TO: P

[Guest guest]

, I'm in chronic AF, since April, and am in touch with quite a

few others who are also, and you'll find there are other people on

this forum who are in chronic (never any atrial beats...) as well.

Once heart rate and INR (coumadin effectiveness....) are

controlled, it's a heck of a lot better than paroxysmal, where you

go in and out of AF at unpredictable intervals and for varying

times, etc., often disablingly so. But the rate control is absolutely

essential, resting HR well below 100, preferably below 90.

Several of us who are in permanent, chronic AF are kept in

excellent shape by a beta-blocker (Toprol XL 150/day in my

case), coumadin of course, and often digoxin ( .125/day in my

case). In some cases a calcium-channel blocker is more

effective for a given individual. The beta-blocker (or CCB) also

takes care of any hypertension that might be present. I was told

there were many reasons why repeated cardioversions would

not work for me (by several outstanding people here in NYC....),

so I early on opted for chronic AF (my overall heart functions are

completely normal). Several people in the paroxysmal condition,

in and out, have told me they envy those of us who are in AF

chronically. I do have some fatigue and sleep a bit more than I

used to, but I walk several miles a day and regularly climb 25 to

40 subway steps at a time, travel often, and lead a very active life.

A friend of same age (63) and status just completed a bike trip in

Europe; he travels a lot. And we don't worry about the long-term

downsides of the powerful antiarrhythmics, particularly

amiodarone. The research literature of the past few years

suggests that rate control brings about just as high a quality of

life and mortality reduction as does rhythm control. Talk it over

with your cardiologist, figure out what's best for you.

Those of us in chronic do keep our eyes on the ablation

literature, particulary in places like the Cleveland Clinic and

some spots in Europe where the " success rate " keeps climbing.

But there are no good data that show that people who are

successfully ablated (watch the variety of defintions that different

surgeons use for 'success,' it can be very confusing...) ultimately

live longer or, as a group, have a better quality of life ----- there

are anecdotes from individuals who have suffered disasters with

ablation, or repeated failures, and other anecdotes praising the

heavens for their ablation surgeons. Those research studies

are underway but they are difficult to do. Happy New Year.

Kathleen