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Suggest Treatment For Arrhythmia Other Than Medication
Question: HI, MY MOTHER IS 73 Y/O AND WAS JUST RECENTLY DX'D WITH AFIB . SHE HAS BEEN ON METOPROLOL AND IS CURRENTLY TAKING PROPRANOLOL 10MG BID. BOTH OF THESE MEDICATIONS ARE CAUSING SEVERE LE WEAKNESS, DIZZINESS, AND CONFUSION TO THE POINT OF HAVING EXPRESSIVE APHASIA. SHE HAS NOT HAD A CVA OR TIA'S. SHE HAS HAD A CT OF THE BRAIN TO RULES THESE OUT. ALL OF THESE ISSUES STARTED WHEN SHE STARTED ON THE BETA BLOCKER. SHE WAS SWITCHED TO DILTIAZEM AT ONE POINT WHICH EVEN WORSE SIDE EFFECTS. SHE TRIED DECREASED THE PROPRANOLOL BY HALF, TAKING 5MG BID WHICH RESULTED IN HER GOING INTO AFIB, HTN, AND TACHYCARDIA. SHE HAS NO OTHER HEALTH HISTORY AND SHE DOES NOT TAKE ANY OTHER MEDICATIONS. SHE USED TO BE VERY ACTIVE AND HEALTHY. NOW SHE HAS ABSOLUTLEY NO QUALITY OF LIFE AS SHE CAN NOT DRIVE, WALK , OR EVEN CARRY ON AN INTELLIGENT CONVERSATION. SHE STATES SHE FEELS SLIGHTLY NORMAL WHEN SHE WAKES UP IN THE MORNING BUT AFTER ABOUT AN HOUR AFTER SHE TAKES HER MEDICATION SHE EXPERIENCES THE ABOVE S/E'S. THEY HAVE BEEN GETTING WORSE AS THE WEEKS PASS BY. HER CARDIOLOGIST DOES NOT SEEM TO THINK THAT THIS IS TOO SERIOUS AS SHE ALWAYS HAS TO WAIT AT LEAST 2 WEEKS BEFORE SHE CAN GET INTO SEE HIM. I RESEARCHED CRYOMAZE SURGERY AND FEEL THAT SHE MAY BE A CANDIDATE AS SHE SEEMS THAT SHE IS UNABLE TO HANDLE CA CHANNEL OR BETA BLOCKERS AND THE OTHER MEDICATIONS FOR ARRYTHMIA SEEM TO HAVE EVEN MORE SIDE EFFECTS. I WOULD ALSO LIKE TO ADD A SIDE NOTE THAT HER MOTHER HAD ABOUT 20 DRUG ALLERGIES AS DOES HER BROTHER.
THANK YOU FOR YOUR TIME,
XXXXX
THANK YOU FOR YOUR TIME,
XXXXX
Brief Answer:
If intolerant it should be considered
Detailed Answer:
I read your question carefully and I understand your concern.
I must say that in a way I understand your cardiologist because both beta blockers as well as calcium channel blockers causing that much side effect is a little puzzling, especially at that low dose she is under. Do not sound like related to allergies either. I wonder whether you have measured blood pressure and heart rate during these episodes, or if it has been considered to wear a 24 hour monitor for blood pressure and heart rhythm to see variations and their relation to medication.
As for Cryomaze it is one of the several catheter ablation procedures in circulation. Cryomaze uses low temperature, others use high temperature but the basic principle is more or less the same all of them, destroying foci of abnormal rhythm around the pulmonary vein area of the left atrium. Now if intolerant to the antiarrhythmics as you describe then it is a procedure which should be considered, it is indicated when drugs fail, I agree about that. You should keep in mind though that it may not be successful, success rate is at about 70%, recurrences may happen.
On a side note, you say she doesn't take other medication, not even some sort of blood thinner. Atrial fibrillation is one of the main causes of stroke so she should be under a blood thinner to prevent that from happening.
I remain at your disposal for other questions.
If intolerant it should be considered
Detailed Answer:
I read your question carefully and I understand your concern.
I must say that in a way I understand your cardiologist because both beta blockers as well as calcium channel blockers causing that much side effect is a little puzzling, especially at that low dose she is under. Do not sound like related to allergies either. I wonder whether you have measured blood pressure and heart rate during these episodes, or if it has been considered to wear a 24 hour monitor for blood pressure and heart rhythm to see variations and their relation to medication.
As for Cryomaze it is one of the several catheter ablation procedures in circulation. Cryomaze uses low temperature, others use high temperature but the basic principle is more or less the same all of them, destroying foci of abnormal rhythm around the pulmonary vein area of the left atrium. Now if intolerant to the antiarrhythmics as you describe then it is a procedure which should be considered, it is indicated when drugs fail, I agree about that. You should keep in mind though that it may not be successful, success rate is at about 70%, recurrences may happen.
On a side note, you say she doesn't take other medication, not even some sort of blood thinner. Atrial fibrillation is one of the main causes of stroke so she should be under a blood thinner to prevent that from happening.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you,
I know that it sounds puzzling but she was fine until January 1st when all of this started. The only common denominator is that she started on medication. The other coincidence is that she notices that these symptoms get magnified x10 about an hour after taking the meds and when they start to wear off then she starts to feel better. I have had her document all of these events in a diary and it just seems too coincidental that it all revolves around these medications.
I do have her check her HR and BP when she is having these issues. There is no significant changes in either while this is happening. although she does continue to have an irregular regular HR which is not uncommon with someone who has afib. She did have an echo done which showed that she had " a heart of a 40 year old". As I stated before she has always been active and keeps herself in good shape. The symptoms that I had mentioned above intensify approximately 1 hour after taking the meds the get gradually worse, after about 9-10 hours she starts feeling somewhat "normal" again. She does take an 81mg aspirin daily, she is unable to tolerate 325mg as she becomes flushed and nauseated on anything above the 81 mg dose. No Halter monitor or stress test have been done as the cardiologist felt it was not warranted at this time.
thank you
I know that it sounds puzzling but she was fine until January 1st when all of this started. The only common denominator is that she started on medication. The other coincidence is that she notices that these symptoms get magnified x10 about an hour after taking the meds and when they start to wear off then she starts to feel better. I have had her document all of these events in a diary and it just seems too coincidental that it all revolves around these medications.
I do have her check her HR and BP when she is having these issues. There is no significant changes in either while this is happening. although she does continue to have an irregular regular HR which is not uncommon with someone who has afib. She did have an echo done which showed that she had " a heart of a 40 year old". As I stated before she has always been active and keeps herself in good shape. The symptoms that I had mentioned above intensify approximately 1 hour after taking the meds the get gradually worse, after about 9-10 hours she starts feeling somewhat "normal" again. She does take an 81mg aspirin daily, she is unable to tolerate 325mg as she becomes flushed and nauseated on anything above the 81 mg dose. No Halter monitor or stress test have been done as the cardiologist felt it was not warranted at this time.
thank you
Brief Answer:
Read below.
Detailed Answer:
Thank you for the feedback.
While I remain puzzled by those side effects you seem to have been attentive in monitoring her regularly and documenting the episodes, so it seems that your theory on the meds being the cause is justified.
In that case I can only agree again that a catheter ablation procedure is necessary.
In the meanwhile, regarding the blood thinners, I am not sure I agree with aspirin. In a case of atrial fibrillation anticoagulants are more effective in preventing stroke. Anticoagulants include Warfarin or the new oral anticoagulants (apixaban, dabigatran, rivaroxaban, edoxaban). Aspirin may be at times enough in young patients with a lower risk of stroke, but not in this case an anticoagulant is better.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for the feedback.
While I remain puzzled by those side effects you seem to have been attentive in monitoring her regularly and documenting the episodes, so it seems that your theory on the meds being the cause is justified.
In that case I can only agree again that a catheter ablation procedure is necessary.
In the meanwhile, regarding the blood thinners, I am not sure I agree with aspirin. In a case of atrial fibrillation anticoagulants are more effective in preventing stroke. Anticoagulants include Warfarin or the new oral anticoagulants (apixaban, dabigatran, rivaroxaban, edoxaban). Aspirin may be at times enough in young patients with a lower risk of stroke, but not in this case an anticoagulant is better.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, yes you have been helpful. Unfortunately my mother does not want to take an anticoagulant, I agree that it is best that she take one but she refuses and what are you going to do with someone who has been strong willed all of her life.
Thanks again.
Thanks again.
Brief Answer:
Read below.
Detailed Answer:
I am sorry about that. Perhaps she refuses because she has heard about the need to have regular blood tests with Warfarin therapy and the risk for cerebral hemorrhage. If that is the cause the new oral anticoagulants I mentioned before would be a good solution as they do not need monitoring (it's a fixed dose) and have lower cerebral hemorrhage risk. If she's agreed to taking aspirin I don't see why she shouldn't agree to take those.
Let me know if I can further assist you
Read below.
Detailed Answer:
I am sorry about that. Perhaps she refuses because she has heard about the need to have regular blood tests with Warfarin therapy and the risk for cerebral hemorrhage. If that is the cause the new oral anticoagulants I mentioned before would be a good solution as they do not need monitoring (it's a fixed dose) and have lower cerebral hemorrhage risk. If she's agreed to taking aspirin I don't see why she shouldn't agree to take those.
Let me know if I can further assist you
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I agree, she will note take any of the anticoagulants because she is too afraid of the side effects. When she had her initial episode on January 1st I was able to convince her to take Eliquis for at least a month. After that time she went onto the aspirin and refuses to take any other anticoagulant.
Brief Answer:
Hemorrhage risk of Eliquis is similar to Aspirin
Detailed Answer:
She shouldn't be that afraid, or at least she should be much more afraid of having a stroke, that risk is higher. And also the one trial comparing Eliquis with Aspirin, the AVERROES trial, didn't show any significant difference in hemorrhagic side effects between the two. You/she can read herself the recap at this link if convincing is needed http://www.nejm.org/doi/full/10.1056/NEJMoa0000
But I know that it's easier said that done though, it's you who has the tough convincing job to do, hopefully you will be able to change her mind.
Hemorrhage risk of Eliquis is similar to Aspirin
Detailed Answer:
She shouldn't be that afraid, or at least she should be much more afraid of having a stroke, that risk is higher. And also the one trial comparing Eliquis with Aspirin, the AVERROES trial, didn't show any significant difference in hemorrhagic side effects between the two. You/she can read herself the recap at this link if convincing is needed http://www.nejm.org/doi/full/10.1056/NEJMoa0000
But I know that it's easier said that done though, it's you who has the tough convincing job to do, hopefully you will be able to change her mind.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the link. I will certainly review it and discuss with my mom.
Thanks again and have a good day
Thanks again and have a good day
Brief Answer:
You're welcome.
Detailed Answer:
Hope things will work out for the best
You're welcome.
Detailed Answer:
Hope things will work out for the best
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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