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Heart Rhythm Control Medication

Heart Rhythm Conditions | Last Active: Aug 18 5:13pm | Replies (16)

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First, you are in good hands. They know their stuff.
Secondly, you are right to be inquisitive, cautious, and to want to be on top of your own care...for your own good!
So far, so good...welcome to Mayo Connect and to atrial fibrillation (AF in the medical abbreviation community).
Firstly, I am not a physician, and have no other medical training. I have had AF for eight years now, two ablations (the first failed, a 25% probability across the medical establishment). I have read a lot, viewed hundreds of videos, asked a lot of questions. Here is what I have learned:
First general rule: AF is a progressive disorder. It will get worse over time, especially if poorly managed. For some, the progression is quick through the stages to 'permanent', while for a great many it takes years.
Second general rule: because it is progressive, it becomes more resistant to any kind of intervention the more advanced and complex it is. So, the logic goes that one should be somewhat aggressive with its management as soon as possible after diagnosis. You can google AF and its subsequent stages and possible outcomes, the final one being 'heart failure', a most unfortunate choice of term because the heart doesn't fail.
Third general rule: the risk of stroke is now about six times what it was before you developed AF....generally. So, you should take your DOAC religiously as prescribed (direct-acting oral anti-coagulant).
Heart medicines work very well for the most part, but some cannot tolerate them, at least for long, and some have to be started and titrated during a three day stay in hospital (Dofetilide, or Tikosyn, as an example). Anti-arrhythmic drugs tend to lose their effect, especially as the disorder progresses. This is why some physicians encourage their patients who are occasional AF sufferers (meaning paroxysmal) to use a PIP (pill in pocket) approach to using the drug. If/when you fibrillate, pop the pill in your wallet, wait 40 minutes, and you'll probably respond well. Happens quite reliably for many who use this approach.
I only have experience with the Big Hammer....amiodarone. I didn't want to take it, but by EP and the internist at the ER agreed between them that I was going to have to take it for a few weeks at least. I did, and it worked really well to stop my chaotic heart six days after my failed index ablation. I in the unlucky 25% failure group. I have no experience with flecainide, propafenone, Sotalol, Multaq, or other anti-arrhythmics, nor with Diltiazem, bisoprolol, and other rate control medications (mine was metoprolol).
This is getting long, maybe more than you want to digest. But one last caution for you: do keep a close eye on your blood pressure. The rate control medications, as dosages climb over time (maybe, maybe not) can cause very low blood pressure when the heart is behaving in NSR. If you find your heart rate dropping to the mid-thirties fairly often, or if your diastolic pressures sink down to 60 or less, you need to be careful, especially about falling, especially after standing from a long time seated.

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Replies to "First, you are in good hands. They know their stuff. Secondly, you are right to be..."

Hi Gloaming, thank you for your information. I have done a fair amount of reading and listened to a couple of good sources but there is a wide range of even the best of the best doctors position on things, and you only get so much face to face time with the doctors you meet. I have a lot to learn.

Medical opinions such as Afib is progressive and gets worse over time are not for lay people no matter how much you have read. This not what my EP or Cardiologist says.