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Suggest Options Beside Surgery For Maintaining Normal Rhythm In A Patient Having Atrial Fibrillation Recurrence?
Question: My mother was cardiiverted last week and has since gone back into afib. What are her options besides surgery to try to maintain normal rhythm? As she developed pulmonary artery hypertension and right atrial pressure while in afib and controlled pulse control, so don't think just controlling her pulse is an option? She had an ablation march 2017, which did not work, and she doesn't want to do anymore surgeries. Her left atrium, I think, is moderately enlarged, and she does have moderate regurgitation in her tricuspid valve.
Also, she does suffer from stress, anxiety, depression, and has trouble sleeping. In thinking these factors could 've co tributing to her going back into afib. If there is a way to control these factors ( don't know how though), will this help her maintain normal rhythm?
She is currently on flecanide 100mg twice a day, metoprolol 25 mg once a day( when not in afib), lisinopril 10 mg once a day, glipizide 10 mg twice a day, lasix 20 mg once a day, potassium, lipitor 10 mg once a day, and coumadin.
Also, she does suffer from stress, anxiety, depression, and has trouble sleeping. In thinking these factors could 've co tributing to her going back into afib. If there is a way to control these factors ( don't know how though), will this help her maintain normal rhythm?
She is currently on flecanide 100mg twice a day, metoprolol 25 mg once a day( when not in afib), lisinopril 10 mg once a day, glipizide 10 mg twice a day, lasix 20 mg once a day, potassium, lipitor 10 mg once a day, and coumadin.
Brief Answer:
Please see the explanation below.
Detailed Answer:
Hello!
I passed carefully through your mother's medical history and would explain that as your mother has returned back into afib the best thing to do for the moment is controlling her heart rate by optimizing her medications scheme.
Beta-blockers (Metoprolol, Atenolol, Bisoprolol, etc.) or calcium channel blockers (Verapamil, and Diltiazem) would be rational alternatives in this regard.
As your mother doesn't prefer to go through invasive procedures any more (a repeated cardiac ablation procedure), probably a new attempt of electrical cardioversion should be tried.
Meanwhile, whichever be the result of a new cardioversion attempt, an important issue would be to follow a safe anticoagulation scheme to prevent potential cardioembolic events.
I agree with you that anxiety and depression are important triggering factors of afib recurrences and properly managing them would be a good start to a better control of cardiac arrhythmia.
In this regard, a review of blood levels of thyroid hormones would be advisable. Furthermore, antidepressants, and anxiolytics could be beneficial as well.
You should discuss with her attending doctor on the above mentioned issues.
Hope to have been helpful to you. In case of any further uncertainties feel free to ask me again.
Kind regards,
Dr. Ilir Sharka, Cardiologist
Please see the explanation below.
Detailed Answer:
Hello!
I passed carefully through your mother's medical history and would explain that as your mother has returned back into afib the best thing to do for the moment is controlling her heart rate by optimizing her medications scheme.
Beta-blockers (Metoprolol, Atenolol, Bisoprolol, etc.) or calcium channel blockers (Verapamil, and Diltiazem) would be rational alternatives in this regard.
As your mother doesn't prefer to go through invasive procedures any more (a repeated cardiac ablation procedure), probably a new attempt of electrical cardioversion should be tried.
Meanwhile, whichever be the result of a new cardioversion attempt, an important issue would be to follow a safe anticoagulation scheme to prevent potential cardioembolic events.
I agree with you that anxiety and depression are important triggering factors of afib recurrences and properly managing them would be a good start to a better control of cardiac arrhythmia.
In this regard, a review of blood levels of thyroid hormones would be advisable. Furthermore, antidepressants, and anxiolytics could be beneficial as well.
You should discuss with her attending doctor on the above mentioned issues.
Hope to have been helpful to you. In case of any further uncertainties feel free to ask me again.
Kind regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Why was her pulmonary artery pressure and right atrial pressure high while in afib with controlled pulse rate? What can be done for this? Should she try another cardioversion when the last one failed a week ago?
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Pulmonary artery and atrial pressure may increase during atrial fibrillation even with controlled ventricular response as atrial contribution is lost and this may be easily reflected especially in structurally abnormal hearts.
Your mother has dilated left atrium and moderate tricuspid regurgitation and this supports the alternative of structural heart abnormalities presence.
Coming to this point, the first step to follow is reviewing her cardiac ultrasound report (explore possible cardiomyopathy).
In addition investigation of pulmonary artery network to rule out possible pulmonary embolism would be advisable. Pulmonary angio CT would be helpful in this regard.
The third point of interest would be to investigate for possible cardiac ischemia, as she is suffering from diabetes (which is an important coronary risk factor).
In conclusion, a new attempt of electrical cardioversion would be worth a try, as the most safe and effective measure of afib conversion to normal sinus rhythm.
Hope I have answered your query.In case of further questions, please let me know.
I remain at your disposal.
Regards,
Dr. Ilir Sharka, Cardiologist
My opinion as follows:
Detailed Answer:
Hello again!
Pulmonary artery and atrial pressure may increase during atrial fibrillation even with controlled ventricular response as atrial contribution is lost and this may be easily reflected especially in structurally abnormal hearts.
Your mother has dilated left atrium and moderate tricuspid regurgitation and this supports the alternative of structural heart abnormalities presence.
Coming to this point, the first step to follow is reviewing her cardiac ultrasound report (explore possible cardiomyopathy).
In addition investigation of pulmonary artery network to rule out possible pulmonary embolism would be advisable. Pulmonary angio CT would be helpful in this regard.
The third point of interest would be to investigate for possible cardiac ischemia, as she is suffering from diabetes (which is an important coronary risk factor).
In conclusion, a new attempt of electrical cardioversion would be worth a try, as the most safe and effective measure of afib conversion to normal sinus rhythm.
Hope I have answered your query.In case of further questions, please let me know.
I remain at your disposal.
Regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
At my mother's doctor appointment today, ekg revealed she had ectopic atrial rhythm and not afib. Is this "better" than afib., or can it get worse? Also, I asked about increasing lasix from 20 to 40 mg., because her echo ( though she was in afib at the time of echo) showed pah of 50 and right atrial pressure of 15. The doctor did not see any fluid buildup in the lower legs or ankles and also in the lungs. If there really is no fluid buildup, would the 40 mg lasix be safe? If the artery pressures do not decrease, what then?
Brief Answer:
I would explain:
Detailed Answer:
Hello!
Considering the fact your mother is not in afib, but instead only with atrial ectopic beats is quite a better news.
It is necessary to perform a quantitative measure of this arrhythmic finding (atrial ectopics) and possibly investigate for any other potential arrhythmia not detectable on a simple ECG.
Serving such purpose, an ambulatory ECG (24 hours) monitoring would be beneficial.
Regarding Lasix daily dose increase, it seems to be rational as far as an increased systolic pulmonary artery pressure persists at 20 mg. This measure appears safe despite the fact no obvious venous congestion is present.
It is necessary to periodically check pulmonary pressures and potential evidence of congestion by means of cardiac ultrasound to properly guide diuretics therapy.
Hope my answer is helpful.
Regards,
Dr. Ilir Sharka, Cardiologist
I would explain:
Detailed Answer:
Hello!
Considering the fact your mother is not in afib, but instead only with atrial ectopic beats is quite a better news.
It is necessary to perform a quantitative measure of this arrhythmic finding (atrial ectopics) and possibly investigate for any other potential arrhythmia not detectable on a simple ECG.
Serving such purpose, an ambulatory ECG (24 hours) monitoring would be beneficial.
Regarding Lasix daily dose increase, it seems to be rational as far as an increased systolic pulmonary artery pressure persists at 20 mg. This measure appears safe despite the fact no obvious venous congestion is present.
It is necessary to periodically check pulmonary pressures and potential evidence of congestion by means of cardiac ultrasound to properly guide diuretics therapy.
Hope my answer is helpful.
Regards,
Dr. Ilir Sharka, Cardiologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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