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Dr. Andrew Rynne

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How can atrial fibrillation be treated apart from surgery?

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Dr. Bhanu Partap

Cardiologist

Practicing since :2010

Answered : 2056 Questions

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Posted on Wed, 5 Sep 2018 in Hypertension and Heart Disease
Question: My mother was cardioverted last week and was in normal rhythm for about a week but has since gone back into afib. What are her options ( besides surgery) to help her go back into normal rhythm? While in afib, she developed pulmonary hypertension and right atrial pressure, so don't think pulse control is an option ? Also, she does suffer from anxiety and gets stressed out easily and does not sleep well, will anti anxiety help keep the afib controlled?
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:

Please refer to the detailed answer below.

Detailed Answer:

Hi,

After going through the medical details provided by you I understand your concern for your mother's health and I would like to know few things before giving my opinion.

1. Since how long she has developed this AF?

2. What's the average rate while she is in AF and when she is in sinus rhythm?

3. Any other valvular heart disease?

4. All the medications (with dose) which she is taking?

Kindly revert back with the required information.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Bhanu Partap 37 minutes later
Shes been in afib for about three years. Her left atrium , I think, is moderately enlarged. In afib, think it goes up to low 100s but has been as high as 140 s. She took 100 mg metoprolol and it has gone down in the 70 s and 80s. While in afib, her pulmonary artery pressure is 49 and when shes not, it was 31. Right atrial pressure was 15 when in afib and 3 when not.
She did ablation march2017 but it did not work and she does not want anymore surgeries.

Shes on flecanide 100 mg twice day, metoprolol 25 mg once a day, lisinopril 10 mg once a day, lasix 20 mg once a day, potassium, glipizide 10mg twice a day, lipitor 10 mg once a day, and coumadin
I don't want her on amiodarone or digoxin due to the side effects. What else can be done besides surgery to get her back in rhythm? Will getting her stress, anxiety, and sleep distubances under control help as well? Thank you.
doctor
Answered by Dr. Bhanu Partap 21 minutes later
Brief Answer:

Hello again.

Detailed Answer:

Hi,

Is there any history of Rheumatic Heart Disease In the Past?

Thanks for the feedback.

Taking all the factors into consideration like her Age group, recurrent and long-standing AF, failed RFA, Dilated LA the best approach for her is simple rate control along with anticoagulation because the chances of her reverting back permanently into sinus rhythm are low.

Once the heart rate will be adequately controlled her Heart function will improve. Ideal heart rate should be between 70-80 bpm.

Yes stress and anxiety definitely contributes in increased rate due to sympathetic stimulation.

Amiodarone is a very good drug for AF and it's not about your choice what you want or not it's about the Risk-Benefit ratio of that drug for the patient.

For now, the best thing for her is the optimal medical therapy and stress reduction.

Hope I have answered your query. Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Bhanu Partap 22 minutes later
Are there safer alternatives to amiodarone and doesn't amiodarone have the potential to cause cancer? Also, her pulse rate was under control but her pay and right atrial pressure were severely high? Why was this? And what can be done to lower them?

Pulmonary artery hypertension not pay
Autocorrect mistake sorry
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:

Hello Again.

Detailed Answer:

Hi,

The side effects which are associated with its use are on very long-term use. It's not known to cause any cancer.

During AF and fast rate, the pumping efficacy of left ventricle decreases due to which back pressure effect increases on lungs which increases right atrial pressures.

This can very well take care with heart rate control and diuretics.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Bhanu Partap 6 hours later
I think some have linked amiodarone with thyroid and other types of cancers, but if u don't think she will be able to maintain normal rhythm, will she even need an antiarrythmic?
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:

Hello again.

Detailed Answer:

Hi,

Patients with long-standing chronic AF usually don't require an antiarrhythmic.

However, as she is already taking Flecainide so it's advisable to discuss with her treating cardiologist for continuing this medication.

In my opinion, if her ejection fraction is adequate then rate control medication like Metoprolol and an anticoagulant like coumarin will be sufficient.

Take care

Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Prasad
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