DEAR DR. ROACH: I am an 88-year-old female in relatively good health. A year and a half ago, I did experience atrial fibrilliation and had two cardioversions. (The first was good for a year; the second lasted only three months.) The diagnosis is paroxysmal AFib.
My cardiologist has recommended a third cardioversion, which would require taking 400 mg of Multaq twice a day prior to the procedure, and remaining on this medication for the rest of my life (presuming the procedure is successful; if not, a stronger medication would be required). Or — my choice — I can do nothing, as long as I can tolerate these episodes of fatigue, shortness of breath and palpitations. At the present time, I must be in “remission,” as I am not experiencing any symptoms. (However, when I take an EKG test, it always shows I have AFib.) My blood pressure, cholesterol, triglycerides, etc., are all at good levels. My question: In your opinion, if I choose to “tolerate” intermittent episodes of AFib, in the long run, would this not eventually lead to the development of congestive heart failure? — S.S.
ANSWER: The major concern here, apart from reducing symptoms (which you don’t normally have), is the development of a stroke, so every person with atrial fibrillation is considered for anticoagulation. There are other concerns, including development of heart failure. People with atrial fibrillation who have frequent, fast heart rates are at risk for developing heart failure. “Paroxysmal” AFib comes and goes: There is about the same risk of a stroke with paroxysmal AFib as with continuous AFib.