketritch
So the laundry list the doc spat out was cartizem then amiodrone which I retorted my objections to that and mentioned flecanide and ticosyn which he sort of shot down stating that they were no longer in favor and that amiodrone was the preferred way to go.

If your mom has been in persistent afib for 15 years, the chances of a rhythm med working (except maybe amiodarone????) is pretty low.

I know flec is contraindicated for someone with heart failure & if your mom has been in these high rates for some time, she may likely be in heart failure.

Best wishes to her.

My angiography doctor said metoprolol maxed out at 200 mg/diem.

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GeorgeN

So the laundry list the doc spat out was cartizem then amiodrone which I retorted my objections to that and mentioned flecanide and ticosyn which he sort of shot down stating that they were no longer in favor and that amiodrone was the preferred way to go.


If your mom has been in persistent afib for 15 years, the chances of a rhythm med working (except maybe amiodarone????) is pretty low.

I know flec is contraindicated for someone with heart failure & if your mom has been in these high rates for some time, she may likely be in heart failure.

Best wishes to her.

I'm hoping she hasn't been constantly elevated. Even if it's only been for a month or so. She hasn't had any issues that she has noticed over this period. And she was just to her PCP a couple times over the past several months for non related issues. And if she was elevated at those times he surely would have done something.

I was surprised antiarrhythmic drugs even came up in the conversation since she has been in AFib for so long. I would have thought the focus would have been on other rate control drugs.

I don't think AAR drugs have a snowball's chance in hell of working. Maybe (and it's a big maybe) if they preloaded her with amiodarone and then cardioverted her, but the odds are low. I would think rate limitation would be their first consideration. They can go higher on the metoprolol and they can try diltiazem instead or in combination.

Since she's not responding to 100 mg of metoprolol, that makes me wonder if it's actually flutter. Flutter often isn't responsive to rate control. Those two EKGs showing 162 and 142 raise my suspicions further since they're both close to 150, but surely they would have noted that it wasn't afib when they did those EKGs?

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Carey
I don't think AAR drugs have a snowball's chance in hell of working. Maybe (and it's a big maybe) if they preloaded her with amiodarone and then cardioverted her, but the odds are low. I would think rate limitation would be their first consideration. They can go higher on the metoprolol and they can try diltiazem instead or in combination.

Since she's not responding to 100 mg of metoprolol, that makes me wonder if it's actually flutter. Flutter often isn't responsive to rate control. Those two EKGs showing 162 and 142 raise my suspicions further since they're both close to 150, but surely they would have noted that it wasn't afib when they did those EKGs?

I concur. Here is the strip from today

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Carey
Since she's not responding to 100 mg of metoprolol, that makes me wonder if it's actually flutter. Flutter often isn't responsive to rate control. Those two EKGs showing 162 and 142 raise my suspicions further since they're both close to 150, but surely they would have noted that it wasn't afib when they did those EKGs?

Would your Mom consider an ablation? If it is flutter, an elite EP might have a better chance of getting her out of those high rates with ablation rather than rate control with high medication doses.

That strip is regular in a few places, but overall it's mostly irregular. Could be a mix of flutter and afib, which is common, but I can't call that strip flutter.

That strip looks a LOT like the one I generated from my Samsung Galaxy watch at the request of the AF clinic outreach nurse at Royal Jubilee. No P waves, varied intervals in QRS, and lots of noise in between. I took it as recurrent AF, and my EP called me to agree and to arrange another ablation.

Mom came home yesterday. They added Tiazac to her metoprolol and had her stop her BP meds

Looking for opinions/experience with Multaq. I had ablation in November and was in rhythm for two weeks - then persistent pulse rate of 140. We decided to cardiovert just this week and that put me back in rhythm. But doc wants me on Multaq for one month - to keep things quiet and in rhythm. I am concerned about the side effects I have read about.
I would love any feedback on this. I am still on Eliquis and low 25 mg metoprolol for now - but would come off that when I start Multaq. I actually have the prescription but am wary to start. I would welcome any feedback. I am a new member.

I replied to your other question about it. I don't know what side effects you've read about or where you read it, but Multaq has few, if any, side effects for most people. Are you mixing it up with amiodarone?

I also had an ablation on November 8 and my EP (Natale) put me on Multaq afterwards. So far I'm staying in rhythm. I had been on Multaq for 8 months before the ablation and it didn't work so well then. As far as side-effects--aside from the price!--not much. You need to take it with a meal that includes fat and protein I've read. I have had minor digestive issues with it. I am supposed to take it until sometime in January. Hope it works for you.

Thank you for responses - I am going ahead for the month and trying to stay positive.

Thanks Carey - I did read your response - I probably shouldn't have posted in two places - but I did want some assurance that Multaq is effective with no severe side effects. I have read, however, that it can increase the effect of eliquis?? Should I be worried about that?

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PeggyK
I have read, however, that it can increase the effect of eliquis?? Should I be worried about that?

Nah. It's a very modest interaction. Probably more than half the people in the world taking Multaq are also taking Eliquis, and I've never heard of any EP adjusting the dosage because of it.