“In one of your articles it said that having an ablation was better than living in A-Fib. I’ve been taking 75 mg of propafenone 3X/day for seven years and have only had 5 A-Fib attacks in 7 years. If your article means Paroxysmal too, then I will consider an ablation.”
Five A-Fib attacks in seven years is very few. With paroxysmal A-Fib like yours, most doctors would say to continue on propafenone till you start having more or longer A-Fib attacks. (As a point of reference, about 54% of those in paroxysmal A-Fib will go into permanent A-Fib within one year. You’ve made it 7 years!) You aren’t really “living in A-Fib.” The antiarrhythmic drug you’re taking is fairly successful in keeping you out of A-Fib.
A-Fib is a progressive disease that tends to get worse over time. So, consider this. By the time propafenone loses its effectiveness (which is probably inevitable), how permanently damaged will your heart be? How much will your A-Fib have progressed? Will your A-Fib be harder to cure than if you had had a catheter ablation earlier? …. Read the two steps Steve recommends to this reader->
1. “Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?”
A doctor’s choice of drug therapy depends on one’s overall heart health, i.e., if there’s a heart condition other than Atrial Fibrillation.
In general, current medications don’t always work on A-Fib. People tend to react differently to meds. What works for one person may be terrible for another. What medications are best for you is a judgment call only you and your doctor can make..
When trying a new med, there is a fine line between allowing time for your body to adjust to it versus recognizing that this drug is causing bad, unacceptable side effects.
When starting a new med, your doctor may hospitalize you in order to monitor how the drug affects you and to get the dosage right.
If you’ve just been diagnosed with paroxysmal (occasional) A-Fib, flecainide (brand name Tambocor) or propafenone (Rythmol) might work for you. Some people have had good luck with the relatively new drugs dofetilide (brand name Tikosyn) and Rhythmol SR (propafenone sustained release). The newest antiarrhythmic med is Multaq (dronedarone) which is a less toxic substitute for amiodarone. Also see Treatments/Drug Therapies.
Guidelines from the ACC/AHA/ESC based on one’s overall heart health and heart conditions other than Atrial Fibrillation:
• Minimal or no heart disease. Flecainide, propafenone, sotalol. The object is to “minimize organ toxicity,” to select drugs that will not harm the rest of the body. The above drugs can cause “proarrhythmia” (an increase in heart rhythm problems), “but in patients without heart disease, this risk is extremely small.”
• If these drugs don’t work, then dofetilide and amiodarone can be considered. And “in experienced hands one might choose (Pulmonary Vein) Ablation (Isolation) for a primary cure.”
• Congestive heart failure. Only dofetilide and amiodarone have been demonstrated to be safe in randomized trials.
• Congestive heart failure and significant lung disease. “I would likely consider dofetilide as my first choice.”
• Congestive heart failure who are “hypokalemic” (have low levels of potassium). Amiodarone.
• Coronary artery disease. Sotalol is recommended because of its beta blocking and antiarrhythmic effects. Amiodarone or dofetilide combined with a beta blocker can also be used. Propafenone and flecainide aren’t recommended.
• Hypertension. Propafenone or flecainide.
• Hypertension and substantial left ventricular “hypertrophy” (increase in size). Amiodarone, because it has the least proarrhythmic effect.
(These guidelines are based on a presentation by Dr. Eric Prystowsky, see Boston AF/2003/ Prystowsky.)
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