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Suggest Treatment For Atrial Fibrillation And High Heart Rate
Question: Hi there,
Wondered if i could ask for some advise regarding my dad.
He had a stroke back in October which turned out to be caused by atrial fibrillation.
He had become very symptomatic the last couple of months so we went to see a cardiologist to get something done about it, he is in constant AF.
The cardiologist said that he could give him tablets as the heart rate was normal and the tablets would slow his heart rate more so that wasn't an option
He had a echo and 24hr monitor done and the decision was to have a cardioversion.
This was done on Friday and normal sinus rhythm was restored after the first attempt.
Unfortunately my dad is back in AF.
The doctor now wants to try rate control to reduce his heart rate as it is higher than before.
What i want to know is what would be the reason for not trying a rhythm control drug to try and maintain normal rhythm?
Thanks in advance
Wondered if i could ask for some advise regarding my dad.
He had a stroke back in October which turned out to be caused by atrial fibrillation.
He had become very symptomatic the last couple of months so we went to see a cardiologist to get something done about it, he is in constant AF.
The cardiologist said that he could give him tablets as the heart rate was normal and the tablets would slow his heart rate more so that wasn't an option
He had a echo and 24hr monitor done and the decision was to have a cardioversion.
This was done on Friday and normal sinus rhythm was restored after the first attempt.
Unfortunately my dad is back in AF.
The doctor now wants to try rate control to reduce his heart rate as it is higher than before.
What i want to know is what would be the reason for not trying a rhythm control drug to try and maintain normal rhythm?
Thanks in advance
Brief Answer:
Can you please provide more data?
Detailed Answer:
Hi and thank you for asking!
I read your query very carefully and understood your concerns.
After reviewing the data you provided I would like to give a look on all his medical data especially blood work, hormonal balance (especially thyroid function) and cardiac ECHO.
Can you please upload these data for me?
Moreover I would like to know if your father was put on any medication (antiarrhythmic drug) after cardioversion? If yes, what drug did he take?
If all these data are within accepted limits you should discuss with his doctor to try another cardioversion.
I'm waiting for more data from you!
Dr. Shehu
Can you please provide more data?
Detailed Answer:
Hi and thank you for asking!
I read your query very carefully and understood your concerns.
After reviewing the data you provided I would like to give a look on all his medical data especially blood work, hormonal balance (especially thyroid function) and cardiac ECHO.
Can you please upload these data for me?
Moreover I would like to know if your father was put on any medication (antiarrhythmic drug) after cardioversion? If yes, what drug did he take?
If all these data are within accepted limits you should discuss with his doctor to try another cardioversion.
I'm waiting for more data from you!
Dr. Shehu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your reply.
Im afraid i don't have the results but i know most of them.
He had chest x-rays and blood work done which all came back fine, he also had the Echo which showed that the left atrium was enlarged about 5cm but no sign of heart failure or anything else.
He also had a 24hr monitor which his average HR was 73bpm but had a lows of about 30bpm.
It would seem that my dad feels worse when he had the slow beating.
The DR said he couldnt put him any any medication after the cardioversion becuase of how low his HR had been and it was too dangerous to try.
He has suggested amidrone and a cardioversion but we dont really like the sound of the side effects that go with it.
The dads resting HR after cardioversion is now about 85bpm and the dr wants to put him on rate control tablets, surely this will bring him back to the slow beats that made him feel ill.
Why can't rhythm control medication be used? is it because he is in constant AF?
I cant see how another cardioversion would help as we suspect he has had this for about 3 years or more but has only now become persistent.
What about pacemakers?
Look forward to your reply.
Im afraid i don't have the results but i know most of them.
He had chest x-rays and blood work done which all came back fine, he also had the Echo which showed that the left atrium was enlarged about 5cm but no sign of heart failure or anything else.
He also had a 24hr monitor which his average HR was 73bpm but had a lows of about 30bpm.
It would seem that my dad feels worse when he had the slow beating.
The DR said he couldnt put him any any medication after the cardioversion becuase of how low his HR had been and it was too dangerous to try.
He has suggested amidrone and a cardioversion but we dont really like the sound of the side effects that go with it.
The dads resting HR after cardioversion is now about 85bpm and the dr wants to put him on rate control tablets, surely this will bring him back to the slow beats that made him feel ill.
Why can't rhythm control medication be used? is it because he is in constant AF?
I cant see how another cardioversion would help as we suspect he has had this for about 3 years or more but has only now become persistent.
What about pacemakers?
Look forward to your reply.
Brief Answer:
Following advice...
Detailed Answer:
Hi back,
After reviewing the new data I would like to say that your father has an enlarged atrium (5 cm) that make it difficult to maintain his rhythm to norm and this is why a second cardioversion isn't recommended.
For the same reason (enlarged atria), it isn't recommended for your dad to take any rhythm control medication. You should know that your father will be on atrial fibrillation for the rest of his life.
In your father case the best treatment strategy is heart rate control ( below 90 bpm at rest and 130 bpm on physical activity) and anticoagulation.
You are asking about pacemaker. Pacemakers would be indicated only in the following situations:
- if on his holter were observed severe bradycardias with ventricular pauses >2.5 seconds,
- or he have had syncope (faint) episodes in the past.
Hope this will be of help!
Wish you health!
Dr. Shehu
Following advice...
Detailed Answer:
Hi back,
After reviewing the new data I would like to say that your father has an enlarged atrium (5 cm) that make it difficult to maintain his rhythm to norm and this is why a second cardioversion isn't recommended.
For the same reason (enlarged atria), it isn't recommended for your dad to take any rhythm control medication. You should know that your father will be on atrial fibrillation for the rest of his life.
In your father case the best treatment strategy is heart rate control ( below 90 bpm at rest and 130 bpm on physical activity) and anticoagulation.
You are asking about pacemaker. Pacemakers would be indicated only in the following situations:
- if on his holter were observed severe bradycardias with ventricular pauses >2.5 seconds,
- or he have had syncope (faint) episodes in the past.
Hope this will be of help!
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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