What different medications control rhythm

Posted by jwooders3 @jwooders3, Feb 27 9:23pm

I’m an 81 year old female with a CRT pacer. I have a history of chronic A-fib and recently had a Super Ventricular Tachycardia episode. Historically I’ve resisted using various heart meds because they slow my heart too much, make me fatigued and/or cause my thinking to lose its sharpness. Also, I’ve had typical dermatitis from numerous medications. My new cardiologist gave me amlodipine.
What are some of the choices or problems people here have had?

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I misspoke what medication they gave me; it was amiodarone. Last night I had strong restless legs and hands with itching!

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Amiodorone did not suit me. Hair loss, joint pain, hot flashes, skin discolouring. I now have different drug that keep my Heart in rhythm.. I hope you have better luck

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I'm male, turning 81 yo, have Tachycardia for about 8 years, some AFIB the last 3 years.
Xeralto - did nothing for me.
Had ablation - unsuccessful
Amiodarone - took for two years. Worked great by keeping my "events" under 150 bpm, and worst "events" occured only after unusually excessive exercise (hiking, Tai Chi, etc.) Cardiologist then weaned me off of it (concerns about the drug doing long-term heart damage) and put me on Metoprolol
Metoprolol - working great. I've never had to use more than 25mg/day and keeping "events" below 135 bpm. Also, I'm doubling up my exercise time with confidence w/o having any "events" necessarily result.
Warning: Some experienced Metoprolol side effect of low 30s or 40's bpm. My resting pulse went from mid-60's bpm to upper-50's bpm. No enough to bother me or slow me down.

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Hello to all

I have been taking Metoprolol for many years and my pulse usually resting is around 50-60 range…but I also take 10mg of Ramipril, 5 mg Amlodipine and
10mg of chlorthalidone for CAD and Hypertension…these drugs have been helping and I’m sure prolonging my life…however, with GERD, hiatal hernia and General Anxiety Disorder, when the PVCS start to act up, it’s very unnerving as well as terribly uncomfortable…but these are the meds my cardiologist and PCM have had me on for years…🙏 pvctom

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I began with paroxysmal AF, but it showed signs of increasing aggressiveness after three years and I was referred to an electrophysiologist for an assessment to see if I was a candidate for catheter ablation. Meanwhile, for five years, I was initially on metoprolol and apixaban (rate control and stroke prevention respectively). A week after my index ablation, I was on amiodarone because my heart was running at 180 beats at times and I was in both flutter and AF, but not concurrently.

Metoprolol and other beta blockers, and calcium channel blockers, are more about keeping the heart subdued, but NOT keeping it out of arrhythmia. They're rate control, not rhythm control. And, when they are given for a while, and if the dose rises over time to keep the lid on the rate during AF, there can be periods with bradycardia, or low heart rate. In my case, I was getting tingling around my neck and jaw, and I felt I might faint. Turned out I was getting too much metoprolol. I was told to cease it immediately, and the ER put me on amiodarone for eight weeks...only. This was because they wanted to put a Holter monitor on me at the 10 week mark to get a veridical picture of what was going on. The amiodarone has a strong residual value for weeks afterwards, so it had to be stopped for two weeks before the Holter.

There are other drugs such as diltiazem for rate control. For rhythm, there are many options. Most start with something mild like Sotolol, Multaq, maybe propafenone. Flecainide is often given, but it must be carefully monitored because some can't take it without other problems, including yet more arrhythmia. Taken with metoprolol at the same time, it can lead to long pauses between beats and bradycardia. It's good, for those who can tolerate it, as a PIP. or pill-in-pocket to have with you if you break into AF, but are otherwise not taking it.

As a general rule, AF is progressive. It will advance and evolve over time, and drugs will lose their potency. Before your left atrium enlarges, which it will do if left in AF for weeks and months, and before the AF evolves to persistent or permanent forms, consult an electrophysiologist, and make sure he/she is the best in 100 miles. You want the busy ones who do 15 ablations each week and have been doing it for at least five years...ideally. Get a first consultation in and see if an ablation might be the best way ahead, and sooner rather than wait for the AF to begin to act up more aggressively as your drugs lose their efficacy.

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@gloaming

I began with paroxysmal AF, but it showed signs of increasing aggressiveness after three years and I was referred to an electrophysiologist for an assessment to see if I was a candidate for catheter ablation. Meanwhile, for five years, I was initially on metoprolol and apixaban (rate control and stroke prevention respectively). A week after my index ablation, I was on amiodarone because my heart was running at 180 beats at times and I was in both flutter and AF, but not concurrently.

Metoprolol and other beta blockers, and calcium channel blockers, are more about keeping the heart subdued, but NOT keeping it out of arrhythmia. They're rate control, not rhythm control. And, when they are given for a while, and if the dose rises over time to keep the lid on the rate during AF, there can be periods with bradycardia, or low heart rate. In my case, I was getting tingling around my neck and jaw, and I felt I might faint. Turned out I was getting too much metoprolol. I was told to cease it immediately, and the ER put me on amiodarone for eight weeks...only. This was because they wanted to put a Holter monitor on me at the 10 week mark to get a veridical picture of what was going on. The amiodarone has a strong residual value for weeks afterwards, so it had to be stopped for two weeks before the Holter.

There are other drugs such as diltiazem for rate control. For rhythm, there are many options. Most start with something mild like Sotolol, Multaq, maybe propafenone. Flecainide is often given, but it must be carefully monitored because some can't take it without other problems, including yet more arrhythmia. Taken with metoprolol at the same time, it can lead to long pauses between beats and bradycardia. It's good, for those who can tolerate it, as a PIP. or pill-in-pocket to have with you if you break into AF, but are otherwise not taking it.

As a general rule, AF is progressive. It will advance and evolve over time, and drugs will lose their potency. Before your left atrium enlarges, which it will do if left in AF for weeks and months, and before the AF evolves to persistent or permanent forms, consult an electrophysiologist, and make sure he/she is the best in 100 miles. You want the busy ones who do 15 ablations each week and have been doing it for at least five years...ideally. Get a first consultation in and see if an ablation might be the best way ahead, and sooner rather than wait for the AF to begin to act up more aggressively as your drugs lose their efficacy.

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I’ve had an AV node ablation 21 years ago. I am recently in the hospital for SVT since Monday. Everything seems normal again. I reverted in the ambulance. The EMT and i watched the monitor alternately indicate 70 to 180 for 2 or 3 beats. It’s unclear why my CRT pacer did not stop the tachycardia from happening. You describe the feeling clearly!
I’ve tried several medications but my unmedicated heart rate is 115/78. A slow heart rate was a problem with Metoporol and Losartan within the past 6 months.

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I am on diltiazam 60mg. I was prescribed 160mg but it made me too dizzy. If I have Afib I increase the dose depending using my self judgement. I am 78.

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I have had afib for over 20 years. I am on multaq twice a day for a least 5 years. It has worked wonders for me. Rarely have an occurrence with afib now.

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68M. Chronic Afib since 2002; CHF - diastolic dysfunction. I've had several Type II heart attacks due to extended periods of very high BP and pulse triggered by Afib. My pulse has been as high as 244. I'm on 100mg/day of metoprolol to contain it, and it works.

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@mydelilah

I have had afib for over 20 years. I am on multaq twice a day for a least 5 years. It has worked wonders for me. Rarely have an occurrence with afib now.

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What is multaq?

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