Back from cardiologist and confused...

April 6, 2006

He laid out the usual mode of treatment for AF... medications, then

shock then ablation.

To review, my husband is currently taking 50mg of toprol xl and

coumadin.

Now he wants him to take half the toprol, and take digoxin and 80mg of

Betapace. Continue the coumadin of course. (My husband has yet to be

in the right INR range... just under 2 still). He wanted to see him in

2 weeks and ordered an echocardiogram.

When we went to make the appointments, they only do echos on Mondays

and so the first appt is Apr 17. Then the dr is on vacation in 2 weeks

so he will be seen in 3 weeks instead. This, although I know is

common, was irritating and rather scary. It's nervewracking to be

placed on all these drugs and not be followed a little closer than this.

I'd like to get your take on a few things...

1. Is Betapace and Sotalol the same thing? It appears to be.

2. I know they aren't necessarily hospitalizing patients that start

betapace/sotalol anymore, but to start this medication and not be seen

for 3 weeks? What do you all think about that?

3. He spoke a lot about ablation. I have a feeling that he's thinking

since my husband is only 38, this in the end will be his best option.

And the one that would lead to little or no continuing medications. But

here I've seen multiple people have failed ablations although I know

they do work for many. My husband is very leary of this procedure.

4. Wouldn't it be important to perform all the tests on heart structure

before you start the medication protocol?

I feel quite overwhelmed. Thanks in advance for sharing your personal

experiences with me!

Karyn

April 6, 2006

>

> 1. Is Betapace and Sotalol the same thing? It appears to be.

Solatol is the generic for Betapace. Generics have a little wider

tolerance in the acceptable percentage of the operative ingredient

but they're basically the same thing.

>

> 2. I know they aren't necessarily hospitalizing patients that

start

> betapace/sotalol anymore, but to start this medication and not be

seen

> for 3 weeks? What do you all think about that?

He has to give his system a while to adjust to the new meds. If

anything unusual happens you can always call or go to the ER. It

almost never does. I think that's a pretty standard procedure.

>

> 3. He spoke a lot about ablation. I have a feeling that he's

thinking

> since my husband is only 38, this in the end will be his best

option.

My husband is very leary of this procedure.

All of us who have had ablations have been leery of it; but most

(over 75%) are glad we did it and some have had it multiple times.

It's certainly normal to be apprehensive about something like a PVAI

but there's really little downside risk and so much upside

satisfaction, particularly for someone your husband's age. Go to a

top rate facility and have one of the top rated EP's do the

procedure if you decide to have it done. The success rates vary

quite a bit depending upon expertise.

>

> 4. Wouldn't it be important to perform all the tests on heart

structure

> before you start the medication protocol?

No, but certainly before the ablation.

>

> I feel quite overwhelmed. Thanks in advance for sharing your

personal

> experiences with me!

They always say that if one take their medication that afib will not

be what kills one, but it is certainly uncomfortable for all and

more than that in some people. It is not gong to improve on it's

own as your husband ages. His real choice is to stick with a

medication that works now and wait for improvements in the PVAI or

new meds or have the PVAI sooner and get off the undesirable meds.

Of all the hospital procedures to have, the PVAI is probably one of

the mentally most challenging because they're playing around with

your beating heart. Physically, however, it's one of the least

challenging. You're in the hospital for less than 24 hours, you're

most likely completely out of it during the procedure and you have a

fast recovery. If you get the right doc and the right hospital and

your husband is in otherwise good shape there's no reason that he

couldn't expect a 90+ percent probability of success.

If you go through the analysis of the problems caused and potential

problems that could be caused by the meds and the afib itself and

compare that to the downside risk and upside benefits of the

procedure you will find the best course of action is always to have

the procedure. There are those EP's who now think that the first

line of treatment for lone afib should be an ablation compared to

trying at least two drug regimens before having the procedure.

I suggest you go wherever you have to and get an evaluation by an

experienced EP. I belive the Cleveland Clinic, one of the top rated

institutions doing ablations, even has a second opinion by mail.

All of us who've had ablations have gone through the pertubations

about getting older, about handling the problem though diet or

supplements, about putting off the procedure hoping for a new drug

or procedure, and dozens of other mental exercises; but in the end,

successful or not in most cases, I believe you'll find that we're

glad we did it and would do it again if need be. Certainly that's

the case with me.

Gordon

April 7, 2006

> [sNIP]

> 1. Is Betapace and Sotalol the same thing? It appears to be.

Hi Karyn, yes betapace is a brand name of sotalol.

> 2. I know they aren't necessarily hospitalizing patients that start

> betapace/sotalol anymore, but to start this medication and not be seen

> for 3 weeks? What do you all think about that?

your hospital is only a phone call away - don't be afraid to give them a

ring if you think it is necessary.

>

> 3. He spoke a lot about ablation. I have a feeling that he's thinking

> since my husband is only 38, this in the end will be his best option.

> And the one that would lead to little or no continuing medications. But

> here I've seen multiple people have failed ablations although I know

> they do work for many. My husband is very leary of this procedure.

Having multiple ablations to fix the problem is very common, The trick

is to find a very experienced doctor but even then I'd recommend going

with the attitude that it might take more than one procedure to fix the

problem. (and my personal opinion is that an ablation is still only for

people who are having a rough time with their AF)

> 4. Wouldn't it be important to perform all the tests on heart structure

> before you start the medication protocol?

I guess that depends on the particular med. If you are uncomfortable

about this then the hospital is only a phone call away (or it may be

worth having a chat with your pharmacist - their knowledge of meds is

often as good if not better than the prescribing doctor's)

>

> I feel quite overwhelmed. Thanks in advance for sharing your personal

> experiences with me!

>

> Karyn

>

I know it's a scary situation but please don't think that just because

your doctor has gone on holiday you have lost all medical contact.

Good luck to you and your husband.

--

D (37, NSR since second ablation on 9th Feb)

April 7, 2006

HI Karyn

I really understand your frustration of not being properly monitored

with drugs. I was put on sotalol and never saw the doctor for 3 months,

and that was because I had problems with my INR levels being too High

(10.5) They discovered that I should not have been on that drug because

of the hr was too slow and stopping.

Even after the problems that cardio would say try this, and you may need

to increase the dose and we will see you in 3 months, I don't think that

it should be left up to the patient to work out if you need to increase

or decrease the dose. I seem to hop from one drug to another sotalol to

amirodrone to atenolol to flecainide. I did say last year that enough

was enough and stopped taking the drugs (apart from warfarin) However I

am back on the atenolol as I need to slow down the rate, and my recent

echo showed enlarged left and right enlarged atrium, hopefully this will

reduce with rate control.

Structural test on the heart are important if the doctor is considering

flecainide, this drug could cause serious problems with patients with

heart failure, but is a good drug if the heart is in good condition.

One thing your husband could do if he is concerned about the sotalol is

to keep an eye on his BP and heart rate, speaking from personal

experience my BP was low, 84/42 when I got to the hospital. My HR was

also low, there are some good BP monitors about and are not that

expensive, I got mine for £75 (not sure what that is in dollars) a

worthwhile investment.

I understand your feeling of being overwhelmed, I feel a bit like that

at the moment, having an ablation is a big step and is one that I could

have to consider, I am my the way only 46. The only ablation I would

not consider is an AV node ablation because it is so final, and the

thought of being pacemaker dependant for the rest on my like terrifies

me.

I hope you find this information useful, I only wish that I been better

informed at the time, good luck on Apr 17

ine

Back from cardiologist and confused...

He laid out the usual mode of treatment for AF... medications, then

shock then ablation.

To review, my husband is currently taking 50mg of toprol xl and

coumadin.

Now he wants him to take half the toprol, and take digoxin and 80mg of

Betapace. Continue the coumadin of course. (My husband has yet to be

in the right INR range... just under 2 still). He wanted to see him in

2 weeks and ordered an echocardiogram.

When we went to make the appointments, they only do echos on Mondays

and so the first appt is Apr 17. Then the dr is on vacation in 2 weeks

so he will be seen in 3 weeks instead. This, although I know is

common, was irritating and rather scary. It's nervewracking to be

placed on all these drugs and not be followed a little closer than this.

I'd like to get your take on a few things...

1. Is Betapace and Sotalol the same thing? It appears to be.

2. I know they aren't necessarily hospitalizing patients that start

betapace/sotalol anymore, but to start this medication and not be seen

for 3 weeks? What do you all think about that?

3. He spoke a lot about ablation. I have a feeling that he's thinking

since my husband is only 38, this in the end will be his best option.

And the one that would lead to little or no continuing medications. But

here I've seen multiple people have failed ablations although I know

they do work for many. My husband is very leary of this procedure.

4. Wouldn't it be important to perform all the tests on heart structure

before you start the medication protocol?

I feel quite overwhelmed. Thanks in advance for sharing your personal

experiences with me!

Karyn

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

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send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

April 7, 2006

Hi ine

I asked my EP not to ablate me unless my condition was life threatening. He

did the ablation but told me that it had not been serious, but would now give me

a better quality of life. What worried me was he also said I couldn't ablate any

more because then I would have needed a pacemaker. His diagnosis was Nodal

tachycardia. Does anyone know if this means I have had AV node ablation and

could this lead to further problems? The whole experience for me was very

unsatisfactory, with a doctor who wouldn't listen to me and a procedure that

lasted Ihr 10mins with no sedation.

Thank you

ine pj.gilmartin@...> wrote:

The only ablation I would

not consider is an AV node ablation because it is so final, and the

thought of being pacemaker dependant for the rest on my like terrifies

me.

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

April 7, 2006

Hi

From what I understood of AV node ablation is that they ablate at the AV

node and you become pacemaker dependant. I personally would not allow

them to do this with out looking at other possibilities. I am concerned

that they will choose this option as I have a PM in place and they would

see it as the job being half done already, it sounds like they have done

some work on the AV node but not enough for you to need a PM, to be

honest I am not really sure, but it sounds like he was acting in your

best interest and well worth it if he has given you a better quality of

life, but you should have been able to trust him to carry out your

wishes, I am sorry that you have had such a bad experience and have come

away feeling confused and not sure what the treatment you actually had

was.

ine

RE: Back from cardiologist and confused...

Hi ine

I asked my EP not to ablate me unless my condition was life

threatening. He did the ablation but told me that it had not been

serious, but would now give me a better quality of life. What worried me

was he also said I couldn't ablate any more because then I would have

needed a pacemaker. His diagnosis was Nodal tachycardia. Does anyone

know if this means I have had AV node ablation and could this lead to

further problems? The whole experience for me was very unsatisfactory,

with a doctor who wouldn't listen to me and a procedure that lasted Ihr

10mins with no sedation.

Thank you

ine pj.gilmartin@...> wrote:

The only ablation I would

not consider is an AV node ablation because it is so final, and the

thought of being pacemaker dependant for the rest on my like terrifies

me.

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

April 7, 2006

- are you sure you didn't just have a flutter ablation? 1 hour does not

sound long enough for a pulmonary vein isolation ablation. My PVIA took 6

hours and 10 minutes.

Stef

airhairlair_uk@...> wrote:

Hi ine

I asked my EP not to ablate me unless my condition was life threatening. He

did the ablation but told me that it had not been serious, but would now give me

a better quality of life. What worried me was he also said I couldn't ablate any

more because then I would have needed a pacemaker. His diagnosis was Nodal

tachycardia. Does anyone know if this means I have had AV node ablation and

could this lead to further problems? The whole experience for me was very

unsatisfactory, with a doctor who wouldn't listen to me and a procedure that

lasted Ihr 10mins with no sedation.

Thank you

April 7, 2006

> (snip)

> Structural test on the heart are important if the doctor is

> considering flecainide, this drug could cause serious problems with

> patients with heart failure, but is a good drug if the heart is in

> good condition.

> (snip)

> ine

>

Hi ine,

I know flecainide is not indicated in patients who have had a previous

MI (heart attack). But do you have any references regarding flecainide

not being indicated in patients with heart failure?

, Charlotte NC

In NSR for 12 months on flecainide 150mg x2, magnesium oxide 250mg,

fish oil concentrate 1000mg x2, lipitor 20mg, and aspirin 325mg

April 7, 2006

Re: Back from cardiologist and confused...

> (snip)

> Structural test on the heart are important if the doctor is

> considering flecainide, this drug could cause serious problems with

> patients with heart failure, but is a good drug if the heart is in

> good condition.

> (snip)

> ine

>

Hi ine,

I know flecainide is not indicated in patients who have had a previous

MI (heart attack). But do you have any references regarding flecainide

not being indicated in patients with heart failure?

, Charlotte NC

In NSR for 12 months on flecainide 150mg x2, magnesium oxide 250mg,

fish oil concentrate 1000mg x2, lipitor 20mg, and aspirin 325mg

Hi

Actually I did mean Heart attack, but the doctors are looking at the

heart to be in good condition, I see you are on flecainide does it work

for you?

I went on it last year, I had about a week where the afib was not too

bad, each time I increased the dose it work for about a week before the

afib increased. When I was on the 150 X2 does it affected my PM.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

April 7, 2006

Stef

Had the ablation 3 weeks ago. I don't know what I had done. During the EP

study I had narrow complex tachycardia non-sustained. He said in his letter to

the cardiologist ' Towards the end I delivered energy to the slow pathway with

good junctional rhythm '. The rest of the letter said that apparently this

hasn't cured the problems I am having but should help some of the symptoms. The

cardioloigist said they didn't understand what he had done either.

Anyone know what this means?

Quarter Acre Orchids quarteracreorchids@...> wrote:

- are you sure you didn't just have a flutter ablation? 1 hour does not

sound long enough for a pulmonary vein isolation ablation. My PVIA took 6

hours and 10 minutes.

Stef

airhairlair_uk@...> wrote:

Hi ine

I asked my EP not to ablate me unless my condition was life threatening. He

did the ablation but told me that it had not been serious, but would now give me

a better quality of life. What worried me was he also said I couldn't ablate any

more because then I would have needed a pacemaker. His diagnosis was Nodal

tachycardia. Does anyone know if this means I have had AV node ablation and

could this lead to further problems? The whole experience for me was very

unsatisfactory, with a doctor who wouldn't listen to me and a procedure that

lasted Ihr 10mins with no sedation.

Thank you

April 7, 2006

>

> Hi

> Actually I did mean Heart attack, but the doctors are looking at the

> heart to be in good condition, I see you are on flecainide does it

work

> for you?

>

> I went on it last year, I had about a week where the afib was not

too

> bad, each time I increased the dose it work for about a week before

the

> afib increased. When I was on the 150 X2 does it affected my PM.

>

> ine

>

ine,

Yes, flecainide has been my " wonder drug " . When I was diagnosed PAF

in Feb 2000 I was having almost weekly (but self-terminating)episodes

of 30min to 3 hours. They started me on flecainide 50mg x2, but I

continued to have " breakthroughs " weekly during that first month.

They upped my dose to 100mg x2, and breakthrougs decreased to 1 a

month. In December 2002 they upped my dose to 150mg x2. And about

that same time I started taking magnesium oxide 250mg. My episodes

rapidly diminshed (I still don't know if it was the increased

flecainide or the magnesium). Since then my episodes have been 9-14

months apart --- but two required cardioversion to terminate. But I

can live with this --- if I can get a year between episodes.

, Charlotte NC

April 7, 2006

>Now he

wants him to take half the toprol, and take digoxin and 80mg of

>Betapace. Continue the coumadin of course. (My

husband has yet to be

>in the

right INR range... just under 2 still). He wanted to see him in

>2 weeks

and ordered an echocardiogram.

Digoxin is no

longer considered suitable for first line threapy of AFIB due to a

combination of limited effectiveness and the risks of side effects (digoxin

toxicity and

heart block). Follow this link for a full discussion of current

recommendations:

http://www.mssm.edu/msjournal/73/73_1_pages_482_492.pdf</\

span>

Given your

husband's age, ablation is likely a good course for him to consider, but it

may be worth waiting a few years for improvements in the procedures. There

are a

lot of new ideas being tried that should make ablations safer and yield a higher

success rate, with less damage to heart tissue, in this relatively new

surgical field.

He may also succeed in delaying the need for ablation by following a healthy

whole-

foods diet regimen to reduce sytemic inflammation.

H

April 7, 2006

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