Valvular Afib Questions

Dear wife's journey thru Afib just became a bit more complicated of late.
Multaq treatment (for paraox afib) began failing about a year ago and became persistant afib with rapid ventricular response. Local Cardo sent us to local EP who pushed very hard for immediate ablation. Acquaintances had had successes with Tikosyn so we opted for that route. (We had also been warned by other local MDs to not trust the local EP group - but if need be go to Cleveland.)

The Local EP had diagnosed her as non-valvular afib.
After induction of the Tikosyn , the afib seemed to settle into paroxysmal status again, but we could see the writing on the future wall so we consulted with Cleveland C.
There. we consented to the ablation, who ordered a ECHO (previous ECHO was almost 3 years old). Upon reading the echo, (interpretation now of moderately severe aortic valve stenosis) the ablation EP insisted on a valve job before he would consider doing the ablation. So now we are waiting on meeting with the TAVR team.

In the meanwhile, the TAVR team has suggested (and EP agreed) that she should discontinue the Tikosyn, but the only reason given was "it's not doing any good".

So, a couple of questions:
1) Does moderately severe Aortic Valve now classify her as " valvular AFIB", and what is the difference in treating valvular versus non-valvular AFIB?
2) Since starting on the Tikosyn she has experienced several days-long freedom from afib, suggesting that the Tikosyn seems to be providing some benefit. Is there any other reasons to suspend the Tikosyn, for what might be several months, prior to the TAVR?

(BTW, her valve stenosis is not limited to the Aortic, but other valves are not ripe for replacement. Her Aortic Valve stenosis progressed from "mild" to "severe " over the course of three years)

It is standard for surgeons to want more pressing matters cleared up. My father had to have an endarterectomy before the osteo would agree to a hip replacement. !!! It's understandable. Get the occluded carotid fixed, and if he's still viable and able to argue persuasively that an 86 year-old should bother getting hips replaced, we'll do it. And they did.

My wife was suspected of Behcet's Disease. She was placed on colchicine as a preliminary process to see how she'd come along. Then, we finally got to the rheumatologist appointment, and she decided that my wife does not have the typical symptoms and ethnic profile. Some of the symptoms, but not enough. Meanwhile, she has improved dramatically on colchicine. It's nothing short of miraculous. I haven't seen her happier and more energetic in two years! So, we anticipate that her GP will agree, for now, to keep on keepin' on. Why remove something that appears to have settled my wife's various autoimmune problems down? Could it hurt to keep your wife on "Tik? It seems to me that you'd like her heart to be in rhythm, thanks very much, and leave her with just one other problem for now, that being the partly calcified aortic valve. Don't put more strain on the heart's function than is necessary!!

I'm not an expert, so whaddo I know...

I can't comment on the difference in treating "valvular Afib" and non-valvular. I'd guess that this is not a clear-cut distinction as many of us, including me, have had valve involvement that became an issue somewhere in our journey with Afib. It is possible that it is the effects of Tikosyn in particular that might be in question as you prepare for a TAVR--maybe someone else knows more.

Though I had mild mitral valve prolapse and regurgitation for decades before being diagnosed with Afib, this is a common condition and didn't play a part in how my EP treated my Afib (with antiarrhythmics). After I had failed the meds, I decided that I wanted to have an ablation with Dr. Natale and sent him my medical records. He asked for an updated echo which showed that I now had severe mitral valve regurgitation so he asked me to get that repaired and then he would re-evaluate me for an ablation. After the repair I did go to him for an ablation but he warned me that because of the valve issue the ablation would be more extensive and might require a touch-up. Looking back it would have been much better if my local EP had kept up with my echos and spotted the valve problem earlier, but still I think my Afib would have been treated in the same way, as even after the repair, my local EP prescribed Multaq. Can you question your EP as to why, in particular, he wants your wife to discontinue Tikosyn?

Daisy said "Can you question your EP as to why, in particular, he wants your wife to discontinue Tikosyn?"

I've already sent him a message to the effect of : Is there more of an issue with taking Tikosyn beyond that just 'it's not doing any good'.

Just to be clear it was the Valve replacement doc that suggested stopping the Tikosyn, and he asked the Cleveland EP for agreement.

The valve replacement may be months away, and Tikosyn extinction is 50 hours.

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Searching9
1) Does moderately severe Aortic Valve now classify her as " valvular AFIB", and what is the difference in treating valvular versus non-valvular AFIB?
2) Since starting on the Tikosyn she has experienced several days-long freedom from afib, suggesting that the Tikosyn seems to be providing some benefit. Is there any other reasons to suspend the Tikosyn, for what might be several months, prior to the TAVR?

1) Probably not since valvular afib is afib caused by mitral stenosis or an artificial valve and she has aortic stenosis. But you did say her other valves have stenosis as well, so a cardiologist might argue that it is. I honestly don't know that it really matters much from a practical standpoint.

2) I cannot find any contraindications to Tikosyn associated with valve disease, so it would seem the only reason to stop it is the doctor's opinion that it's doing no good. But you disagree and think it is helping at least some. So unless that doc can give you a better reason, I would continue it. One thing I noticed and everyone I've known who's been on Tikosyn agrees is that it becomes more effective the longer you take it, so that's another reason to continue it.

Thanks to all for the information.

I know I am a little late here with my comments but I was wondering if you got any more clarification on Tikosyn? I agree that it is very odd for the doctors to stop a medication without a clearer explanation. I have some experience with Tikosyn and all the others (AAD) out there and each time there was always a clear medical reason why I had to stop it, anything from elevated liver enzymes to prolonging QT. Tikosyn can only be started in a hospital setting for one thing, and in my case it did prolong the QT.
Hope this helps.
Mary