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What different medications control rhythm
Heart Rhythm Conditions | Last Active: Jan 23 12:16pm | Replies (24)Comment receiving replies
What factors might one consider of ablation vs. medication? Apparently, med no longer working. This is for 87 year old, male with dementia that’s pretty substantial. Quadruple bypass in 2000 with 4 stents since. On Amiodarone for last couple of years prescribed by top cardiologist who is located in another city from patient. Cardioversion worked well several years ago, but AF returned despite meds. Care now with PCP due to difficulty of travel long distance for cardiologist. Concern since patient doesn’t understand surroundings and does not tolerate anything on his skin like IVs. Picks at any wound, difficult to manage in a facility as he demands to leave immediately. We are considering hospice evaluation, but not sure if any procedure could help with comfort at this point. He reports no pain, but weakness, fatigue. EF score has been low, under 35, since 2016, with the exception of one time period. Any input appreciated. Trying to be realistic.
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This is easy for me to offer because I have no 'skin in the game' except for my conscience and learning, but no expertise. I used to teach ethics at the university level, if that helps.
Elderly patients are at risk for general anesthesia, so the option would probably be propofol, but that would be up to the anesthetist. A profoundly demented patient, as you seem to suggest your friend/kin is, is perhaps demented due to the effects of prior arrhythmia that went unnoticed or poorly managed, perhaps for years. So, I'm inclined to suggest to you that your patient be allowed to live out the rest of his life 'naturally' with the best medicines that work, but not with mechanical remediation such as what an ablation has to offer. IOW, I think that an ablation might be the best option for the aim of controlling his heart rhythm, as it is for the heavy majority of us without dementia, but I don't think it's the best option for him due to the risk and to the expense. I would even hazard a guess that, given his state, he's not likely to live much longer after an ablation than he would have just being monitored and kept comfortable.
I appreciate that you are attempting to take a serious look at this, even to the extent of seeking other opinions. Mine is but one. Please be patient and others will offer their own in time, and please count theirs with the same weight as you do mine.