Atrial Fibrillation

[Valentine]

Been prescribed Lanoxin & Atenolol for A Fib, I was already taking warfarin so is included in the mix. Some side effects are not so good & seem to be getting more arrythmias than before. I have read that Atenolol can actually cause this. Wondering what ither alternative combinations or treatment which might be better.

[Lefty]

I have had AFIB for years and take only warfrin,No side  effects and feel great.Been seen by number of cartiologists in the U S. no recommendation to modify treatment.

Lefty

[Sheryl]

It is important to understand what these drugs are given for and what their expected effect is. NONE of them are expected to stop the arrythmia or make the heart beat more regular.

 

Warfarin  is given to reduce the risk of blood clots which are a known complication of A-fib. No effect on the heart rate or rhythm at all.

 

Lanoxin and atenolol  slow the ventricular response to atrial fibrillation (how fast the heart beats) so are used when the A-fib is accompanied by a high heart rate, as rapid heart rates result in significantly reduced cardiac output and can lead to congestive heart failure.  In someone whose heart rate is not too fast, these drugs are not needed. Their efficacy is assessed based on the change in heart rate, which in atrial fibrillation must be  measured with a stethoscope listening to the heart, peripheral pulses are not accurate because beats that come right after another one will often not pump much blood.

 

There are drugs which can be used to try to correct the arrythmia itself. Typically this is attempted only after the heart rate is well controlled. These drugs have significant side effects and require close monitoring, and they do not always work. They include  amiodarone, quinidine and others.

 

An alternative to drugs to restore normal heart rhythm is surgical ablation, for those who are good surgical risks.

 

Depending on a patient's overall; physical condition and age, it is sometimes deemed safer not to try to correct the heart rhythm at all but rather to only control the heart rate (if necessary) and give medications to reduce the risk of blot clot formation.  These would be cases where the patient is older, has other physical conditions that make them a poor surgical candidtae and high risk for adverse effects of anti-arrythmic drugs etc.

 

OP - you would not be getting "more arrythmias than before" as in A-fib it is a continuous arrythmia. The irregularity of the heart beats may be more apparent to you as a result of a slower heart rate, leading more of the beats to perfuse (be palpable at the wrist).  That is normal.

 

What you may want to discuss with your cardiologist  is (1) adding additional medications to try to restore a normal heart rhythm and/or (2) surgical ablation. If you tell me where you are located in Thailand I may be able to suggest a cardiologist as it does not sound like the level of communication you have with your current doctor is optimal.

[Valentine]

16 hours ago, Sheryl said:

It is important to understand what these drugs are given for and what their expected effect is. NONE of them are expected to stop the arrythmia or make the heart beat more regular.

 

Warfarin  is given to reduce the risk of blood clots which are a known complication of A-fib. No effect on the heart rate or rhythm at all.

 

Lanoxin and atenolol  slow the ventricular response to atrial fibrillation (how fast the heart beats) so are used when the A-fib is accompanied by a high heart rate, as rapid heart rates result in significantly reduced cardiac output and can lead to congestive heart failure.  In someone whose heart rate is not too fast, these drugs are not needed. Their efficacy is assessed based on the change in heart rate, which in atrial fibrillation must be  measured with a stethoscope listening to the heart, peripheral pulses are not accurate because beats that come right after another one will often not pump much blood.

 

There are drugs which can be used to try to correct the arrythmia itself. Typically this is attempted only after the heart rate is well controlled. These drugs have significant side effects and require close monitoring, and they do not always work. They include  amiodarone, quinidine and others.

 

An alternative to drugs to restore normal heart rhythm is surgical ablation, for those who are good surgical risks.

 

Depending on a patient's overall; physical condition and age, it is sometimes deemed safer not to try to correct the heart rhythm at all but rather to only control the heart rate (if necessary) and give medications to reduce the risk of blot clot formation.  These would be cases where the patient is older, has other physical conditions that make them a poor surgical candidtae and high risk for adverse effects of anti-arrythmic drugs etc.

 

OP - you would not be getting "more arrythmias than before" as in A-fib it is a continuous arrythmia. The irregularity of the heart beats may be more apparent to you as a result of a slower heart rate, leading more of the beats to perfuse (be palpable at the wrist).  That is normal.

 

What you may want to discuss with your cardiologist  is (1) adding additional medications to try to restore a normal heart rhythm and/or (2) surgical ablation. If you tell me where you are located in Thailand I may be able to suggest a cardiologist as it does not sound like the level of communication you have with your current doctor is optimal.

Thx. I am in Phuket. Had to wait 3 months to have an echocardiogram at Vachira after which had not more than 2 minutes with cardiologist. It is a busy place.

[Sheryl]

Unfortunately it is slim pickings in Phuket and mostly pretty young doctors without training abroad.

 

I recommend you invest in a trip to Bangkok and consult Prof. Buncha Sunnsaneewitayakul, who is a very experienced, US-trained cardiologist specializing in treatment of a-fib.

 

He can be seen through the after hours clinic at Chulalongkhiorn Univ Hospital, where he is on faculty, or at Bumrungrad https://www.bumrungrad.com/doctors/Buncha-Sunsaneewitayakul

 

Consultation will be cheaper at Chula but you can't make appointment in advance have to go in person to do it, which will entail  added time in Bangkok, hotel etc.  Consultation at Bumrungrad is likely to run about 1,500 baht then some hospital surcharged so think of it as 1,800 - 2,000. Maybe 1,000 more if they have to do an EKG -- if you are able to get your records from Vachira to bring with you it will help.  Do not buy meds at the hospital pharmacy!! There is a large mark-up. Buy instead at a pharmacy.

 

If you prefer to keep trying in Phuket, the cardiologist at Vachira (Dr. Khorawit Sooklim) also has hours at Bangkok Phuket Hospital and seeing him there will allow more time for discussion. There are also a number of cardiologists at Phuket International Hospital, though I can't recommend one over the other.

 

As mentioned before, the key points you ant to discuss are:

 

- whether you would be a candidate for ablation and if so, the pros/cons/risks (if you have this done you will not want to do it in a private hospital due to cost and I would advise not to do it in Phuket as you want it done by a team with significant experience. Suggest Chulalongkhorn).

 

- if not, the pros/cons of "chemical cardioversion" i.e. taking medications to try to normalize the heart rhythm.