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Atrial fibrillation, on prodaxa, metropolal, warfarin, carvedilol, amiodarone. Safe to take these medications ?

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Cardiologist, Interventional
Practicing since : 1996
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My wife has a fib diagnosed two months ago. Yesterday she was converted - and it worked. She was on Prodaxa and Metropolal before. Now she is starting on Warfarin, Carvedilol and Amiodarone.
I am concerned that the amiodarone has too many side effects and is to be used in "life threatening situuations" She is not in that situation. Are we right to question such a high risk drug being used?
Posted Tue, 8 May 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Raja Sekhar Varma 10 hours later
Thank you for your query.

Atrial fibrillation is a common arrhythmia wherein the atria (receiving chambers of the heart) has extremely irregular and disorganized electrical activity and as a result do not pump effectively.

The problems of AF are 1) possibility of fast heart rate 2) enlargement of the atria 3) stasis of blood in the atria leading to clot formation 4) dislodgement and embolisation of such clots to lungs, brains, arteries of limbs, kidneys, spleen etc 4) reduction in cardiac output due to loss of atrial "kick" , etc

The risk of thrombo-embolism is a significant risk in patients with AF. It could lead to life-threatening stroke, etc.

There is a lot of benefit in attempting to maintain the normal rhythm of the heart. After conversion from AF to normal sinus rhythm, drug therapy is needed in most patients to maintain this. The most commonly used drug is amiodarone. Dofetilide and dronedarone are two newer drugs which are available now. You can speak to your treating Cardiologist about this.

It is true that amiodarone does have a lot of side effects. However, careful testing of liver, kidney and thyroid function along with chest x-rays and ECG, both before starting the medicine and regularly during follow-up can identify most side effects. Also, side effects can be minimised by using the least dose of the drug that is effective.

Dronedarone is a newer drug, related to amiodarone, but with lesser liver, kidney and thyroid toxicity. It cannot be used in patients with heart failure, however. Long term data on comparative efficacy versus amiodarone is awaited. Although clinicians weigh the benefits and risks before treatment program.

Dofetilide is also an effective drug to maintain sinus rhythm in patients with AF. However, initiation of the drug has to be done in the hospital setting only. It can cause QT prolongation in the ECG and sometimes can lead to a XXXXXXX arrhythmia called torsades. Hence, close monitoring of the ECG is needed and again, the least effective dose has to be used.

Other options in the treatment of AF include special types of pacemakers, radio-frequency ablation procedures like pulmonary vein isolation, and implantation of automatic atrial defibrillators. These are, however, invasive procedures, expensive, involves some peri-procedural risk and does have occasional failures with recurrence of AF.

Ultimately, one has to consider the cause for AF and the chances of recurrence. If there is hypertension, LVH, multiple previous episodes of AF, atrial enlargement, and increasing age, there is every risk of recurrence of AF.

In deciding the treatment, a balanced decision has to be taken, after weighing the numerous benefits of maintaining sinus rhythm against the risks and side effects of anti-arrhythmic therapy. In addition to other factors, you could also consider the age, other co-existing illnesses, affordability, likelihood of compliance with complex drugs and dosing regimens before taking a final decision.

I hope this answers your query. If you need any further clarifications, feel free to contact me again.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
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