Afib returns

Posted by babheart @babheart, 2 days ago

I posted a few months ago asking for info re open heart vs minimally invasive surgery for MVP and appreciate the info shared. The surgeon and my cardiologist don’t think the moderate MVP plume requires repair yet. Afib first noted by my Fitbit in ‘22 but not noted by me or diagnosed until after multiple PEs and complications in ‘23. Long prior hx of mild-moderate MVP which produced severe LA enlargement that was not picked up on echo until it was severe this year. Afib episodes started while sleeping & were once a year for a few waking hours til 11/25. In late 12/25 started w more debilitating symptoms- SOB lightheaded weak shaky nauseous and persisted until I had a cardioversion 12 days later. I felt great until the next morning when Afib restarted. Sx were as before- breathlessness was severe w activity and took a while to resolve , Orthostatic B/P drops were severe so had ablation of PV and back LA wall in early March. No more Afib. A few instances of PVCs etc expected w the blanking period. Other sx were very slow to improve but did over the past months aided by compression hose. As long as I didn’t push too hard and rested between efforts I was close to 40% activity tolerance. ( I am 78 but had been swimming and doing water aerobics 3x/week, strength training 2x/week and Yoga. Now I’m finally able to do yoga most of the time) EP gave the go ahead to push activity in June. So I did. Gently. Afib reoccurred. Seems tied to activity- HR 115-120 over an hour or more even when I pause to let it settle down, which it does within minutes but then picks back up faster when I resume activity and segues to Afib. Slowing down and stopping if HR gets close to 100 seems to prevent Afib so far. So my EP ( the best of the best😉) recommends dofitilide at this point to try to reduce HR w activity. Resting HR, as always, is in the 50s. EP doesn’t see that as an issue w dofitilide as it was w metoprolol. I’ve read past accounts on this site of folks using dofitilide and see it’s been super helpful for some. I’d appreciate any thoughts re what to ask, consider at this point. Thanks!

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AI Overview Dofetilide (brand name Tikosyn) is a Class III antiarrhythmic agent. It is specifically used to restore and maintain a normal heartbeat in patients with highly symptomatic atrial fibrillation or atrial flutter.Mechanism of ActionIn the Vaughan Williams classification system, Class III drugs are known as potassium channel blockers. Dofetilide selectively blocks the rapid component of the delayed rectifier potassium current (\(I_{Kr}\)) in the heart. This inhibition delays the repolarization phase of the cardiac action potential, effectively prolonging the QT interval and increasing the refractory period in heart muscle cells.Important Safety InformationBecause it prolongs the QT interval, dofetilide carries a risk of causing a serious and potentially fatal form of ventricular tachycardia called Torsades de Pointes. Due to this risk, the FDA mandates that patients starting or restarting dofetilide must be continuously monitored in a hospital or specialized facility for at least 3 days.For comprehensive guidelines and prescribing restrictions, consult the official FDA Prescribing Information or review the Dofetilide Drug Information via MedlinePlus.

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